A09366
THE GENERAL ASSEMBLY OF PENNSYLVANIA
HOUSE BILL
No.
1532
Session of
2017
INTRODUCED BY PHILLIPS-HILL, BARBIN, COX, DRISCOLL, GROVE,
JAMES, MILLARD, ORTITAY, READSHAW, ROTHMAN, SANTORA, SAYLOR,
WHEELAND AND NEILSON, JUNE 12, 2017
AS AMENDED ON SECOND CONSIDERATION, HOUSE OF REPRESENTATIVES,
JUNE 29, 2017
AN ACT
Amending the act of October 27, 2014 (P.L.2911, No.191),
entitled "An act providing for prescription drug monitoring;
creating the ABC-MAP Board; establishing the Achieving Better
Care by Monitoring All Prescriptions Program; and providing
for unlawful acts and penalties," further providing for
access to prescription information.
The General Assembly of the Commonwealth of Pennsylvania
hereby enacts as follows:
Section 1. Section 9(b) of the act of October 27, 2014
(P.L.2911, No.191), known as the Achieving Better Care by
Monitoring All Prescriptions Program (ABC-MAP) Act, is amended
by adding a paragraph to read:
Section 1. Section 9(b)(7) of the act of October 27, 2014
(P.L.2911, No.191), known as the Achieving Better Care by
Monitoring All Prescriptions Program (ABC-MAP) Act, is amended
and the subsection is amended by adding a paragraph to read:
Section 9. Access to prescription information.
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(b) Authorized users.--The following individuals may query
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the system according to procedures determined by the board and
with the following limitations:
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(12) A Medicaid managed care organization, as defined
under section 1903(m)(1)(A) of the Social Security Act (49
Stat. 620, 42 U.S.C. ยง 1396b(m)(1)(A)), that is a party to a
Medicaid managed care contract with the Department of Human
Services. The following shall apply:
(i) The Medicaid managed care organization may query
the system to review the requested dispensing or
prescribing of a controlled substance under this act to
an individual to whom the organization provides services
under the State's plan for medical assistance under Title
XIX of the Social Security Act.
(ii) The Medicaid managed care organization shall
notify the Department of Human Services and the
appropriate law enforcement agency OFFICE OF ATTORNEY
GENERAL if the organization has reason to believe that a
controlled substance prescribed or dispensed to an
enrollee under the State's plan for medical assistance
under Title XIX of the Social Security Act is fraudulent.
(7) Designated Commonwealth personnel and contracted
staff who are responsible for the development and evaluation
of quality improvement strategies, program integrity
initiatives or conducting internal compliance reviews and
data reporting for the medical assistance program, Children's
Health Insurance Program (CHIP), Pharmaceutical Assistance
Contract for the Elderly (PACE) or Pharmaceutical Assistance
Contract for the Elderly Needs Enhancement Tier (PACENET).
* * *
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(12) Personnel of an organization that has an agreement
to be paid on a capitated basis to provide services to
medical assistance beneficiaries, who are engaged in care
management, the development and evaluation of quality
improvement strategies, program integrity initiatives or
conducting internal compliance reviews and data reporting for
the medical assistance program. Personnel engaged in these
activities:
(i) May query the system to review the requested
dispensing or prescribing of a controlled substance under
this act to an individual to whom the organization
provides services under Title XIX of the Social Security
Act.
(ii) Shall notify the Department of Human Services
and the Office of Attorney General if fraud is suspected
based on the results of the query and review of the
database.
* * *
Section 2. This act shall take effect in 60 days.
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