D.C. Mun. Regs. tit. 29, r. 29-2714

Current through Register Vol. 71, No. 49, December 6, 2024

Rule 29-2714 - DRUG UTILIZATION REVIEW BOARD (DUR BOARD)

2714.1

Pursuant to the requirements of 42 C.F.R. part 456, subpart K, the District of Columbia has established the Drug Utilization Review Board ("DUR Board") at DHCF.

2714.2

The DUR Board's mission and mandate is to establish reporting structure, use investigatory powers and employ other regulatory measures to confirm that prescribed drugs are clinically appropriate, medically necessary, cost-effective, and not fraudulently obtained or prescribed.

2714.3

Consistent with 42 C.F.R. § 438.3(s)(4), each Medicaid managed care organization (MCO), or its designee, shall operate its own DUR program consistent with federal requirements. The MCO program must be as comprehensive as the program operated by DHCF.

2714.4

The DUR Board shall require a monthly report from the Medicaid Management Information System (MMIS) and each MCO, or its designee, to include information identifying beneficiaries who meet criteria for potential misuse or inappropriate use of prescription drugs, such as:

(a) The information outlined in §2712.3 of this Chapter;

(b) Enrolled children under eighteen (18), and those in foster care, prescribed antipsychotic medications; and

(c) A beneficiary who is concurrently prescribed opioids and:

(1) Benzodiazepines; or

(2) Antipsychotics.

2714.5

The DUR Board shall require the institution of safety edits on opioid prescriptions.

2714.6

The DUR Board shall evaluate and develop guidelines for beneficiary inclusion in the Medicaid FFS and Medicaid MCO Pharmacy Lock-In Programs.

D.C. Mun. Regs. tit. 29, r. 29-2714

Notice of Final Rulemaking published at 59 DCR 2298, 2311 (March 23, 2012); amended by Final Rulemaking published at 70 DCR 2719 (3/3/2023)

Authority: The Director of the Department of Health Care Finance (DHCF), pursurant to the authority set forth in An Act to enable the District of Columbia to receive federal financial assistance under Title XIX of the Social Security Act for a medical assistance program, and forth other purposes, approved December 27, 1967 (81 Stat. 774; D.C. Official Code § 1-307.02 (2006 Repl. & 2011 Supp.)) and section 6(6) of the Department of Health Care Finance Establishment Act of 2007, effective February 27, 2008 (D.C. Law 17-109; D.C. Official Code § 7-771.05(6)) (2008 Repl.)).