42 CFR 456.23
§ 456.23 Post-payment review process.
United States · 42 CFR — Public Health · Status: effective
Cite this
- Citation
- 42 CFR 456.23, § 456.23 Post-payment review process, United States, version 1 as recorded 2026-07-09, yourstate.us, https://yourstate.us/provision/206603
- Permanent ID
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Full text
The agency must have a post-payment review process that—
(a) Allows State personnel to develop and review—
(1) Beneficiary utilization profiles;
(2) Provider service profiles; and
(3) Exceptions criteria; and
(b) Identifies exceptions so that the agency can correct misutilization practices of beneficiaries and providers.
Legislative history
This is a federal regulation, adopted through agency rulemaking under the Administrative Procedure Act — not enacted by a recorded vote of Congress.