Session of 1998
                   
HOUSE BILL No. 2990
         
By Committee on Appropriations
         
2-24
            9             AN ACT concerning the department of social and rehabilitation services;
10             providing for a Kansas medicaid drug program; prescribing guidelines;
11             rules and regulations.
12            
13       Be it enacted by the Legislature of the State of Kansas:
14           Section 1. As used in this act:
15           (a) ``Department'' means the department of social and rehabilitation
16       services.
17           (b) ``Kansas medicaid drug program'' means the program established
18       pursuant to this section to provide pharmaceutical care to medicaid re-
19       cipients.
20           (c) ``Medicaid program'' means the Kansas program of medical assis-
21       tance for which federal or state moneys, or any combination thereof, are
22       expended as administered by the department, or its fiscal agent, or any
23       successor federal or state health insurance program or other program
24       providing medical assistance or health care benefits, whether or not op-
25       erated pursuant to appropriate waivers to applicable federal medicaid
26       provisions.
27           (d) ``Medicaid recipient'' means any person eligible to receive health
28       care benefits pursuant to the medicaid program.
29           (e) ``Pharmaceutical care'' means services provided by a pharmacist
30       which augment the services of a physician by assisting a medicaid recip-
31       ient in disease state management, by assisting in the management of a
32       medicaid recipient's drug therapy or by monitoring outcomes and drug
33       therapy regimens of medicaid recipients.
34           (f) ``Pharmacist'' means any person licensed under the pharmacy act
35       of the state of Kansas.
36           (g) ``Physician'' means a person licensed under the laws of Kansas to
37       practice medicine and surgery.
38           (h) ``Secretary'' means the secretary of social and rehabilitation serv-
39       ices.
40           Sec. 2. (a) Pharmacy benefits payable to medicaid recipients shall be
41       administered directly by the secretary and shall not be assigned by con-
42       tract or otherwise to any other person or entity. In administering phar-
43       macy benefits payable to medicaid recipients, the secretary shall establish

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  1       the Kansas medicaid drug program by rules and regulations in accordance
  2       with this act.
  3           (b) The purposes of the Kansas medicaid drug program are to im-
  4       prove outcomes of medicaid recipients involved in drug therapy or disease
  5       state management and to reduce drug-related morbidity and mortality.
  6       In developing rules and regulations for the Kansas medicaid drug pro-
  7       gram the secretary shall consult with the various professional associations
  8       of pharmacists and physicians.
  9           Sec. 3. The rules and regulations establishing the Kansas medicaid
10       drug program shall take effect on or before January 1, 1999, and shall
11       conform to and be subject to the following:
12           (a) The Kansas medicaid drug program shall be based upon estab-
13       lished standards of disease state management and shall establish and de-
14       fine the following phases of pharmaceutical care:
15           (1) Phase I shall (A) allow the use of drug starter doses to determine
16       drug compatibility; (B) limit the amount of medication a pharmacist may
17       dispense to no more than a 34-day supply; (C) require patient compliance
18       monitoring by the pharmacist; and (D) include services beyond the
19       requirements of law for the dispensing of drug products.
20           (2) Phase II shall (A) involve levels of service beyond the require-
21       ments of law for the dispensing of drug products; (B) involve extensive
22       options and either an extensive amount or complexity of data to be con-
23       sidered; (C) involve the provision of services to medicaid recipients who
24       have a high level of risk because of their need to maintain strict conformity
25       with the prescribed drug therapy or disease state management; (D) in-
26       volve services requiring significantly more time than the services involved
27       in phase I; and (E) establish standards for the pharmaceutical care re-
28       quired of a pharmacist to coordinate drug therapy management for a
29       medicaid recipient with the physician or physicians involved.
30           (3) Phase III shall (A) involve levels of service beyond the require-
31       ments of law for the dispensing of drug products; (B) involve extensive
32       options and either an extensive amount or complexity of data to be con-
33       sidered; (C) involve medicaid recipients who are at a high level of risk
34       because of their need to maintain strict conformity with the prescribed
35       drug therapy or disease state management; (D) involve services requiring
36       significantly more time than the services involved in phase I or phase II;
37       and (E) establish standards for the pharmaceutical care required of a
38       pharmacist to coordinate case management by disease state with the phy-
39       sician or physicians involved.
40           (b) The Kansas medicaid drug program shall be an enhancement of
41       physicians' services and shall be consistent with the provisions of Kansas
42       law which allow only a physician to initiate drug therapy or authorize
43       changes in drug therapy.

