CERTIFICATION OF NEED FOR CARE

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

• § 456.350 - Scope.

• § 456.351 - Definition.

MEDICAL, PSYCHOLOGICAL, AND SOCIAL EVALUATIONS AND ADMISSION REVIEW

• § 456.370 - Medical, psychological, and social evaluations.

• § 456.371 - Exploration of alternative services.

• § 456.372 - Medicaid agency review of need for admission.

PLAN OF CARE

• § 456.380 - Individual written plan of care.

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

UTILIZATION REVIEW (UR) PLAN: GENERAL REQUIREMENT

• § 456.400 - Scope.

• § 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

UR PLAN: ADMINISTRATIVE REQUIREMENTS

• § 456.405 - Description of UR review function: How and when.

• § 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.

• § 456.407 - UR responsibilities of administrative staff.

UR PLAN: INFORMATIONAL REQUIREMENTS

• § 456.411 - Beneficiary information required for UR.

• § 456.412 - Records and reports.

• § 456.413 - Confidentiality.

UR PLAN: REVIEW OF NEED FOR CONTINUED STAY

• § 456.431 - Continued stay review required.

• § 456.432 - Evaluation criteria for continued stay.

• § 456.433 - Initial continued stay review date.

• § 456.434 - Subsequent continued stay review dates.

• § 456.435 - Description of methods and criteria: Continued stay review dates.

• § 456.436 - Continued stay review process.

• § 456.437 - Notification of adverse decision.

• § 456.438 - Time limits for notification of adverse decision.