(6)__The rules must define "clinical records."

(7)__The rules must provide an exemption to the prior authorization process for a period of 6 months for a provider if the provider routinely prescribes drugs from the preferred drug list or if the provider's requests for prior authorization have been routinely approved in the past.

D.__The department shall adopt rules to streamline the appeals process for the prior authorization process.

(1)__The rules must provide for a decision by the commissioner or the commissioner's designee.

(2)__The rules must provide that the decision of the commissioner or the commissioner's designee is final agency action.

(3)__The rules must provide for final decision on a request for a fair hearing within 90 days of the date of request for the hearing and, if a decision is not made within 90 days and the delay past 90 days is not a result of a request, fault or consent of the member, for temporary approval of a prior authorization request until a final decision is made.

(4) The rules must provide for approval of the prior authorization request if the hearing officer determines that the notice of decision provided by the department fails to substantially comply with the department's rules regarding the content of notices and the hearing officer determines that further delay would prejudice the rights of the member.

E.__The department shall adopt rules establishing a consumer information sheet on prior authorization of pharmacy benefits.__The information sheet must include a telephone number for the member to call for assistance in accessing pharmacy benefits. The rules must require the information sheet to be available at pharmacies and to be given to a member when the department refuses to grant prior authorization.

§3174-HH.__Drug utilization review committee