GroundRules
42 CFR 456.714: DUR/surveillance and utilization review relationship.
Where this section sits in the code
- Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS
- PART 456—UTILIZATION CONTROL
- Subpart K—Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims
(a) The retrospective DUR requirements in this subpart parallel a portion of the surveillance and utilization review (SUR) requirements in subpart A of this part and in part 455 of this chapter.
(b) A State agency may direct DUR staffs to limit review activities to those that focus on what constitutes appropriate and medically necessary care to avoid duplication of activities relating to fraud and abuse under the SUR program.
Collected 2026-08-27T02:26:11Z. Source file · JSON