120 STAT. 112
PUBLIC LAW 109–171—FEB. 8, 2006 ‘‘(A) LIMITATION ON FUNDS.—The total amount of payments under this subsection shall be equal to, and shall not exceed— ‘‘(i) $75,000,000 for fiscal year 2007; and ‘‘(ii) $75,000,000 for fiscal year 2008. This subsection constitutes budget authority in advance of appropriations Acts and represents the obligation of the Secretary to provide for the payment of amounts provided under this subsection. ‘‘(B) ALLOCATION OF FUNDS.—The Secretary shall specify a method for allocating the funds made available under this subsection among States. Such method shall provide preference for States that design programs that target health providers that treat significant numbers of Medicaid beneficiaries. Such method shall provide that not less than 25 percent of such funds shall be allocated among States the population of which (as determined according to data collected by the United States Census Bureau) as of July 1, 2004, was more than 105 percent of the population of the respective State (as so determined) as of April 1, 2000. ‘‘(C) FORM AND MANNER OF PAYMENT.—Payment to a State under this subsection shall be made in the same manner as other payments under section 1903(a). There is no requirement for State matching funds to receive payments under this subsection. ‘‘(5) MEDICATION RISK MANAGEMENT PROGRAM.— ‘‘(A) IN GENERAL.—For purposes of this subsection, the term ‘medication risk management program’ means a program for targeted beneficiaries that ensures that covered outpatient drugs are appropriately used to optimize therapeutic outcomes through improved medication use and to reduce the risk of adverse events. ‘‘(B) ELEMENTS.—Such program may include the following elements: ‘‘(i) The use of established principles and standards for drug utilization review and best practices to analyze prescription drug claims of targeted beneficiaries and identify outlier physicians. ‘‘(ii) On an ongoing basis provide outlier physicians— ‘‘(I) a comprehensive pharmacy claims history for each targeted beneficiary under their care; ‘‘(II) information regarding the frequency and cost of relapses and hospitalizations of targeted beneficiaries under the physician’s care; and ‘‘(III) applicable best practice guidelines and empirical references. ‘‘(iii) Monitor outlier physician’s prescribing, such as failure to refill, dosage strengths, and provide incentives and information to encourage the adoption of best clinical practices. ‘‘(C) TARGETED BENEFICIARIES.—For purposes of this paragraph, the term ‘targeted beneficiaries’ means Medicaid eligible beneficiaries who are identified as having high prescription drug costs and medical costs, such as
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