Title 42

PART 456 SUBPART C

Subpart C - Utilization Control: Hospitals

• Sec. 1102 of the Social Security Act (42 U.S.C. 1302), unless otherwise noted.
• 43 FR 45266, Sept. 29, 1978, unless otherwise noted.

42:4.0.1.1.14.3.143	SUBJGRP 143	Certification of Need for Care
42:4.0.1.1.14.3.143.1	SECTION 456.50	456.50 Scope.
42:4.0.1.1.14.3.143.2	SECTION 456.51	456.51 Definitions.
42:4.0.1.1.14.3.143.3	SECTION 456.60	456.60 Certification and recertification of need for inpatient care.
42:4.0.1.1.14.3.144	SUBJGRP 144	Plan of Care
42:4.0.1.1.14.3.144.4	SECTION 456.80	456.80 Individual written plan of care.
42:4.0.1.1.14.3.145	SUBJGRP 145	Utilization Review (UR) Plan: General Requirement
42:4.0.1.1.14.3.145.5	SECTION 456.100	456.100 Scope.
42:4.0.1.1.14.3.145.6	SECTION 456.101	456.101 UR plan required for inpatient hospital services.
42:4.0.1.1.14.3.146	SUBJGRP 146	UR Plan: Administrative Requirements
42:4.0.1.1.14.3.146.7	SECTION 456.105	456.105 UR committee required.
42:4.0.1.1.14.3.146.8	SECTION 456.106	456.106 Organization and composition of UR committee; disqualification from UR committee membership.
42:4.0.1.1.14.3.147	SUBJGRP 147	UR Plan: Informational Requirements
42:4.0.1.1.14.3.147.9	SECTION 456.111	456.111 Beneficiary information required for UR.
42:4.0.1.1.14.3.147.10	SECTION 456.112	456.112 Records and reports.
42:4.0.1.1.14.3.147.11	SECTION 456.113	456.113 Confidentiality.
42:4.0.1.1.14.3.148	SUBJGRP 148	UR Plan: Review of Need for Admission 1
42:4.0.1.1.14.3.148.12	SECTION 456.121	456.121 Admission review required.
42:4.0.1.1.14.3.148.13	SECTION 456.122	456.122 Evaluation criteria for admission review.
42:4.0.1.1.14.3.148.14	SECTION 456.123	456.123 Admission review process.
42:4.0.1.1.14.3.148.15	SECTION 456.124	456.124 Notification of adverse decision.
42:4.0.1.1.14.3.148.16	SECTION 456.125	456.125 Time limits for admission review.
42:4.0.1.1.14.3.148.17	SECTION 456.126	456.126 Time limits for final decision and notification of adverse decision.
42:4.0.1.1.14.3.148.18	SECTION 456.127	456.127 Pre-admission review.
42:4.0.1.1.14.3.148.19	SECTION 456.128	456.128 Initial continued stay review date.
42:4.0.1.1.14.3.148.20	SECTION 456.129	456.129 Description of methods and criteria: Initial continued stay review date; close professional scrutiny; length of stay modification.
42:4.0.1.1.14.3.149	SUBJGRP 149	UR Plan: Review of Need for Continued Stay
42:4.0.1.1.14.3.149.21	SECTION 456.131	456.131 Continued stay review required.
42:4.0.1.1.14.3.149.22	SECTION 456.132	456.132 Evaluation criteria for continued stay.
42:4.0.1.1.14.3.149.23	SECTION 456.133	456.133 Subsequent continued stay review dates.
42:4.0.1.1.14.3.149.24	SECTION 456.134	456.134 Description of methods and criteria: Subsequent continued stay review dates; length of stay modification.
42:4.0.1.1.14.3.149.25	SECTION 456.135	456.135 Continued stay review process.
42:4.0.1.1.14.3.149.26	SECTION 456.136	456.136 Notification of adverse decision.
42:4.0.1.1.14.3.149.27	SECTION 456.137	456.137 Time limits for final decision and notification of adverse decision.
42:4.0.1.1.14.3.150	SUBJGRP 150	UR Plan: Medical Care Evaluation Studies
42:4.0.1.1.14.3.150.28	SECTION 456.141	456.141 Purpose and general description.
42:4.0.1.1.14.3.150.29	SECTION 456.142	456.142 UR plan requirements for medical care evaluation studies.
42:4.0.1.1.14.3.150.30	SECTION 456.143	456.143 Content of medical care evaluation studies.
42:4.0.1.1.14.3.150.31	SECTION 456.144	456.144 Data sources for studies.
42:4.0.1.1.14.3.150.32	SECTION 456.145	456.145 Number of studies required to be performed.

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