2024 -- S 2387

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LC004652

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     STATE OF RHODE ISLAND

IN GENERAL ASSEMBLY

JANUARY SESSION, A.D. 2024

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A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- OFFICE OF HEALTH AND

HUMAN SERVICES

     

     Introduced By: Senators Ujifusa, Miller, Valverde, Lauria, DiMario, Murray, Mack,
Lawson, DiPalma, and Zurier

     Date Introduced: February 12, 2024

     Referred To: Senate Health & Human Services

     It is enacted by the General Assembly as follows:

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     SECTION 1. Section 42-7.2-5 of the General Laws in Chapter 42-7.2 entitled "Office of

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Health and Human Services" is hereby amended to read as follows:

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     42-7.2-5. Duties of the secretary.

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     The secretary shall be subject to the direction and supervision of the governor for the

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oversight, coordination, and cohesive direction of state-administered health and human services

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and in ensuring the laws are faithfully executed, notwithstanding any law to the contrary. In this

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capacity, the secretary of the executive office of health and human services (EOHHS) shall be

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authorized to:

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     (1) Coordinate the administration and financing of healthcare benefits, human services, and

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programs including those authorized by the state’s Medicaid section 1115 demonstration waiver

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and, as applicable, the Medicaid state plan under Title XIX of the U.S. Social Security Act.

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However, nothing in this section shall be construed as transferring to the secretary the powers,

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duties, or functions conferred upon the departments by Rhode Island public and general laws for

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the administration of federal/state programs financed in whole or in part with Medicaid funds or

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the administrative responsibility for the preparation and submission of any state plans, state plan

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amendments, or authorized federal waiver applications, once approved by the secretary.

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     (2) Serve as the governor’s chief advisor and liaison to federal policymakers on Medicaid

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reform issues as well as the principal point of contact in the state on any such related matters.

 

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     (3)(i) Review and ensure the coordination of the state’s Medicaid section 1115

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demonstration waiver requests and renewals as well as any initiatives and proposals requiring

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amendments to the Medicaid state plan or formal amendment changes, as described in the special

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terms and conditions of the state’s Medicaid section 1115 demonstration waiver with the potential

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to affect the scope, amount, or duration of publicly funded healthcare services, provider payments

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or reimbursements, or access to or the availability of benefits and services as provided by Rhode

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Island general and public laws. The secretary shall consider whether any such changes are legally

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and fiscally sound and consistent with the state’s policy and budget priorities. The secretary shall

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also assess whether a proposed change is capable of obtaining the necessary approvals from federal

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officials and achieving the expected positive consumer outcomes. Department directors shall,

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within the timelines specified, provide any information and resources the secretary deems necessary

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in order to perform the reviews authorized in this section.

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     (ii) Direct the development and implementation of any Medicaid policies, procedures, or

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systems that may be required to assure successful operation of the state’s health and human services

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integrated eligibility system and coordination with HealthSource RI, the state’s health insurance

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marketplace.

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     (iii) Beginning in 2015, conduct on a biennial basis a comprehensive review of the

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Medicaid eligibility criteria for one or more of the populations covered under the state plan or a

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waiver to ensure consistency with federal and state laws and policies, coordinate and align systems,

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and identify areas for improving quality assurance, fair and equitable access to services, and

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opportunities for additional financial participation.

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     (iv) Implement service organization and delivery reforms that facilitate service integration,

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increase value, and improve quality and health outcomes.

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     (4) Beginning in 2020, prepare and submit to the governor, the chairpersons of the house

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and senate finance committees, the caseload estimating conference, and to the joint legislative

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committee for health-care oversight, by no later than September 15 of each year, a comprehensive

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overview of all Medicaid expenditures outcomes, administrative costs, and utilization rates. The

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overview shall include, but not be limited to, the following information:

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     (i) Expenditures under Titles XIX and XXI of the Social Security Act, as amended;

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     (ii) Expenditures, outcomes, and utilization rates by population and sub-population served

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(e.g., families with children, persons with disabilities, children in foster care, children receiving

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adoption assistance, adults ages nineteen (19) to sixty-four (64), and elders);

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     (iii) Expenditures, outcomes, and utilization rates by each state department or other

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municipal or public entity receiving federal reimbursement under Titles XIX and XXI of the Social

 

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Security Act, as amended;

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     (iv) Expenditures, outcomes, and utilization rates by type of service and/or service

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provider;

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     (v) Expenditures by mandatory population receiving mandatory services and, reported

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separately, optional services, as well as optional populations receiving mandatory services and,

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reported separately, optional services for each state agency receiving Title XIX and XXI funds; and

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     (vi) Information submitted to the Centers for Medicare & Medicaid Services for the

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mandatory annual state reporting of the Core Set of Children’s Health Care Quality Measures for

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Medicaid and Children’s Health Insurance Program, behavioral health measures on the Core Set of

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Adult Health Care Quality Measures for Medicaid and the Core Sets of Health Home Quality

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Measures for Medicaid to ensure compliance with the Bipartisan Budget Act of 2018, Pub. L. No.

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115-123.

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     The directors of the departments, as well as local governments and school departments,

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shall assist and cooperate with the secretary in fulfilling this responsibility by providing whatever

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resources, information and support shall be necessary.

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     (5) Resolve administrative, jurisdictional, operational, program, or policy conflicts among

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departments and their executive staffs and make necessary recommendations to the governor.

