StacksVerified U.S. regulatory reference

42 CFR §456.23

Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
The agency must have a post-payment review process that—
  1. (a)Allows State personnel to develop and review—
    1. (1)Beneficiary utilization profiles;
    2. (2)Provider service profiles; and
    3. (3)Exceptions criteria; and
  2. (b)Identifies exceptions so that the agency can correct misutilization practices of beneficiaries and providers.