[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: 42CFR456.80]



[Page 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.  456.80  Individual written plan of care.



    (a) Before admission to a hospital or before authorization for 

payment, a physician and other personnel involved in the care of the 

individual must establish a written plan of care for each applicant or 

recipient.

    (b) The plan of care must include--

    (1) Diagnoses, symptoms, complaints, and complications indicating 

the need for admission;

    (2) A description of the functional level of the individual;

    (3) Any orders for--

    (i) Medications;

    (ii) Treatments;

    (iii) Restorative and rehabilitative services;

    (iv) Activities;

    (v) Social services;

    (vi) Diet;

    (4) Plans for continuing care, as appropriate; and

    (5) Plans for discharge, as appropriate.

    (c) Orders and activities must be developed in accordance with 

physician's instructions.

    (d) Orders and activities must be reviewed and revised as 

appropriate by all personnel involved in the care of an individual.

    (e) A physician and other personnel involved in the recipient's case 

must review each plan of care at least every 60 days.



            Utilization Review (UR) Plan: General Requirement