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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 F - Utilization Control: Intermediate Care Facilities |
| § 456.350 - Scope. |
| § 456.351 - Definition. |
| Utilization Review (Ur) Plan: General Requirement |
| § 456.400 - Scope. |
| § 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services. |
| Medical, Psychological, and Social Evaluations and Admission Review |
| § 456.370 - Medical, psychological, and social evaluations. |
| § 456.371 - Exploration of alternative services. |
| § 456.372 - Medicaid agency review of need for admission. |
| Certification of Need for Care |
| § 456.360 - Certification and recertification of need for inpatient care. |
| Ur Plan: Review of Need for Continued Stay |
| § 456.431 - Continued stay review required. |
| § 456.432 - Evaluation criteria for continued stay. |
| § 456.433 - Initial continued stay review date. |
| § 456.434 - Subsequent continued stay review dates. |
| § 456.435 - Description of methods and criteria: Continued stay review dates. |
| § 456.436 - Continued stay review process. |
| § 456.437 - Notification of adverse decision. |
| § 456.438 - Time limits for notification of adverse decision. |
| Ur Plan: Informational Requirements |
| § 456.411 - Beneficiary information required for UR. |
| § 456.412 - Records and reports. |
| § 456.413 - Confidentiality. |
| Ur Plan: Administrative Requirements |
| § 456.405 - Description of UR review function: How and when. |
| § 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR. |
| § 456.407 - UR responsibilities of administrative staff. |
| Plan of Care |
| § 456.380 - Individual written plan of care. |
| § 456.381 - Reports of evaluations and plans of care. |