Thank you for taking our survey. Your response is very important to us.
OMB approved # 0938-0659
MEDICAID DRUG UTILIZATION REVIEW ANNUAL REPORT
FEDERAL FISCAL YEAR 2013
Section 1927(g)(3)(D) of the Social Security Act requires each State to submit an annual report on the operation of its Medicaid Drug Utilization Review (DUR) program. Such reports are to include: descriptions of the nature and scope of the prospective and retrospective DUR programs; a summary of the interventions used in retrospective DUR and an assessment of the education program; a description of DUR Board activities; and an assessment of the DUR program's impact on quality of care as well as any cost savings generated by the program.
This report is to cover the period October 1, 2012 to September 30, 2013 and is due for submission to CMS Central Office by no later than June 30, 2014. Answering the attached questions and returning the requested materials as attachments to the report will constitute full compliance with the above-mentioned statutory requirement.
If you have any questions regarding this survey instrument or the DUR annual report, please contact CMS at : DURPolicy@cms.hhs.gov
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-0659. The time required to complete this information collection is estimated to average 30 hours per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: Paperwork Reduction Act Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.
DUR ANNUAL REPORT
INSTRUCTIONS:Nomenclature Format for Attachments
States: Please use the standardized format for naming attachments.
ATT#-FFY-State Abbrev-Abbreviated Report name (NO SPACES!)
Example for Arizona: (each state should insert their State code)
Attachments:
ATT1-2013-AZ-POCCR (Pharmacy Oral Counseling Compliance Report)
ATT2-2013-AZ-REOS (RetroDUR Educational Outreach Summary)
ATT3-2013-AZ-SDBA (Summary of DUR BD Activities)
ATT4-2013-AZ-GDSP (Generic Drug Substitution Policies)
ATT5-2013-AZ-CSCAM (Cost Savings/Cost Avoidance Methodology)
ATT6-2013-AZ-IPN (Innovative Practices Narrative)
ATT7-2013-AZ-EAS (E-Prescribing Activity Summary)
ATT8-2013-AZ-ES (Executive Summary)
______________________________
CMS-R-153
Please print a copy of this section for your records before clicking "NEXT" button.