What CMS published on August 21
CMS published the Paperwork Reduction Act notice on August 21, 2026. It seeks comments on a revision to CMS-R-153, the annual Medicaid Drug Utilization Review program collection. Comments are due October 20. The notice does not amend the Code of Federal Regulations, approve a final form, or impose an effective date for a new pharmacy workflow.
The proposed fee-for-service survey covers federal fiscal year 2026, from October 1, 2025, through September 30, 2026, and says state submissions are due June 30, 2027. The collection covers the 50 states, the District of Columbia, and Puerto Rico. CMS provides the instrument to states and managed care programs, pharmacists employed or contracted by those programs complete it, and state Medicaid agencies submit the annual reports.
Read the two new nursing-home questions literally
The fee-for-service crosswalk identifies two additions in the DUR Board Activity section. One asks whether the state takes steps to ensure nursing-home facilities are compliant with retrospective DUR under part 483, as required by 42 CFR 456.712. The other asks the same yes-or-no question about prospective DUR. The crosswalk says both were added pursuant to section 456.712.
Section 456.712 is an annual-report provision. Among other items, it requires the state report to describe steps taken to include in prospective and retrospective DUR drugs dispensed to residents of a nursing facility that is not complying with the drug-regimen-review procedures in part 483. A yes-or-no survey answer will not identify a facility, show which steps a state took, establish resident-level compliance, or demonstrate that an intervention improved care.
Keep Medicaid DUR separate from the monthly resident review
Medicaid DUR operates at a program and claims level. Prospective DUR screens covered prescriptions before they are filled or delivered for issues such as duplication, interactions, dose, duration, allergy, and misuse. Retrospective DUR periodically examines claims and other records for patterns that may warrant state intervention with prescribers or pharmacists.
The nursing-facility duty in 42 CFR 483.45(c) is different and remains in force independently of this proposal. Each resident's drug regimen must be reviewed at least monthly by a licensed pharmacist, the review must include the medical chart, identified irregularities must be reported, and the facility must maintain procedures for the review process. CMS-R-153 does not change that cadence, expand the pharmacist's authority, or substitute a state survey response for resident-specific work.
Who files the report—and who does not
A useful reference record needs the source, document status, reporting period, respondent, unit of analysis, and next date. For this item: CMS-R-153 is proposed; comments close October 20; the planned state reporting period is FFY 2026; the respondent is a state or managed care program; and the nursing-home additions are two state-level yes-or-no questions. Those fields prevent a policy team or software vendor from converting an information request into a new facility task.
If a state Medicaid program later requests data from a pharmacy or contractor, verify that request against the state's actual authority, specification, population, and deadline. Keep any claim extract or program response separate from the resident's medication record and monthly review. The CMS supporting statement says dispensing pharmacists do not produce the exception reports: claims flow electronically, and the state or its point-of-sale vendor produces those reports for program review.
What to watch after October 20
Comments may be submitted through Regulations.gov and should reference CMS-R-153 or OMB control number 0938-0659. CMS specifically invites comments on whether the collection is necessary and useful, whether its burden estimates are accurate, how to improve clarity, and whether automated methods could reduce burden. After October 20, check the OMB review record and CMS package for the approved form, expiration date, and any response to comments.
The proposed survey says FFY 2026 reports are due June 30, 2027, and the supporting statement says CMS plans to post a comparison or summary within six months of that due date. The supporting statement still refers to a 2025 collection and an August 17 notice. Use the published Federal Register notice for the current dates and the survey and crosswalk for the proposed questions, then recheck the package after OMB review.