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  1           (c) With respect to drug therapy and disease state management, the
  2       Kansas medicaid drug program shall recognize the ability of pharmacists
  3       to make physicians aware of problems and to participate in drug therapy
  4       and disease state management in response to directives of a physician.
  5           (d) Requirements shall be imposed on pharmacists for the documen-
  6       tation of services provided in rendering pharmaceutical care to any med-
  7       icaid recipient.
  8           (e) Criteria shall be developed to insure that pharmacists providing
  9       pharmaceutical care have received necessary and appropriate education
10       and training in the particular phases and levels of the pharmaceutical care
11       provided.
12           (f) Reimbursement of pharmacists providing pharmacy benefits to
13       medicaid recipients shall distinguish between pharmacists who are pro-
14       viding pharmaceutical care and those who are not providing services be-
15       yond those required by law for the dispensing of drug products.
16           (g) Reimbursement for pharmaceutical care shall be established so
17       as to provide incentives for pharmacists to provide services to medicaid
18       recipients beyond those required by law for the dispensing of drug prod-
19       ucts and such reimbursement shall be consistent with the various phases
20       of pharmaceutical care.
21           Sec. 4. (a) The secretary shall evaluate the Kansas medicaid drug
22       program annually and shall prepare and submit to the Kansas legislature
23       a report of the secretary's findings at the beginning of each regular ses-
24       sion. The evaluation shall be based on both patient outcomes and per-
25       formance. To facilitate such evaluations, the secretary shall develop out-
26       comes and cost-shifting data resulting from the implementation of the
27       Kansas medicaid drug program.
28           (b) In conducting these evaluations, the secretary shall seek the as-
29       sistance of (1) the medicaid program's fiscal agent and the entity-admin-
30       istering data processing system utilized by the fiscal agent in carrying out
31       its duties; (2) the university of Kansas school of pharmacy; (3) the drug
32       utilization review board and its computer data processing system; and (4)
33       the department's SURS unit.
34           (c) Each of the entities specified in subsection (b) shall cooperate
35       with and assist the secretary (1) in developing data collection and tracking
36       procedures; (2) in developing evaluation criteria and procedures; (3) in
37       developing the outcomes and cost-shifting data necessary to the evalua-
38       tion; and (4) in the performance of the evaluations.
39           Sec. 5. (a) Reimbursement of pharmacists who provide pharmaceu-
40       tical care under the Kansas medicaid drug program shall be paid entirely
41       from the amount appropriated to the department for the payment of
42       pharmacy benefits to medicaid recipients and in no event shall the estab-
43       lishment and implementation of the Kansas medicaid drug program be

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  1       construed as creating any obligation or liabilitiy of the secretary, the de-
  2       partment or the state of Kansas for the payment to any person of any
  3       moneys in excess of such appropriated amount.
  4           (b) In order to fund reimbursement of pharmacists providing phar-
  5       maceutical care, the amount of the professional dispensing fee authorized
  6       to be paid to pharmacists dispensing drug products to medicaid recipi-
  7       ents, but who are not providing any services to such medicaid recipients
  8       beyond the requirements of law for dispensing of drug products, shall be
  9       reduced, but shall not be reduced in an amount greater than $.25 per
10       prescription.
11           Sec. 6.  Nothing in this section or in the secretary's rules and regu-
12       lations establishing the Kansas medicaid drug program shall:
13           (a) Override, mitigate or in any way conflict with the lawful authority
14       of a physician to prescribe medication or drug therapy for the physician's
15       patients; or
16           (b) authorize a pharmacist to take any action not authorized by the
17       pharmacy act of the state of Kansas, including the rules and regulations
18       adopted by the state board of pharmacy thereunder.
19           Sec. 7. This act shall take effect and be in force from and after its
20       publication in the statute book.
21      
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