Section 369-BB. Drug utilization review board

1. A thirteen-member drug
  utilization review board is hereby created in the department.  The board
  is responsible for  the  establishment  and  implementation  of  medical
  standards  and  criteria  for  the  retrospective  and  prospective  DUR
  program.
    2. The members of the DUR board shall be appointed by the commissioner
  and shall serve a three-year term.  Members may be reappointed upon  the
  completion  of  other  terms.   The membership shall be comprised of the
  following:
    (a) Five persons licensed and actively  engaged  in  the  practice  of
  medicine  in the state, at least one of whom shall have expertise in the
  area of mental health, who shall be selected from  a  list  of  nominees
  provided  by  the  medical  society  of  the state of New York and other
  medical associations.
    (b)  Five  persons  licensed  and  actively  practicing  in  community
  pharmacy  in  the  state  who  shall be selected from a list of nominees
  provided by pharmaceutical societies/associations of New York state.
    (c) Two persons with expertise in  drug  utilization  review  who  are
  either  health  care  professionals  licensed  under  Title  VIII of the
  education law or who are pharmacologists.
    (d) One person from the department of social services (commissioner or
  designee).
    3. The appointed members to the board, or its  agents  shall  have  no
  sanctions against them by medicare or medicaid.
    4.  The appointments to this board shall be made so that the length of
  the terms are staggered.  In making the appointments,  the  commissioner
  shall consider geographic balance in the representation on the board.
    5.  The DUR board shall elect a chairperson from among its members who
  shall serve a one-year term as chairperson. The  chairperson  may  serve
  consecutive terms.
    6.  Members  of the DUR utilization review board and all its employees
  and agents shall be deemed to be an "employee" for purposes  of  section
  seventeen of the public officers law.
    7.  The  department  shall  provide  administrative support to the DUR
  board.
    8. The duties of the DUR board are as follows:
    (a) The development and application of the predetermined criteria  and
  standards  to  be  used in retrospective and prospective DUR that ensure
  that such criteria and standards are based on  the  compendia  and  that
  they  are  developed with professional input in a consensus fashion with
  provisions for timely revisions and assessments as  necessary.  Further,
  that  the  DUR  standards  shall  reflect  the  appropriate practices of
  physicians in order to monitor:
    (i) Therapeutic appropriateness;
    (ii) Overutilization or underutilization;
    (iii) Therapeutic duplication;
    (iv) Drug-disease contraindications;
    (v) Drug-drug interactions;
    (vi) Incorrect drug dosage or duration of drug treatment; and
    (vii) Clinical abuse/misuse.
    (b)  The  development,  selection,  application,  and  assessment   of
  interventions  or  remedial  strategies for physicians, pharmacists, and
  recipients that are educational and not punitive in  nature  to  improve
  the quality of care including:
    (i)  Information  disseminated to physicians and pharmacists to ensure
  that physicians and pharmacists are aware  of  the  board's  duties  and
  powers;

    (ii)  Written,  oral,  or  electronic reminders of patient-specific or
  drug-specific  information  that  are  designed  to  ensure   recipient,
  physician,  and pharmacist confidentiality, and suggested changes in the
  prescribing or dispensing practices designed to improve the  quality  of
  care;
    (iii)  Use of face-to-face discussions between experts in drug therapy
  and the prescriber or pharmacist who has been targeted  for  educational
  intervention;
    (iv)  Intensified  reviews  or  monitoring  of selected prescribers or
  pharmacists;
    (v) The creation of an educational program using data provided through
  DUR to provide for active and ongoing educational outreach  programs  to
  improve  prescribing  and  dispensing  practices  as  provided  in  this
  subdivision.  (This may be done directly or through contract with  other
  entities);
    (vi)  The  timely  evaluation  of  interventions  to  determine if the
  interventions have improved the quality of care; and
    (vii) The review of case  profiles  prior  to  the  conducting  of  an
  intervention.
    (c)  The publication of an annual report which shall be subject to the
  department's comment prior to its issuance to the federal department  of
  health  and  human  services by December first of each year.  The annual
  report also shall be submitted  to  the  governor  and  the  legislature
  before  December  first  of  each  year.  The  report  shall include the
  following information: (i) A description of the activities of the board,
  including the nature and scope of the prospective and retrospective drug
  use review programs;
    (ii) A summary of the interventions used;
    (iii) An assessment of the impact of these  educational  interventions
  in quality of care;
    (iv)  An  estimate  of  the cost savings generated as a result of such
  program; and
    (v) Recommendations for program improvement.
    (d) The development of a working agreement  for  the  DUR  board  with
  related  boards or agencies, including, but not limited to: the board of
  pharmacy, the board of medicine,  the  SURS  staff,  and  staff  of  the
  department  of  health  and  the  office  of  mental health, in order to
  clarify the areas of  responsibility  for  each  where  such  areas  may
  overlap.
    (e)  The  establishment  of  a process where physicians or pharmacists
  will have the opportunity to submit responses  to  the  DUR  educational
  letters.
    (f)  The  publication  and dissemination of educational information to
  physicians and pharmacists on the DUR  board  and  the  DUR  program  to
  include information on:
    (i)  Identifying  and  reducing  the  frequency  of patterns of fraud,
  abuse, gross overuse, or inappropriate  or  medically  unnecessary  care
  among physicians, pharmacists, and recipients;
    (ii) Potential or actual severe/adverse reactions to drugs;
    (iii) Therapeutic appropriateness;
    (iv) Overutilization or underutilization;
    (v) Appropriate use of generics;
    (vi) Therapeutic duplication;
    (vii) Drug-disease contraindications;
    (viii) Drug-drug interactions;
    (ix) Incorrect drug dosage/duration of drug treatments;
    (x) Drug allergy interactions; and
    (xi) Clinical abuse/misuse.

    (g)  The  adoption and implementation of procedures designed to ensure
  the confidentiality of any  information  collected,  stored,  retrieved,
  assessed  or  analyzed  by  the  DUR  board,  staff  to  the  board,  or
  contractors to the DUR program, that identifies  individual  physicians,
  pharmacists,  or  recipients.   The board may have access to identifying
  information for purposes of carrying out  intervention  activities,  but
  such  identifying information may not be released to anyone other than a
  member of the DUR board or the department and its agents.
    (h) The improper release of identifying information  in  violation  of
  this article may subject that person to criminal or civil penalties.
    (i)  The  board may release cumulative non-identifying information for
  purposes of legitimate research.
    9. The relationship of the DUR board to the department is as follows:
    (a) The department shall monitor the DUR board's compliance to federal
  and state statute and regulation.
    (b) The DUR board shall serve at the discretion of the commissioner.
    (c) The department shall have authority on all fiscal matters relating
  to the DUR program.
    (d) The department shall have authority on all administrative  matters
  relating  to the administration of the medical assistance program within
  the DUR program.
    (e) The DUR board shall have responsibility for  all  medical  matters
  relating to the DUR program.
    (f)   The  DUR  board  may  utilize  medical  consultants  and  review
  committees as necessary, subject to department approval.