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completion of other terms. The membership shall be comprised of the
following:
(a) Five

persons

licensed and actively engaged in the practice of medicine in the state who shall be selected from list of nominees provided by the medical society of the state of New York and other medical associations.

(b) Five persons licensed and actively practicing in community pharmacy in the state who shall be selected from a list of nominees provided by pharmaceutical societies/associations of New York state. (c) Two persons

with expertise in drug utilization review who are either health care professionals licensed under Title VIII of the education law or who are pharmacologists.

(d) One person from the department of social services (commissioner or designee).

3. The appointed members to the board, or its agents shall have no sanctions against them by medicare or medicaid.

4. The appointments to this board shall be made so that the length of the terms are staggered. In making the appointments, the

commissioner shall consider geographic balance in the representation on the board.

5. The DUR board shall elect a chairperson from among its members who shall serve a one-year term as chairperson. The chairperson may consecutive terms.

Members of the DUR utilization review board and all its employees and agents shall be deemed to be an "employee" for purposes of section seventeen of the public officers law.

7. The department shall provide administrative support to the DUR board.

8. The duties of the DUR board are as follows:

(a) The development and application of the predetermined criteria and standards to be used in retrospective and prospective DUR that ensure that such criteria and standards are based on the compendia and that they are developed with professional input in a consensus fashion with provisions for timely revişions and assessments as necessary. Further, that the DUR standards shall reflect the local practices of physicians in order to monitor :

(i) Therapeutic appropriateness;
ii) Overutilization or underutilization;
(iii) Therapeutic duplication;
(iv) Drug-disease contraindications;
(v) Drug-drug interactions;
(vi) Incorrect drug dosage' or duration of drug treatment; and
(vii) Clinical abuse/misuse.

(b). The development, selection, application, and assessment of interventions or remedial strategies for physicians, pharmacists, and recipients that are educational and not punitive in nature to improve the quality of care including:

(i) Information, disseminated to physicians and pharmacists to ensure that physicians and pharmacists are aware of the board's duties and powers; (11) Written,

Written, oral, electronic reminders of patient-specific or drug-specific information that are designed to ensure recipient, physician, and pharmacist confidentiality, and suggested changes in the prescribing or dispensing practices designed to improve the quality of care;

(iii) Use of face-to-face discussions between experts in drug therapy, and the prescriber or pharmacist who has been targeted for educational intervention;

(iv) Intensified reviews monitoring of selected prescribers or pharmacists;

(v) The creation of an educational program using data provided through DUR to provide for active and ongoing educational outreach programs, to improve prescribing and dispensing practices as provided in this subdivision. (This may be done directly or through contract with other entities);

(vi) The timely evaluation of interventions to determine if the interventions have improved the quality of care; and

(vii) The review of case profiles prior to the conducting of an intervention.

(c) The publication of an annual report which shall be subject to the department's comment prior to its issuance to the federal department of health and

human serpices by December first of each year. The annual report also shall be submitted to the governor and the legislature

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before December first of each year. The report shall include the fol-
lowing information:

(i) A description of the activities of the board, including the nature
and scope of the prospective and retrospective drug use review programs;
(ii) A summary of the interventions used;

(iii) An assessment of the impact of these educational interventions in quality of care;

(iv) An estimate of the cost savings generated as a result of such program; and

(v) Recommendations for program improvement.

(d) The development of working agreement for the DUR board with
related boards or agencies, including, but not limited to: the board of
pharmacy, the board of medicine, the SURS staff, and staff of the
department of health, in order to clarify the areas of responsibility
for each where such areas may overlap.

(e) The establishment of a grievance/appeals process for physicians or
pharmacists under this chapter.

(f). The publication and dissemination of educational information to
physicians and pharmacists on the DUR board and the DUR program to in-
clude information on:

(i) Identifying and reducing the frequency of patterns of fraud,
abuse, gross overuse, or inappropriate medically unnecessary care
among physicians, pharmacists, and recipients;

(ii) Potential or actual severe/adverse reactions to drugs;
(iii) Therapeutic appropriateness;

;
(v) Appropriate use of generics;
(vi) Therapeutic duplication;
(vii) Drug-disease contraindications;
(viii) Drug-drug interactions;
(ix) Incorrect drug dosage/duration of drug treatments;
(x) Drug allergy interactions; and
(xi) Clinical abuse/misuse.

