42 CFR 456.432 : Public Health (Part 1 To Parts 1009-1099) — (§ 430.0 To Part 481) — Centers For Medicare & Medicaid Services, Department Of Health And Human Services (Continued) (§ 430.0 To Part 481) — Medical Assistance Programs (§ 430.0 To § 456.725) — Utilization Control (§ 456.1 To § 456.725) — Utilization Control: Intermediate Care Facilities (§ 456.350 To § 456.438) — Ur Plan: Review Of Need For Continued Stay (§ 456.431 To § 456.438) — Evaluation criteria for continued stay.

4 Aug 2016

The UR plan must provide that -

(a) The group performing UR develops written criteria to assess the need for continued stay.

(b) The group develops more extensive written criteria for cases that its experience shows are -

(1) Associated with high costs;

(2) Associated with the frequent furnishing of excessive services; or

(3) Attended by physicians whose patterns of care are frequently found to be questionable.

42 CFR 456.432