RetroDUR involves state Medicaid agencies ongoing and periodic review of claims data to identify patterns of: Incorrect drug dosage, duration or overutilization and underutilization of drug treatment.Incorrect dosage, frequency or duration of treatment.Drug-disease interactions and contraindications.ProDUR involves state Medicaid agencies electronic monitoring system to screen prescription drug claims to identify problems such as: The MCO DUR program must be as comprehensive as the states FFS program. The Medicaid DUR Program promotes patient safety through state-administered utilization management tools and systems that interface with the claims processing systems. Additionally, consistent with 42 CFR §438.3(s)(4) and (5) the Centers for Medicare and Medicaid Services (CMS) requires any Managed Care Organization (MCO) that includes covered outpatient drugs to operate a DUR program that complies with section 1927(g)(3)(D) and 42 CFR 456, subpart K. Since 1993, section 1927(g) of the Act has required each state to develop a DUR program targeted, in part, at reducing clinical abuse and misuse of outpatient prescription drugs covered under the State’s Medicaid Program. Medicaid DUR is a structured, ongoing program that interprets patterns of drug use in Medicaid programs and includes prospective drug review, retrospective drug use review, data assessment of drug use against predetermined standards, and ongoing educational outreach activities conducted by Medicaid state agencies, managed health care systems, pharmacy benefit managers (PBMs), academic institutions and/or other applicable stakeholders. Medicaid MAGI & CHIP Application Processing Time.Testing Experience & Functional Tools demonstration.Alternatives to Psychiatric Residential Treatment Facilities Demonstration.Balancing Long Term Services & Supports.Person-Centered Hospital Discharge Model.State Drug Utilization Review Reporting.Antipsychotic Medication Use in Children.Vision and Hearing Screening Services for Children and Adolescents.Early and Periodic Screening, Diagnostic, and Treatment.State Planning Grants for Qualifying Community-Based Mobile Crisis Intervention Services.SUPPORT Act Provider Capacity Demonstration.SUPPORT Act Innovative State Initiatives and Strategies.Medicaid Eligibility & Enrollment Toolkit.Medicaid Enterprise Certification Toolkit.Medicaid Information Technology Architecture.Section 223 Demonstration Program to Improve Community Mental Health Services.Actuarial Report on the Financial Outlook for Medicaid.CMS-64 FFCRA Increased FMAP Expenditure Data.State Budget & Expenditure Reporting for Medicaid and CHIP.Medicaid Eligibility Quality Control Program.Medicaid Third Party Liability & Coordination of Benefits.Seniors & Medicare and Medicaid Enrollees.Coronavirus Disease 2019 (COVID-19): Section 1115 Demonstrations.1115 Substance Use Disorder Demonstrations.1115 Demonstration Monitoring & Evaluation.Medicaid & CHIP Marketplace Interactions.Performance Indicator Technical Assistance.Medicaid Enrollment Data Collected Through MBES.March 2022 Medicaid & CHIP Enrollment Data Highlights.Home & Community Based Services Authorities.Lawfully Residing Immigrant Children & Pregnant Women.Medicaid and CHIP Quality Resource Library.Affordable Care Act Program Integrity Provisions.Medicaid and CHIP Eligibility & Enrollment Webinars.Unwinding and Returning to Regular Operations after COVID-19. ![]()
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |