[Code of Federal Regulations]

[Title 42, Volume 4]

[Revised as of October 1, 2006]

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

[CITE: 42CFR456.106]



[Page 345]

 

                         TITLE 42--PUBLIC HEALTH

 

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

                  HEALTH AND HUMAN SERVICES (CONTINUED)

 

PART 456_UTILIZATION CONTROL--Table of Contents

 

                Subpart C_Utilization Control: Hospitals

 

Sec.  456.106  Organization and composition of UR committee; 



disqualification from UR committee membership.



    (a) For the purpose of this subpart, ``UR committee'' includes any 

group organized under paragraphs (b) and (c) of this section.

    (b) The UR committee must be composed of two or more physicians, and 

assisted by other professional personnel.

    (c) The UR committee must be constituted as--

    (1) A committee of the hospital staff;

    (2) A group outside the hospital staff, established by the local 

medical or osteopathic society and at least some of the hospitals and 

SNFs in the locality;

    (3) A group capable of performing utilization review, established 

and organized in a manner approved by the Secretary.

    (d) The UR committee may not include any individual who--

    (1) Is directly responsible for the care of the patient whose care 

is being reviewed; or

    (2) Has a financial interest in any hospital.



                   UR Plan: Informational Requirements