[Code of Federal Regulations]

[Title 42, Volume 3]

[Revised as of October 1, 2005]

From the U.S. Government Printing Office via GPO Access

[CITE: 42CFR485.66]



[Page 599-600]

 

                         TITLE 42--PUBLIC HEALTH

 

  CHAPTER IV--CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF 

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 485_CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS--Table 

of Contents

 

    Subpart B_Conditions of Participation: Comprehensive Outpatient 

                        Rehabilitation Facilities

 

Sec. 485.66  Condition of participation: Utilization review plan.



    The facility must have in effect a written utilization review plan 

that is implemented at least each quarter, 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 Sec. 485.56(c), a committee of this group, or



[[Page 600]]



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.