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Code of Federal Regulations Title 42. Public Health § 42.456.122 Evaluation criteria for admission review

Current as of January 02, 2025 | Updated by Findlaw Staff

The UR plan must provide that—

(a) The committee develops written medical care criteria to assess the need for admission;  and

(b) The committee 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.

 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.

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Cite this article: FindLaw.com - Code of Federal Regulations Title 42. Public Health § 42.456.122 Evaluation criteria for admission review - last updated January 02, 2025 | https://codes.findlaw.com/cfr/title-42-public-health/cfr-sect-42-456-122/

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