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Code of Federal Regulations (Last Updated: May 6, 2024) |
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Title 42 - Public Health |
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Chapter IV - Centers for Medicare & Medicaid Services, Department of Health and Human Services |
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SubChapter C - Medical Assistance Programs |
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Part 456 - Utilization Control |
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Subpart C - Utilization Control: Hospitals |
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UR Plan: Review of Need for Admission |
§ 456.122 - Evaluation criteria for admission review.
Latest version.
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§ 456.122 Evaluation criteria for admission review.
The UR plan must provide that -
(a) The committee develops written medical care criteria to assess the need for admission; and
(b) The committee develops more extensive written criteria for cases that its experience shows are -
(1) Associated with high costs;
(2) Associated with the frequent furnishing of excessive services; or
(3) Attended by physicians whose patterns of care are frequently found to be questionable.