42 CFR § 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

(a) The UR plan must include a written description of who performs UR in the ICF.

(b) UR must be performed using a method specified under § 456.401(b) by a group of professional personnel that includes—

(1) At least one physician;

(2) In an ICF that cares primarily for mental patients, at least one individual knowledgeable in the treatment of mental diseases; and

(3) In an institution for individuals with intellectual disabilities, a least one individual knowledgeable in the treatment of intellectual disability.

(c) The group performing UR may not include any individual who—

(1) Is directly responsible for the care of the beneficiary whose care is being reviewed;

(2) Is employed by the ICF; or

(3) Has a financial interest in any ICF.