CERTIFICATION OF NEED FOR CARE

• § 456.160 - Certification and recertification of need for inpatient care.

• § 456.150 - Scope.

• § 456.151 - Definitions.

MEDICAL, PSYCHIATRIC, AND SOCIAL EVALUATIONS AND ADMISSION REVIEW

• § 456.170 - Medical, psychiatric, and social evaluations.

• § 456.171 - [Reserved]

PLAN OF CARE

• § 456.180 - Individual written plan of care.

• § 456.181 - Reports of evaluations and plans of care.

UTILIZATION REVIEW (UR) PLAN: GENERAL REQUIREMENTS

• § 456.200 - Scope.

• § 456.201 - UR plan required for inpatient mental hospital services.

UR PLAN: ADMINISTRATIVE REQUIREMENTS

• § 456.205 - UR committee required.

• § 456.206 - Organization and composition of UR committee; disqualification from UR committee membership.

UR PLAN: INFORMATIONAL REQUIREMENTS

• § 456.211 - Beneficiary information required for UR.

• § 456.212 - Records and reports.

• § 456.213 - Confidentiality.

UR PLAN: REVIEW OF NEED FOR CONTINUED STAY

• § 456.231 - Continued stay review required.

• § 456.232 - Evaluation criteria for continued stay.

• § 456.233 - Initial continued stay review date.

• § 456.234 - Subsequent continued stay review dates.

• § 456.235 - Description of methods and criteria: Continued stay review dates; length of stay modification.

• § 456.236 - Continued stay review process.

• § 456.237 - Notification of adverse decision.

• § 456.238 - Time limits for final decision and notification of adverse decision.

UR PLAN: MEDICAL CARE EVALUATION STUDIES

• § 456.241 - Purpose and general description.

• § 456.242 - UR plan requirements for medical care evaluation studies.

• § 456.243 - Content of medical care evaluation studies.

• § 456.244 - Data sources for studies.

• § 456.245 - Number of studies required to be performed.