Automatic Review Criteria Sample Clauses
Automatic Review Criteria. CD and DSS, in consultation with the Statewide Clinical Consultant and the Psychotropic Medication Advisory Committee (“PMAC” or “the Committee”), will establish, consistent with this Agreement, criteria for selecting cases for automatic review. The cases to receive automatic review shall be determined by applying the criteria to a quarterly pull of Medicaid claims data for all Children in ▇▇▇▇▇▇ care.
a. These criteria shall initially include, as of the date that this Agreement is approved by the Court, the following:
i. Use of an antipsychotic or atypical antipsychotic medication in a Child age four or younger; and
ii. For a Child age five or older:
a) Use of five or more concurrent Psychotropic Medications for 90 days or more;
b) Use of two or more concurrent antipsychotic medications for 90 days or more;
c) Multiple prescribers of any Psychotropic Medication for 90 days or more.
b. Within twelve months from the date that this Agreement is approved by the Court, these criteria shall include the following:
i. Use of any Psychotropic Medication for a Child age three or younger;
ii. For a Child age four or older:
a) Use of three or more Psychotropic Medications for 90 days or more;
b) Use of two or more concurrent antipsychotic medications for 90 days or more;
c) Multiple prescribers of any Psychotropic Medication for 90 days or more; and
iii. A Child is prescribed a dose in excess of the guidelines described in Section III.G of this Agreement.
c. The parties understand and agree that the criteria for identifying cases for automatic review can reasonably be expected to change over time, based on advancements in medical science and health care practice. The parties further understand that Defendants will consult at least annually with their own stakeholder community and medical professionals with respect to the review process and automatic review criteria to be utilized. Defendants may add additional criteria for automatic review at any time.
d. In the event that Defendants wish to alter or discontinue any of the minimum criteria set forth in Sections III.D.4.a-b, except for the dosage criteria, Defendants will submit the proposed changes to the PMAC for study, review, and approval. No changes will be made without the written approval of the PMAC. Defendants may, in consultation with the PMAC, make necessary changes to the parameters of the dosage criteria as needed to reflect advancements in medical science and health care practice. Notice of changes to an...