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By: E. Arokkh, M.B.A., M.B.B.S., M.H.S.

Associate Professor, Indiana University School of Medicine

Do you have at least one naloxone opioid overdose product available without prior authorization Do you currently have restrictions in place to limit the quantity of antipsychotics Do you have a documented program in place to either manage or monitor the appropriate use of antipsychotic drugs in children Yes No muscle relaxant drugs for neck pain buy 60 mg mestinon, please explain why you will not be implementing a program to monitor the appropriate use of antipsychotic drugs in children muscle relaxant yellow house mestinon 60mg for sale. Yes No Do you have a documented program in place to either manage or monitor the appropriate use of stimulant drugs in children If the answer to question 4 is "No spasms pancreas generic mestinon 60 mg line," that is you do not have a documented stimulant monitoring program in place muscle relaxant vs anti-inflammatory generic mestinon 60 mg on-line, do you plan on implementing a program in the future Yes No, please explain why you will not be implementing a program to monitor the appropriate use of stimulant drugs in children. Does your pharmacy system or vendor have a portal to electronically provide patient drug history data and pharmacy coverage limitations to a prescriber prior to prescribing upon inquiry Yes No If the answer to question 1 is "Yes," do you have a methodology to evaluate the effectiveness of providing drug information and medication history prior to prescribing Describe all development and implementation plans/accomplishments in the area of e-prescribing. This consultation does not require prior authorization, can be provided once a year and will be linked to the provider and not to the patient (which allows for a second opinion with a different provider). The visit does not require prior authorization and should occur with the expectation that the case will be completed prior to the client exceeding the age of eligibility for the benefit; this service can be provided once a year and will be linked to the provider and not to the patient; the orthodontic work-up includes the consultation; therefore, consultation will not be reimbursed separately. Minor Treatment to Control Harmful Habits Minor treatment can be used for the correction of oral habits in any dentition. Approval for treatment to control harmful habits when not part of a limited, interceptive or comprehensive case will include appliances, removable or fixed, insertion, all adjustments, repairs, removal, retention and treatment visits to the provider of placement. Replacement of appliances due to loss or damage beyond repair is allowed once and thereafter requires prior authorization and can be considered with documentation of incident and documentation of medical necessity. For prior authorization, a narrative of the clinical findings, treatment plan, estimated treatment time with prognosis and diagnostic photographs and/or models shall be submitted and maintained in the treatment records. If it is determined that minor treatment to control harmful habits will be required in advance of a comprehensive treatment plan which will occur within less than 12 months, it will be considered part of the comprehensive case and will not be reimbursed separately. In this case, the prior 1/2021 Accepted authorization should be submitted for comprehensive orthodontic treatment with an attached treatment plan that indicates the minor treatment to control harmful habits, including the expected time frame for this and the expected initiation (month/year) of the comprehensive treatment. Orthodontic Treatment Services Limited, interceptive and comprehensive orthodontic services must be prior authorized and will be considered for the treatment of the primary dentition, permanent dentition or mixed dentition for treatment of the permanent teeth. Prior authorization determinations shall be made and notice sent to the provider within ten (10) days of receipt of necessary information sufficient for a dental consultant to make an informed decision. In cases where prior authorization is denied, the denial decision must be made by an orthodontist. The denial letter must contain a detailed explanation of the reason(s) for denial; indicate whether additional information is needed and the process for reconsideration. It must also include the name and contact information of the orthodontic consultant that reviewed and denied the treatment request which will allow the treating provider an opportunity to discuss the case. Limited Orthodontic Treatment Limited orthodontic treatment can be considered for treatment not involving the entire dentition and can be used for corrections in any dentition. For prior authorization, the following shall be submitted: Narrative of clinical findings, treatment plan and estimated treatment time; Diagnostic photographs; Diagnostic X-rays or digital films; Diagnostic study models or diagnostic digital study cast images; and, the referring primary care dentist must provide attestation that all needed preventive and dental treatment services have been completed. The reimbursement for the service includes the appliance, insertion, all adjustments, repairs, removal, retention and treatment visits to the provider of placement. Therefore, the case shall be completed even if eligibility is terminated at no additional charge to the member. Replacement of retainers or removable appliances due to loss or damage beyond repair requires prior authorization and can be considered with documentation of medical necessity. If it is determined that limited orthodontic treatment is part of a comprehensive treatment plan which will occur within less than 12 months, it will be considered part of the comprehensive case 1/2021 Accepted and will not be reimbursed separately. In this case, the prior authorization should be submitted for comprehensive orthodontic treatment with an attached treatment plan that indicates the limited treatment phase including the expected time frame for this and the expected initiation (month/year) of the comprehensive treatment. Upon completion of the case pre-treatment and post-treatment photographs must be submitted. Interceptive Orthodontics Interceptive treatment can be considered for localized tooth movement and may be for redirection of ectopic eruptions, correction of dental crossbites or recovery of space in the primary or transitional dentition.

