Innovative practices in healthcare serve as the cornerstone for advancing patient outcomes, enhancing operational efficiencies, and shaping the future of medicine. In an era marked by rapid technological advancements, demographic shifts, and evolving healthcare needs, the sharing of innovative practices is crucial. As healthcare organizations face unprecedented challenges to improve quality, access, and efficiency, the sharing of innovative practices between states and their managed care programs (MCP) fosters innovative solutions and helps to accelerate and produce a change in critical areas of care. By accelerating learning curves and shedding light on transformative potentials, sharing innovative practices paves the way for a more responsive, effective, and equitable healthcare system and fosters a culture of continuous improvement.
States and their MCPs have the flexibility to submit diverse approaches aimed at innovating, streamlining, and enhancing the efficiency of their Medicaid program while improving the quality of care for beneficiaries. The Centers for Medicare & Medicaid Services (CMS) features these Innovative Practice Narratives submitted by States and their MCPs through the annual Drug Utilization Review (DUR) surveys. CMS shares this useful information on these activities with the goal of enhancing the quality of care and prudent delivery of programs.
Please note that the State examples provided in the below table do not encompass all approaches that states may employ, as these submissions are voluntary. For further details about any of these programs, please reach out to the designated contact person listed in the contact information within the corresponding DUR FFS State individual reports. MCP innovative practice narratives can be accessed in the DUR MCO State Reports.
Note: CMS does not edit State and MCP submitted innovative practice narratives, nor are these narratives reviewed by CMS for compliance with statutes and regulations prior to publishing on Medicaid.gov.
42 CFR Subpart K – Drug Use Review (DUR) Program and Electronic Claims Management System for Outpatient Drug Claims Section 456.700-456.725 provides the requirements for the DUR program.
Please direct all communications to the CMSDUR@cms.hhs.gov resource mailbox.
Disclaimer: Please note that the information provided on this web page does not bind or obligate the Centers for Medicare and Medicaid Services (CMS). The statements included on this web page are intended to provide information on CMS Medicaid Drug Utilization Review and do not in any way revise or modify the requirements set forth in Section 1927 of the Act, regulations or program releases.
Page last updated on February 27, 2024