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.
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