[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: 42CFR456.51]



[Page 343-344]

 

                         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.  456.51  Definitions.



    As used in this subpart:

    Inpatient hospital services--

    (a) Include--

    (1) Services provided in an institution other than an institution 

for mental disease, as defined in Sec.  440.10;

    (2) [Reserved]

    (3) Services provided in specialty hospitals and



[[Page 344]]



    (b) Exclude services provided in mental hospitals. Utilization 

control requirements for mental hospitals appear in subpart D.

    Medical care appraisal norms or norms means numerical or statistical 

measures of usually observed performance.

    Medical care criteria or criteria means predetermined elements 

against which aspects of the quality of a medical service may be 

compared. These criteria are developed by health professionals relying 

on their expertise and the professional health care literature.



[43 FR 45266, Sept. 29, 1978, as amended at 51 FR 22041, June 17, 1986]



                     Certification of Need for Care