55 Pa. Code § 1163.73 - Hospital utilization review plan
(a) Hospital utilization review plans shall
provide for a utilization review committee that meets the requirements set
forth in §
1163.74 (relating to requirements
for hospital utilization review committees).
(b) Hospital utilization review plans shall
describe the organization, composition and functions of the utilization review
committee and specify the frequency of the meetings of the committee.
(c) Hospital utilization review plans shall
provide for a review of each recipient's admission to the hospital under §
1163.77 (relating to admission
review requirements).
(d) Hospital
utilization review plans shall provide for a review of potential outlier cases
under §
1163.78a or §
1163.78b (relating to review
requirements for day outliers; or review requirements for cost
outliers).
(e) Hospital utilization
review plans shall describe the methods that the utilization review committees
use to select and conduct Medical Care Evaluation studies under §
1163.79 (relating to Medical Care
Evaluation studies).
Notes
This section cited in 55 Pa. Code § 1163.41 (relating to general participation requirements).
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