Ill. Admin. Code tit. 77 § 2080.325

Current through Register Vol. 48, No. 43, October 25, 2024

Section 2080.325 - Peer Review Committee

The ILPMPAC is authorized to have a standing subcommittee. This subcommittee shall be a ten-member Peer Review Committee. The Peer Review Committee shall advise the ILPMP on matters relating to the advisory committee's field of competence, establish a formal peer review of the professional performance of prescribers and dispensers, and develop communications to transmit to prescribers and dispensers. The deliberations, information, and communications of the Peer Review Committee are privileged and confidential and shall not be disclosed in any manner except in accordance with current law.

a) The ILPMPAC shall select 10 of its members to be part of the Peer Review Committee.

b) The Peer Review Committee shall consist of the following:

1) three physicians;

2) three pharmacists;

3) one dentist;

4) one advanced practice registered nurse;

5) one physician assistant; and

6) one optometrist.

c) The Peer Review Committee shall meet, at a minimum, semi-annually.

d) The Peer Review Committee shall periodically review the data contained within the ILPMP database to identify those prescribers or dispensers who may be prescribing or dispensing outside the currently established professional standards for the prescriber's or dispenser's field of practice and for the type of medication (e.g., opioids) or type of care (e.g., hospice) applicable to the prescription under review. The Peer Review Committee member(s), whose profession is the same as the prescriber or dispenser being reviewed, shall make recommendations for any non-action or action. The ILPMP Clinical Director and staff shall provide necessary assistance and data as required. [720 ILCS 570/320(f)(1) ]

e) The Peer Review Committee may request information regarding the prescribing or dispensing practices of identified providers. Requests for information shall be sent via certified mail. A prescriber or dispenser shall have 30 days to respond to the request for information. [720 ILCS 570/320(f)(2) ]

f) Pursuant to 720 ILCS 570/320(f)(3), the Peer Review Committee shall refer a prescriber or dispenser to DFPR:

1) if a prescriber or dispenser does not respond to three successive requests for information;

2) if, in the opinion of a majority of the members of the Peer Review Committee, the prescriber or dispenser does not have a satisfactory explanation for the practices identified by the Peer Review Committee or the prescriber or dispenser does not have a satisfactory explanation for the practices identified by the Peer Review Committee in its request for information; or

3) if, following communications with the Peer Review Committee, the prescriber or dispenser does not sufficiently rectify the practices identified in the request for information in the opinion of a majority of the members present of the Peer Review Committee.

g) The Peer Review Committee shall prepare an annual report to the General Assembly starting on July 1, 2017. Pursuant to 720 ILCS 570/320(5), the annual report shall be delivered electronically to the Department and to the General Assembly. The report to the General Assembly shall be filed with the Clerk of the House of Representatives and the Secretary of the Senate in electronic form only, in the manner that the Clerk and the Secretary shall direct. The report shall contain the following information:

1) the number of times the Peer Review Committee was convened;

2) the number of prescribers or dispensers who were reviewed by the Peer Review Committee;

3) the number of requests for information sent out by the Peer Review Committee; and

4) the number of prescribers or dispensers referred to DFPR.

Ill. Admin. Code tit. 77, § 2080.325

Added at 41 Ill. Reg. 11909, effective 9/13/2017

Amended at 47 Ill. Reg. 13500, effective 9/8/2023