(8) The adoption and implementation of procedures designed to ensure
the confidentiality of any information collected, stored, retrieved, as-
sessed or analyzed by the DUR board, staff to the board, or contractors
to the DUR program, that identifies individual physicians, pharmacists,
or recipients. The board may have access to identifying information for
purposes of carrying out intervention activities, but such identifying
information may not be released to anyone other than a member of the DUR
board or the department and its agents.

(h) The improper release of identifying information in violation of
this article may subject that person to criminal or civil penalties.

(i) The board may release cumulative non-identifying information for
purposes of legitimate research.
9. The relationship of the DUR board to the department is as follows:

(a) The department shall monitor the DUR board''s compliance to federal
and state statute and regulation.

(b) The DUR board shall serve at the discretion of the commissioner.
(c) The department shall have authority on all fiscal matters relating
to the DUR program.

(d). The 'DUŘ board shall have responsibility for all medical matters
relating to the DUR program.

(e) The DUR board may utilize medical consultants and review commit-
tees as necessary, subject to department approval.

§ 369-cc. Retrospective and prospective drug utilization review. The department, in cooperation with the DUR board, shall include in its state plan the creation and implementation of à retrospective and prospective DUR program for medicaid outpatient drugs to ensure that the prescriptions

appropriate, medically necessary, and not likely to result in adverse medical outcomes.

1. The retrospective and prospective DUR program shall be operated under the guidelines and procedures established by the DUR board.

2;. The retrospective DUR program shall be based on the guidelines established by the DUR board and shall

use

the mechanized drug claims processing and information retrieval system to analyze claims data to:

(a) Identify patterns of gross overuse, and inappropriate or medically
unnecessary care.
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(b) Assess data on drug use against explicit predetermined standards that are based on the compendia and other sources to monitor the following:

(1) Therapeutic appropriateness;
(ii) Overutilization or underutilization;
(iii) Therapeutic duplication;
(iv) Drug-disease contraindications;
(v) Drug-drug interactions;
(vi) Incorrect drug dosage or duration of drug treatment; and
(vii) Clinical abuse/misuse.
3. The prospective DUR program shall be based on the guidelines estab-
lished by the DUR board not in conflict with education social
vices laws and shall provide that prior to the prescription being filled
or delivered, a review will be conducted by the pharmacist at the point
of sale to screen for potential drug therapy problems resulting from:

(a) Therapeutic duplication;
(b) Drug-drug interactions;
(c) Incorrect dosage/duration of treatment;
(d) Drug-allergy interactions;

e) Clinical abuse/misuse.
In conducting the prospective DUR, the pharmacist may not alter the
prescribed outpatient drug therapy without the consent of the physician
who prescribed that therapy.

၌ 3. This act shall take effect on the first day of January next succeeding the date on which it shall have become a law, except that the drug utilization review board shall be established and its members appointed on or before the first day of September of the year in which it shall have become a law.

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CHAPTER 633

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AN ACT to amend the tax law, in relation to the imposition of sales and

use taxes by the county of Wyoming Became a law July 24, 1992, with the approval of the Governor. Passed on Home Rule request pursuant to Article IX, section 2(b) (2) of the Constitution by a majority vote, three-fifths being present. The People of the State of New York, represented in Senate and Assembly, do enact as follows:

Section 1. The opening paragraph of section 1210 of the tax law, as amended by chapter 2 of the laws of 1992, is amended to read as follows:

