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