[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: 42CFR456.111]



[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.  456.111  Recipient information required for UR.



    The UR plan must provide that each recipient's record includes 

information needed for the UR committee to perform UR required under 

this subpart. This information must include, at least, the following:

    (a) Identification of the recipient.

    (b) The name of the recipient's physician.

    (c) Date of admission, and dates of application for and 

authorization of Medicaid benefits if application is made after 

admission.

    (d) The plan of care required under Sec.  456.70.

    (e) Initial and subsequent continued stay review dates described 

under Sec. Sec.  456.128 and 456.133.

    (f) Date of operating room reservation, if applicable.

    (g) Justification of emergency admission, if applicable.

    (h) Reasons and plan for continued stay, if the attending physician 

believes continued stay is necessary.

    (i) Other supporting material that the committee believes 

appropriate to be included in the record.