Section 4401 of the Omnibus Budget Reconciliation Act of 1990 and section 1927(d) of the Social Security Act requires States to provide for a Medicaid Drug Utilization Review (DUR) program for covered outpatient drugs. The DUR program is required to assure that prescriptions are appropriate, medically necessary and are not likely to result in adverse medical results. Each State DUR program must consist of prospective drug use review, retrospective drug use review, data assessment of drug use against predetermined standards, and ongoing educational outreach activities. In addition, States are required to submit an annual DUR program report that includes a description of the nature and scope of State DUR activities as outlined in the statute and regulations.
The Centers for Medicare and Medicaid Services, Center for Medicaid, CHIP and Survey and Certification, is requesting a 3-year approval of the State data collection requirements, the CMS forms CMS-R-153, CMS-R-153a, CMS-R-153b, and CMS-R-153c data collection instruments with instructions and the annual reporting contained in the Medicaid Drug Utilization Review regulation.
The survey instrument is being revised to address how states are monitoring clinical practices in the profession and to address innovations going forward in the health care arena. We removed request for data elements that were not considered to be useful any longer such as some demographic information, questions about therapeutic duplication that was addressed elsewhere in the questionnaire, and an attachment that was duplicative of information requested in a table and therefore we no long have a CMS-R-153c. Additionally, we decreased the overall number of problem categories and intervention types that the states had to report to on to CMS by 50 percent.
We added new questions to several sections in the survey. We clarified that the annual report will now be electronically submitted directly to the Central Office (CO) instead of being submitted in hard copy through the Regional Office.
On behalf of this Federal agency, I certify that the collection of information encompassed by this request complies with 5 CFR 1320.9 and the related provisions of 5 CFR 1320.8(b)(3).
The following is a summary of the topics, regarding the proposed collection of information, that the certification covers:
(i) Why the information is being collected;
(ii) Use of information;
(iii) Burden estimate;
(iv) Nature of response (voluntary, required for a benefit, or mandatory);
(v) Nature and extent of confidentiality; and
(vi) Need to display currently valid OMB control number;
If you are unable to certify compliance with any of these provisions, identify the item by leaving the box unchecked and explain the reason in the Supporting Statement.
Form CMS-R-153 Medicaid Drug Ulilization Review (DUR) Annual Report (CMS-R-153)
Crosswalk for Medicaid DUR Report 2-26-14.docx
Medicaid Drug Ulilization Review (DUR) Annual Report (CMS-R-153)