42 CFR Subpart C - Subpart C—Utilization Control: Hospitals
- § 456.50 Scope.
- § 456.51 Definitions.
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Certification of Need for Care (§ 456.60)
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Plan of Care (§ 456.80)
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Utilization Review (UR) Plan: General Requirement (§§ 456.100 - 456.101)
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UR Plan: Administrative Requirements (§§ 456.105 - 456.106)
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UR Plan: Informational Requirements (§§ 456.111 - 456.113)
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UR Plan: Review of Need for Admission 1 (§§ 456.121 - 456.129)
- § 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.
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. -
UR Plan: Review of Need for Continued Stay (§§ 456.131 - 456.137)
- § 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.
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UR Plan: Medical Care Evaluation Studies (§§ 456.141 - 456.145)