[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: 42CFR456.142]



[Page 348-349]

 

                         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.  456.142  UR plan requirements for medical care evaluation studies.



    (a) The UR plan must describe the methods that the committee uses to 

select and conduct medical care evaluation studies under paragraph 

(b)(1) of this section.

    (b) The UR plan must provide that the UR committee--

    (1) Determines the methods to be used in selecting and conducting 

medical care evaluation studies in the hospital;

    (2) Documents for each study--

    (i) Its results; and

    (ii) How the results have been used to make changes to improve the 

quality of care and promote more effective and efficient use of 

facilities and services;

    (3) Analyzes its findings for each study; and

    (4) Takes action as needed to--

    (i) Correct or investigate further any deficiencies or problems in 

the review



[[Page 349]]



process for admissions or continued stay cases;

    (ii) Recommend more effective and efficient hospital care 

procedures; or

    (iii) Designate certain providers or categories of admissions for 

review prior to admission.