42 CFR Subpart C - Utilization Control: Hospitals

  1. § 456.50 Scope.
  2. § 456.51 Definitions.
  3. Utilization Review (UR) Plan: General Requirement (§§ 456.100 - 456.101)
    1. § 456.100 Scope.
    2. § 456.101 UR plan required for inpatient hospital services.
  4. UR Plan: Review of Need for Admission 1 (§§ 456.121 - 456.129)
    1. § 456.121 Admission review required.
    2. § 456.122 Evaluation criteria for admission review.
    3. § 456.123 Admission review process.
    4. § 456.124 Notification of adverse decision.
    5. § 456.125 Time limits for admission review.
    6. § 456.126 Time limits for final decision and notification of adverse decision.
    7. § 456.127 Pre-admission review.
    8. § 456.128 Initial continued stay review date.
    9. § 456.129 Description of methods and criteria: Initial continued stay review date; close professional scrutiny; length of stay modification.

    1 The Department was enjoined in 1975 in the case of American Medical Assn. et al. v. Weinberger, 395 F. Supp. 515 (N.D. Ill., 1975), aff'd., 522 F2d 921 (7th cir., 1975) from implementing the admission review requirements contained in §§ 456.121-456.127. This case was dismissed on the condition that these requirements be revised. They are presently being revised, and will not be in force until that revision is completed.