Notwithstanding any other provision of law to the contrary, but subject to the limitations and exemptions in part II of this article, any city in this state or county in this state, except a county wholly within a city, acting through its local legislative body, is hereby authorized and empowered to adopt and amend local laws, ordinances or resolutions imposing in any such city or county the following taxes, the rate of one-half, one, one and one-half, two, two and one-half or three percent, provided, however, that for the first, nineteen hundred seventy-four and ending June thirtieth, nineteen

period beginning June hundred seventy-five,, any such city having a population of

one million or more is hereby authorized and empowered to adopt and amend local laws imposing such taxes in any such city, at the rate of four

percent and, provided further, however, that the county of Nassau is hereby further authorized and empowered to adopt and amend local laws imposing such taxes: (i) at a rate which is one percent additional to the three percent rate authorized above in this paragraph for such

county for the period beginning, June first, nineteen hundred eighty-three and ending December thirty-first, nineteen hundred eighty-five; and (ii) at a

rate which is three-quarters percent additional to the three percent rate authorized above in this paragraph for such county for the period beginning January first, nineteen hundred eighty-six and ending December thirty-first, nineteen hundred ninety-three subject to the

limitation set forth section twelve hundred sixty-two-e of this chapter, and provided further, however, that the county of Nassau is

hereby further

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authorized and empowered to adopt and amend local laws or resolutions
imposing such taxes at a rate which is one-half percent additional to
the three percent rate authorized above in this paragraph and which is
additional to the three-quarters percent rate also authorized above in
this paragraph for such county for the period beginning September first,
nineteen hundred ninety-one and ending December thirty-first, nineteen
hundred ninety-three, and provided further, however, that the county of
Erie is hereby further authorized and empowered to adopt and amend local
laws or resolutions imposing such taxes at a rate which is one percent
additional to the three percent rate authorized above in this paragraph
for such county for: (i) the period beginning March first, nineteen hun-
dred eighty-five and ending December thirty-first, nineteen hundred
eighty-seven; and (ii) the period beginning January tenth, nineteen hun-
dred éighty-eight and ending February twenty-eighth, nineteen hundred
ninety-three and provided further, however, that the county of Cattarau-
gus is hereby further authorized and empowered to adopt and amend local

resolutions imposing such taxes at a rate which is one percent
additional to the three percent rate authorized above in this paragraph
for such county for the period beginning March first, nineteen hundred
eighty-six and ending February twenty-eighth, nineteen hundred ninety-
four and provided further,

however,

that the county of Wyoming is hereby further authorized and empowered to adopt and amend local laws or resolutions imposing such taxes at a rate which is one percent additional to the three percent rate authorized above in this paragraph for such county for the period beginning September first, nineteen hundred ninety-two and ending . August thirty-first, nineteen hundred ninetythree, and provided further, however, that the county of Allegany is hereby further authorized and empowered to adopt and amend local laws or resolutions imposing such taxes at a rate which is one percent additional to the three percent rate authorized above in this paragraph for such county for the period beginning, December first, nineteen hundred eighty-six and ending November thirtieth, nineteen hundred ninety-two, and provided further, however, that the county of Suffolk is hereby further authorized and empowered' to adopt and amend local laws resolutions imposing such taxes at a rate which is one-half percent additional to the three percent rate authorized above in this paragraph for such county for the period beginning September first, nineteen hundred ninety-one and ending December thirty-first,, nineteen hundred ninetythree, and provided further, however, that the city of Yonkers is hereby further authorized and empowered to adopt and amend local laws imposing such taxes

at a rate which is one percent additional to the three percent rate authorized above in this paragraph for such city. (The maximum rate referred to in section twelve hundred twenty-four shall be calculated without reference to such one percent additional rate authorized for Yonkers and the counties of Erie, Cattaraugus and Allegany.), and provided further, however, that the city of Mount Vernon is hereby''further authorized and empowered to adopt and amend local laws imposing such taxes at a rate which is one percent additional to the three percent rate authorized above in this paragraph for such city (The maximum rate referred to in section twelve hundred twenty-four shall be calculated without reference to such one percent additional rate authorized for Mount Vernon. ), and provided further, however, that the city of Rome is hereby further authorized and empowered to adopt and amend local laws, ordinances or resolutions imposing such taxes at a rate which is one-quarter

percent additional to the three percent rate authorized
above in this paragraph for such city for the period beginning September
first, nineteen hundred ninety and ending August thirty-first, two
thousand (The maximum rate referred to in section twelve hundred twenty-
four shall be calculated without reference to such one-quarter of one
percent additional rate authorized for Rome. ), and provided further,
however, that if the county of Dutchess, the county of Orange or the
county of Rockland withdraws from the metropolitan commuter transporta-
tion district pursuant to section twelve hundred seventy-nine-b of the
public authorities law, such county is hereby authorized and empowered,
in the alternative, to adopt and amend local laws, ordinances or resolu-
tions impos ing such taxes at the rate of one-half, three-quarters, one,
one and one-quarter, one and one-half, one and three-quarters, two, two
and one-quarter, two and one-half, two and three-quarters,

