Clinical Reviews Sample Clauses
Clinical Reviews. The Contractor shall perform clinical reviews for pharmaceuticals designated by the P&T as requiring Prior Authorization (PA) and/or Medical Necessity (MN), and based upon P&T established criteria. The P&T Committee will provide PA and/or MN criteria for these pharmaceuticals. The Contractor shall conduct any required clinical reviews using the approved criteria.
Clinical Reviews. In addition to the multidisciplinary case reviews, discussed above, DHUAC will provide individual clinical reviews of the specific categories of cases identified by the Settlement Agreement for immediate or retrospective review (“red flag cases”). DHUAC will document this information by using the ▇▇▇▇▇ R Psychotropic Medication Monitoring Tool, which is in process of being jointly developed by DHUAC and the Court-Appointed Monitoring team. Documentation of the required reviews are provided to the Monitor, as required by the Settlement Agreement. In addition to the reviews required by the Settlement Agreement, DHUAC’s MBHST also reviews all UAC Portal auto-notifications of a psychotropic medication administered to an unaccompanied alien child. The MBHST more closely examines the cases of children who were prescribed a mood stabilizer, an antipsychotic, and/or a medication that does not align appropriately with the diagnosis. As needed, these cases will be followed on a high-risk list and MBHST will reach out to the program to offer assistance and get periodic updates.
Clinical Reviews