Additionally muscle relaxant eperisone purchase mestinon 60 mg mastercard, some migrant workers voluntarily enter into illegal arrangements where they seek freelance work while concurrently paying a Saudi national to sponsor their initial residence permit muscle relaxant leg cramps discount 60 mg mestinon mastercard, thereby becoming vulnerable to extortion and debt-based coercion by their sponsors spasms with kidney stone splint cheap 60mg mestinon free shipping. Some migrants from Yemen and the Horn of Africa who enter Saudi Arabia illegally- involuntarily or through smuggling-via the Yemeni border may be trafficking victims spasms left upper abdomen buy generic mestinon 60mg on-line. Previous reports alleged some Saudi citizens engaged in sex tourism abroad, where they engaged in temporary or seasonal nonbinding "marriages," which included payment for short-term sexual access to children and others whom the purchaser then abandoned. In Saudi Arabia, begging by women and children remains a problem and a significant vulnerability to forced labor, with reported upticks during the holy month of Ramadan and the Muslim pilgrimages of Hajj and Umrah. The child beggar population is comprised primarily of unaccompanied migrant children, most heavily from Yemen and Ethiopia, but approximately 5 percent are Saudi national children of unknown parents. Traffickers compel some of these women and children to work as part of organized begging rings. Past reporting claimed that in some instances Saudi Arabia funded Yemeni militias that hired minors in combatant roles, and that the Saudi Arabian government had provided salaries, uniforms, weapons, and training to Sudanese combatants (which included children 14-17 years old) in Yemen. These efforts included collaborating with an international organization to establish an anti-trafficking database and planning the third phase of its program to remove vulnerable children, including trafficking victims, from the streets of major cities. However, the government did not demonstrate overall increasing efforts compared to the previous reporting period. The government rarely proactively investigated or prosecuted traffickers exploiting children in forced begging and did not take action against officials who refused to investigate such cases. The government only applied adequate prison terms in accordance with the 2005 anti-trafficking law to two convicted traffickers. The government did not identify any adult trafficking victims, and limited understanding of trafficking among government officials persisted. These penalties were sufficiently stringent and, with regards to sex trafficking, commensurate with penalties prescribed for other serious crimes, such as rape. During the reporting period, the government held several workshops to review previously drafted amendments to the 2005 anti-trafficking law to establish separate laws for human trafficking and migrant smuggling to reduce conflation of the two crimes. The government has persistently applied penalties inconsistent with the 2005 anti-trafficking law to convicted traffickers. Officials did not consistently use the 2005 anti-trafficking law to prosecute alleged traffickers. When officials identified a potential forced begging case, they often issued administrative penalties to the alleged perpetrators instead of criminally investigating and prosecuting the case; during the reporting period, seven alleged child forced begging cases were handled administratively. By not criminally investigating or prosecuting these forced begging cases, the government did not adequately hold traffickers accountable. Despite allegations of government complicity-either by refusing to investigate trafficking offenses or pressuring the judiciary to drop cases-the government did not report any investigations, prosecutions, or convictions of government officials complicit in human trafficking offenses. The Ministry of Justice held a four-day training for government officials in December 2019 to prepare for the third phase of "Le retrait des enfants de la rue" campaign to remove vulnerable children from the streets. Other government ministries did not report hosting any additional trainings on human trafficking and child protection. Many law enforcement and judicial personnel remained unaware of the provisions of the 2005 law. This lack of awareness, coupled with limited institutional capacity, inhibited efforts to prosecute and convict traffickers under the law and collect data on such efforts. In October 2019, the government collaborated with an international organization and foreign donor to launch an anti-trafficking database called "Systraite" to collect law enforcement and victim protection data; the government is piloting the system in the regions of Dakar, Saint Louis, Thies, Kedougou, and Tambacounda. Law enforcement, immigration, and social services personnel had formal written procedures to proactively identify trafficking victims among highrisk populations. The government did not report identifying or referring to services any adult trafficking victims, compared with 1,559 potential child trafficking victims and nine adult trafficking victims identified and referred to services during the previous reporting period. During the reporting period, the government began planning the third phase of its "Le retrait des enfants de la rue" campaign to remove vulnerable children, including forced begging victims, from the street in Dakar, Thies, and Saint Louis following similar operations in Dakar in 2016 and 2018; at the end of the reporting period, the program did not yet occur. Compared to past years, there were no reports identifying children who were exploited again in forced begging, nor were any alleged perpetrators reported to be repeat offenders.

