[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: 42CFR456.128]



[Page 346-347]

 

                         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.  456.128  Initial continued stay review date.



    The UR plan must provide that--

    (a) When a recipient is admitted to the hospital under the admission 

review requirements of this subpart, the committee assigns a specified 

date by which the need for his continued stay will be reviewed;

    (b) The committee bases its assignment of the initial continued stay 

review date on--

    (1) The methods and criteria required to be described under Sec.  

456.129;

    (2) The individual's condition; and



[[Page 347]]



    (3) The individual's projected discharge date;

    (c)(1) The committee uses any available appropriate regional medical 

care appraisal norms, such as those developed by abstracting services or 

third party payors, to assign the initial continued stay review date;

    (2) These regional norms are based on current and statistically 

valid data on duration of stay in hospitals for patients whose 

characteristics, such as age and diagnosis, are similar to those of the 

individual whose case is being reviewed;

    (3) If the committee uses norms to assign the initial continued stay 

review date, the number of days between the individual's admission and 

the initial continued stay review date is no greater than the number of 

days reflected in the 50th percentile of the norms. However, the 

committee may assign a later review date if it documents that the later 

date is more appropriate; and

    (d) The committee ensures that the initial continued stay review 

date is recorded in the individual's record.