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Code of Federal Regulations Title 42. Public Health § 42.485.66 Condition of participation:  Utilization review plan

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

The facility must have in effect a written utilization review plan that is implemented annually, to assess the necessity of services and promotes the most efficient use of services provided by the facility.

(a) Standard:  Utilization review committee. The utilization review committee, consisting of the group of professional personnel specified in § 485.56(c), a committee of this group, or a group of similar composition, comprised by professional personnel not associated with the facility, must carry out the utilization review plan.

(b) Standard:  Utilization review plan. The utilization review plan must contain written procedures for evaluating—

(1) Admissions, continued care, and discharges using, at a minimum, the criteria established in the patient care policies;

(2) The applicability of the plan of treatment to established goals;  and

(3) The adequacy of clinical records with regard to—

(i) Assessing the quality of services provided;  and

(ii) Determining whether the facility's policies and clinical practices are compatible and promote appropriate and efficient utilization of services.

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Cite this article: FindLaw.com - Code of Federal Regulations Title 42. Public Health § 42.485.66 Condition of participation:  Utilization review plan - last updated January 02, 2025 | https://codes.findlaw.com/cfr/title-42-public-health/cfr-sect-42-485-66/

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