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The government did not report whether it levied civil or criminal penalties against a recruitment agency it had terminated in the previous reporting period for fraudulent recruitment of Bhutanese to Malaysia through a work-study program muscle relaxant vitamins purchase mestinon 60mg visa. During the reporting period muscle relaxant triazolam buy mestinon 60 mg line, the government suspended registration of all new labor recruitment agencies and agents zerodol muscle relaxant buy mestinon 60mg with visa. The government assisted an international organization in conducting an assessment of trafficking in Bhutan infantile spasms 2 year old order 60 mg mestinon, and the government funded a separate parliamentary study on national trafficking trends to inform current and future anti-trafficking legislation. The government and media reported cases of girls younger than 18 working in drayangs, a violation of the minimum age requirement of 18. The Ministry of Economic Affairs began drafting new guidelines to review and oversee drayangs, including mandating investigations into potentially exploitative working conditions. The government issued closure warnings for failure to comply with labor regulations but did not report levying any civil or criminal penalties against the establishments. Unregistered and unscrupulous foreign employment recruitment agencies and sub-agents increasingly operate through social media. Some traffickers posing as recruiters offer ostensibly well-paying jobs overseas but exploit Bhutanese in forced labor. Some agencies have subjected Bhutanese students in workstudy programs in Japan and Malaysia to indicators of forced labor, including fraudulent contracts, non-payment of wages, and passport retention. Some participants reported indicators of trafficking, including illegal recruitment fees and wage deductions, restricted movement, passport retention, and non-payment of wages. Media outlets reported traffickers have exploited Bhutanese women in sex trafficking in India. In recent years, including 2019, traffickers sent approximately 140 Bhutanese women to Iraq for forced labor in domestic work. Traffickers have exploited Bhutanese women and girls working in domestic labor, caregiving, and in sex and labor trafficking, including through debt bondage and threats of physical abuse. Bhutanese women and girls who work as entertainers in drayangs are vulnerable to labor and sex traffickers. Drayang workers often come from rural areas and sign contracts they later cannot access, that can give more than half of their income to the drayang owners. Additionally, some female drayang entertainers reportedly 109 work in commercial sex after the drayangs close, some of which traffickers might facilitate. Relatives transport rural Bhutanese to urban areas for employment in domestic work, which at times may involve forced labor. An expanding construction sector continues to increase the demand for low-skilled foreign labor. Male Indian migrant workers-including in the construction and hydropower sectors-often receive advances before beginning work in Bhutan. Some workers subsequently report unauthorized deductions and non-payment of wages. The government demonstrated overall increasing efforts compared to the previous reporting period; therefore Bolivia was upgraded to Tier 2. These efforts included investigating and convicting more traffickers, identifying and referring more victims, increasing capacity building opportunities for law enforcement officials, increasing cooperation with civil society organizations, and conducting labor inspections in areas of highrisk for forced labor. It did not prosecute any traffickers, care provided to victims was inconsistent, cases involving complicit officials remained open, and for the second year in a row, it did not report identifying any victims of forced labor exploited within the country. Inconsistent with the definition of trafficking under international law, the definition of trafficking under Article 281bis of the law required a demonstration of force, fraud, or coercion to constitute a child sex trafficking offense and therefore did not criminalize all forms of child sex trafficking. However, Article 322 of the law criminalized all commercial sex acts involving children, thereby addressing this gap. Article 281bis defined trafficking broadly to include illegal adoption without the purpose of exploitation, the sale of organs, and unlawful biomedical research. In addition, Article 321 of Law 2033, which criminalized pimping using force, fraud, or coercion, was used to prosecute sex trafficking crimes. While Law 263 created separate criminal offenses for trafficking in persons and migrant smuggling, one government agency was responsible for both crimes; that agency often conflated the two crimes in its collection of data and response to perpetrators and potential victims of trafficking.

