CIB: State Guidance for Implementation of Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the SUPPORT Act

Today the Centers for Medicare & Medicaid Services (CMS) released an Information Bulletin to provide information on Implementation of Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment (SUPPORT) for Patients and Communities Act (P.L. 115-271). This document addresses the required implementation of these provisions by October 1, 2019, including requirements regarding opioid prescription claim reviews at the point of sale (POS) and retrospective reviews; the monitoring and management of antipsychotic medication in children; identification of processes to detect fraud and abuse; and mandatory DUR report updates, as well as requirements for Medicaid Managed Care Organizations (MCOs). This information also describes the components of the State Plan Amendment (SPA) that each state must submit by December 31, 2019, in order to comply with these new requirements.

• State Guidance for Implementation of Medicaid Drug Utilization Review (DUR) provisions included in Section 1004 of the Substance Use-Disorder Prevention that Promotes Opioid Recovery and Treatment for Patients and Communities Act