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     (6) Ensure continued progress toward improving the quality, the economy, the

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accountability, and the efficiency of state-administered health and human services. In this capacity,

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the secretary shall:

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     (i) Direct implementation of reforms in the human resources practices of the executive

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office and the departments that streamline and upgrade services, achieve greater economies of scale

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and establish the coordinated system of the staff education, cross-training, and career development

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services necessary to recruit and retain a highly-skilled, responsive, and engaged health and human

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services workforce;

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     (ii) Encourage EOHHS-wide consumer-centered approaches to service design and delivery

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that expand their capacity to respond efficiently and responsibly to the diverse and changing needs

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of the people and communities they serve;

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     (iii) Develop all opportunities to maximize resources by leveraging the state’s purchasing

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power, centralizing fiscal service functions related to budget, finance, and procurement,

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centralizing communication, policy analysis and planning, and information systems and data

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management, pursuing alternative funding sources through grants, awards, and partnerships and

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securing all available federal financial participation for programs and services provided EOHHS-

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wide;

 

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     (iv) Improve the coordination and efficiency of health and human services legal functions

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by centralizing adjudicative and legal services and overseeing their timely and judicious

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administration;

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     (v) Facilitate the rebalancing of the long-term system by creating an assessment and

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coordination organization or unit for the expressed purpose of developing and implementing

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procedures EOHHS-wide that ensure that the appropriate publicly funded health services are

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provided at the right time and in the most appropriate and least restrictive setting;

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     (vi) Strengthen health and human services program integrity, quality control and

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collections, and recovery activities by consolidating functions within the office in a single unit that

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ensures all affected parties pay their fair share of the cost of services and are aware of alternative

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financing;

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     (vii) Assure protective services are available to vulnerable elders and adults with

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developmental and other disabilities by reorganizing existing services, establishing new services

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where gaps exist, and centralizing administrative responsibility for oversight of all related

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initiatives and programs.

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     (7) Prepare and integrate comprehensive budgets for the health and human services

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departments and any other functions and duties assigned to the office. The budgets shall be

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submitted to the state budget office by the secretary, for consideration by the governor, on behalf

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of the state’s health and human services agencies in accordance with the provisions set forth in §

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35-3-4.

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     (8) Utilize objective data to evaluate health and human services policy goals, resource use

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and outcome evaluation and to perform short and long-term policy planning and development.

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     (9) Establishment of an integrated approach to interdepartmental information and data

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management that complements and furthers the goals of the unified health infrastructure project

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initiative and that will facilitate the transition to a consumer-centered integrated system of state-

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administered health and human services.

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     (10) At the direction of the governor or the general assembly, conduct independent reviews

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of state-administered health and human services programs, policies and related agency actions and

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activities and assist the department directors in identifying strategies to address any issues or areas

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of concern that may emerge thereof. The department directors shall provide any information and

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assistance deemed necessary by the secretary when undertaking such independent reviews.

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     (11) Provide regular and timely reports to the governor and make recommendations with

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respect to the state’s health and human services agenda.

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     (12) Employ such personnel and contract for such consulting services as may be required

 

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to perform the powers and duties lawfully conferred upon the secretary.

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     (13) Assume responsibility for complying with the provisions of any general or public law

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or regulation related to the disclosure, confidentiality, and privacy of any information or records,

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in the possession or under the control of the executive office or the departments assigned to the

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executive office, that may be developed or acquired or transferred at the direction of the governor

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or the secretary for purposes directly connected with the secretary’s duties set forth herein.

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     (14) Hold the director of each health and human services department accountable for their

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administrative, fiscal, and program actions in the conduct of the respective powers and duties of

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their agencies.

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     (15) Identify opportunities for inclusion with the EOHHS’ October 1, 2023 budget

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submission, to remove fixed eligibility thresholds for programs under its purview by establishing

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sliding scale decreases in benefits commensurate with income increases up to four hundred fifty

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percent (450%) of the federal poverty level. These shall include but not be limited to, medical

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assistance, childcare assistance, and food assistance.

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     (16) Ensure managed care organizations (MCOs) and pharmacy benefit managers (PBMs)

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working for the Rhode Island Medicaid program are transparent, do not increase unnecessary costs

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for the Rhode Island Medicaid program and patients, and demonstrate that they improve patient

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health outcomes, by taking actions and promulgating regulations that achieve these goals, including

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but not limited to:

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     (i) Requiring MCO contracts with PBMs to:

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     (A) Prohibit spread pricing or other practices that are similar to spread pricing;

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     (B) Require PBMs to use pass-through pricing;

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     (C) Prohibit discriminatory treatment of non-affiliated pharmacies and pharmacists by

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PBMs;

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     (D) Prohibit PBMs from using “utilization management” that delays or prevents timely

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medically necessary care; and

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     (E) Require information be provided that permits effective oversight of PBMs and

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enforcement of this subsection.

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     (ii) Developing and implementing a plan for a single PBM to be used by MCOs within

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twelve (12) months of the effective date of this subsection.

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     SECTION 2. This act shall take effect upon passage.

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EXPLANATION

BY THE LEGISLATIVE COUNCIL

OF

A N   A C T

RELATING TO STATE AFFAIRS AND GOVERNMENT -- OFFICE OF HEALTH AND

HUMAN SERVICES

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     This act would impose requirements on a managed care organization (MCO) and pharmacy

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benefit manger (PBM) in order to control Medicaid prescription drug prices.

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     This act would take effect upon passage.

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