A. Any agency making decisions on utilization management measures, coverage, reimbursement or incentive programs shall be required to consult with:
1. Organizations representing patients and people with disabilities, including both self-advocacy organizations and organizations representing patients, prior to proceeding on any measure likely to impact the relevant patient or disability community; and
2. Organizations representing patients and people that advocate for the rights of patients to obtain treatment without regard to the patients' quality of life and representatives of organizations that advocate for the rights of older persons to receive health care.
B. Any agency making decisions on utilization management measures, coverage, reimbursement or incentive programs shall ensure that a process is in place to ensure robust stakeholder engagement and full transparency surrounding the provision of any research and analysis relied upon for decision-making that would impact access to health care treatments and services by patient groups provided for in subsection A of this section, including:
1. Providing stakeholders with meaningful notice and opportunity to comment on the retention of any vendor providing research and analysis to the agency;
2. Subjecting research and analysis relied upon by an agency to meaningful notice and comment process;
3. Ensuring deliberation around the coverage or reimbursement for health care treatments and services occurs in open meetings;
4. Presenting and releasing any research and analysis relied upon for decision-making in public meetings or publicly released prior to deliberation;
5. Requiring full disclosure into funding sources and conflicts of interest of any third party providing research and analysis to the state;
6. Prohibiting sole-source contracts for research and analysis to ensure reliance on a range of evidence; and
7. Preparing an annual report assessing beneficiary access to health care treatments and services. The report shall assess the impact of any form of utilization management on access to care with a specific analysis of the impact on persons with disabilities, chronic illness and advanced age. The report shall be submitted to the State Legislature, be posted on the state Medicaid website, and the agency shall provide an opportunity for public comment.
C. Any research and analysis relied upon for decision-making that would impact coverage and access to health care treatments and services shall measure outcomes prioritized by patients and persons with disabilities as required by this section, as well as consider meaningful differences in the characteristics, needs and preferences of patients and persons with disabilities.
Added by Laws 2020, c. 113, § 6, eff. Nov. 1, 2020.