three
three and one-quarter percent if the revenues from a one-quarter percent
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rate of such tax are required by such local laws, ordinances or resolutions to be set aside for mass transportation purposes, such taxes to be administered, collected and distributed by the commissioner of taxation and finance as provided in subpart B of part III and in part IV of this article:

§ 2. Section 1223 of the tax law, as amended by chapter 769 of the laws of 1990, is amended to read as follows:

§ 1223. Limitations on rates. No transaction taxable under sections twelve hundred two through twelve hundred four shall be taxed pursuant to this article by any county or by any city located therein, or by both, at an aggregate rate in excess of the highest rate set forth in the applicable subdivision of section twelve hundred one of this act or, in the case of any taxes imposed pursuant to the authority of section twelve hundred ten or twelve hundred eleven (other than taxes imposed by a city having a population of one million or more for the limited period provided in section twelve hundred ten or pursuant to subdivision (h) of section_twelve hundred ten or by the counties of Nassau, Erie, Cattaraugus [or], Allegany or Wyoming as provided in section twelve hundred ten) at a rate in excess of three percent, except that, in the city of Yon

ers and in the city of Mount Vernon, the rate may not be in excess of four percent and in the city of Rome, the rate may not be in

of three and one-quarter percent and except that in the city of Poughkeepsie in the county of Dutchess, if such county withdraws from the metropolitan commuter transportation district pursuant to section twelve hundred seventy-nine-b of the public authorities law and if the revenues from a one-quarter percent rate of such tax imposed by such county, pursuant to the authority of section twelve hundred ten of this article,

required by local laws, ordinances or resolutions to be set aside for mass transportation purposes, the rate may not be in excess of three and one-quarter percent. If a transaction is taxed by both a county and a city, the rate of tax on such transaction imposed by the county city,''not having prior right thereto pursuant to section twelve hundred twenty-four, shall be deemed to be reduced (or the entire tax eliminated, if necessary) to the extent necessary to comply with the foregoing requirement. A tax imposed by a county upon any transaction, to the extent that it would require a reduction in any tax rate imposed thereon by a city, shall not become effective in respect

to any

transaction taxed by such city (or in respect of other similar transactions outside of the city which, if occurring in such city, would be subject to such city tax) before the commencement of the city's next succeeding fiscal year and then only if the county shall have given notice to such city of its imposition of a tax on such' transaction at least six months prior to the commencement of such fiscal year, provided however that the local legislative body

body of such city may waive the requirement of such notice and the postponement of the effective date of such tax. A city tax

upon any transaction, to the extent that it would require a reduction in any tax rate imposed by a county thereon, shall not become effective in respect of any transaction taxed by such county before the commencement of the county's next succeeding fiscal year and then only if the city shall have given notice to such county of its imposition of a tax on such transaction at least six months prior to the commencement of such fiscal year, provided, however, that the local legislative body of such county may waive the requirement of such notice and postponement of the effective date of such tax. However, whether or not the six months' nos tice requirement provided in this section has been waived, a tax imposed pursuant to the authority of section twelve hundred ten or twelve hundred eleven shall still be subject to the requirements provided

for in the first three sentences of subdivision (d) of such sections and in subdivision (e) of such sections.

§ 3. Notwithstanding the provisions of subdivision (d) of section 1210 of the tax law or any other provision of law, local law, rule or regulation to the contrary, any local law, ordinance or resolution enacted or amended pursuant to the tax law as amended by this act imposing any additional tax in the county of Wyoming shall become effective in accordance with the provisions of subdivision (d) of section 1210 of the tax law, except that the certified copy of such local law, ordinance or resolution which must be mailed by registered mail to the commissioner of taxation and finance at his or her office in Albany must be so mailed at least thirty days prior to the date such local law,

ordinance resolution is to become effective.

§ 4. This act shall take effect immediately.

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