The State will conduct a needs assessment to determine the areas of service provision that require additional enrollee outreach and education back spasms 6 weeks pregnant cheap mestinon 60mg fast delivery. The assessment will evaluate Member understanding of the managed care system muscle relaxant 2631 generic mestinon 60mg, ability to access appropriate and needed services spasms under breastbone purchase mestinon 60 mg mastercard, effectiveness of enrollee communication methods spasms while eating generic mestinon 60mg on-line, and areas of difficulty for enrollees. The assessment will comprise various informal enrollee surveys conducted by the State throughout the year. The surveys may be conducted in person, by telephone, mail, or other means, and will ascertain information on areas that require additional enrollee outreach and education by the State and/or the Contractor. The Contractor shall cooperate with the State in identifying target groups to survey, topics and materials to survey, and opportunities for revised and/or additional enrollee outreach and education activities as a result of the surveys. The State shall not divulge the names or other identifying information of those surveyed to the Contractor or any other party except in the case where an enrollee gives permission to the State to be contacted for assistance with a stated question or problem. The State will annually summarize and provide to the Contractor, its findings and recommendations for future enrollee outreach and education activities. The Contractor shall establish and maintain a provider advisory committee, consisting of providers contracting with the Contractor to serve enrollees. At least two providers on the committee shall maintain practices or provide services that predominantly serve Medicaid beneficiaries and other indigent populations, in addition to one or more other practicing providers on the committee who have experience and expertise in serving enrollees with long term care needs and special needs. The committee shall meet at least quarterly and its input and recommendations shall be employed to inform and direct Contractor quality management activities and policy and operations changes. The Contractor shall have a system whereby enrollees needing specialty medical, dental, behavioral health and/or long term services and supports will be referred timely and appropriately. The system shall address authorization for specific services with specific limits or authorization of treatment and management of a case when medically indicated. Requests that cannot be decided upon immediately shall be responded to in writing no later than five (5) business days from the date of receipt of the request (with a call made to the Member on final disposition) and postmarked the next day. A referral form which can be given to the Member or, where applicable, an authorized person to take to a specialist. Referral form mailed, faxed, or sent by electronic means directly to the referral provider. Where applicable, the Contractor must also notify the Contractor Care Manager or authorized person. The Contractor shall provide a mechanism to assure the facilitation of referrals when traveling by an enrollee (especially when very ill) from one location to another to pick-up and deliver forms can cause undue hardship for the enrollee. Referrals from practitioners or prior authorizations by the Contractor shall be sent/processed within two (2) working days of the request, one (1) day for urgent cases. The Contractor shall have procedures to allow enrollees to receive a standing referral to a specialist in cases where an enrollee needs ongoing specialty care. Neither the Contractor nor its vendor shall obligate the referring dentist to supply diagnostic documentation similar to that required for a prior authorization request for treatment services as part of a referral request. Neither the Contractor nor its vendor shall obligate the dentist receiving the referral to prepare and submit diagnostic materials in order to approve or reimburse for a referral. Prior authorization decisions for non-emergency services shall be made within fourteen (14) calendar days or sooner as required by the needs of the enrollee. Decisions regarding utilization management, enrollee education, coverage of services, and other areas to which practice guidelines apply should be consistent with such practice guidelines. The written Utilization Review plan shall also include policies and procedures that address the following: 1. The Contractor shall not deny benefits to require enrollees and providers to go through the appeal process in an effort to forestall and reduce needed benefits. The Contractor shall not arbitrarily deny or reduce the amount, duration, or scope of a required service solely because of the diagnosis, type of illness, or condition. If a dispute arises concerning the provision of a service or the level of service, the service, if initiated, shall be continued until the issue is resolved.