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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 |
| § 456.50 - Scope. |
| § 456.51 - Definitions. |
| Ur Plan: Administrative Requirements |
| § 456.105 - UR committee required. |
| § 456.106 - Organization and composition of UR committee; disqualification from UR committee membership. |
| Ur Plan: Medical Care Evaluation Studies |
| § 456.141 - Purpose and general description. |
| § 456.142 - UR plan requirements for medical care evaluation studies. |
| § 456.143 - Content of medical care evaluation studies. |
| § 456.144 - Data sources for studies. |
| § 456.145 - Number of studies required to be performed. |
| UR Plan: Review of Need for Admission 1 |
| Plan of Care |
| § 456.80 - Individual written plan of care. |
| Ur Plan: Review of Need for Continued Stay |
| § 456.131 - Continued stay review required. |
| § 456.132 - Evaluation criteria for continued stay. |
| § 456.133 - Subsequent continued stay review dates. |
| § 456.134 - Description of methods and criteria: Subsequent continued stay review dates; length of stay modification. |
| § 456.135 - Continued stay review process. |
| § 456.136 - Notification of adverse decision. |
| § 456.137 - Time limits for final decision and notification of adverse decision. |
| Ur Plan: Review of Need for Admission 1 |
| Utilization Review (Ur) Plan: General Requirement |
| § 456.100 - Scope. |
| § 456.101 - UR plan required for inpatient hospital services. |
| Certification of Need for Care |
| § 456.60 - Certification and recertification of need for inpatient care. |
| UR Plan: Review of Need for Admission |
| § 456.121 - Admission review required. |
| § 456.122 - Evaluation criteria for admission review. |
| § 456.123 - Admission review process. |
| § 456.124 - Notification of adverse decision. |
| § 456.125 - Time limits for admission review. |
| § 456.126 - Time limits for final decision and notification of adverse decision. |
| § 456.127 - Pre-admission review. |
| § 456.128 - Initial continued stay review date. |
| § 456.129 - Description of methods and criteria: Initial continued stay review date; close professional scrutiny; length of stay modification. |
| Ur Plan: Informational Requirements |
| § 456.111 - Beneficiary information required for UR. |
| § 456.112 - Records and reports. |
| § 456.113 - Confidentiality. |