Title 42

PART 456 SUBPART F

Subpart F - Utilization Control: Intermediate Care Facilities

42:4.0.1.1.14.6.159SUBJGRP 159
Certification of Need for Care
42:4.0.1.1.14.6.159.1SECTION 456.350
   456.350 Scope.
42:4.0.1.1.14.6.159.2SECTION 456.351
   456.351 Definition.
42:4.0.1.1.14.6.159.3SECTION 456.360
   456.360 Certification and recertification of need for inpatient care.
42:4.0.1.1.14.6.160SUBJGRP 160
Medical, Psychological, and Social Evaluations and Admission Review
42:4.0.1.1.14.6.160.4SECTION 456.370
   456.370 Medical, psychological, and social evaluations.
42:4.0.1.1.14.6.160.5SECTION 456.371
   456.371 Exploration of alternative services.
42:4.0.1.1.14.6.160.6SECTION 456.372
   456.372 Medicaid agency review of need for admission.
42:4.0.1.1.14.6.161SUBJGRP 161
Plan of Care
42:4.0.1.1.14.6.161.7SECTION 456.380
   456.380 Individual written plan of care.
42:4.0.1.1.14.6.161.8SECTION 456.381
   456.381 Reports of evaluations and plans of care.
42:4.0.1.1.14.6.162SUBJGRP 162
Utilization Review (UR) Plan: General Requirement
42:4.0.1.1.14.6.162.9SECTION 456.400
   456.400 Scope.
42:4.0.1.1.14.6.162.10SECTION 456.401
   456.401 State plan UR requirements and options; UR plan required for intermediate care facility services.
42:4.0.1.1.14.6.163SUBJGRP 163
UR Plan: Administrative Requirements
42:4.0.1.1.14.6.163.11SECTION 456.405
   456.405 Description of UR review function: How and when.
42:4.0.1.1.14.6.163.12SECTION 456.406
   456.406 Description of UR review function: Who performs UR; disqualification from performing UR.
42:4.0.1.1.14.6.163.13SECTION 456.407
   456.407 UR responsibilities of administrative staff.
42:4.0.1.1.14.6.164SUBJGRP 164
UR Plan: Informational Requirements
42:4.0.1.1.14.6.164.14SECTION 456.411
   456.411 Beneficiary information required for UR.
42:4.0.1.1.14.6.164.15SECTION 456.412
   456.412 Records and reports.
42:4.0.1.1.14.6.164.16SECTION 456.413
   456.413 Confidentiality.
42:4.0.1.1.14.6.165SUBJGRP 165
UR Plan: Review of Need for Continued Stay
42:4.0.1.1.14.6.165.17SECTION 456.431
   456.431 Continued stay review required.
42:4.0.1.1.14.6.165.18SECTION 456.432
   456.432 Evaluation criteria for continued stay.
42:4.0.1.1.14.6.165.19SECTION 456.433
   456.433 Initial continued stay review date.
42:4.0.1.1.14.6.165.20SECTION 456.434
   456.434 Subsequent continued stay review dates.
42:4.0.1.1.14.6.165.21SECTION 456.435
   456.435 Description of methods and criteria: Continued stay review dates.
42:4.0.1.1.14.6.165.22SECTION 456.436
   456.436 Continued stay review process.
42:4.0.1.1.14.6.165.23SECTION 456.437
   456.437 Notification of adverse decision.
42:4.0.1.1.14.6.165.24SECTION 456.438
   456.438 Time limits for notification of adverse decision.