---
kind: "section"
citation: "42 C.F.R. § 441.155"
title: "42"
number: "441.155"
heading: "Individual plan of care."
url: "https://uscodex.org/cfr/42/441.155"
---

# §441.155. Individual plan of care.

- (a) “Individual plan of care” means a written plan developed for each beneficiary in accordance with §§ [456.180](/cfr/42/456.180.md) and [456.181](/cfr/42/456.181.md) of this chapter, to improve his condition to the extent that inpatient care is no longer necessary.
- (b) **The plan of care must—**
  - (1) Be based on a diagnostic evaluation that includes examination of the medical, psychological, social, behavioral and developmental aspects of the beneficiary's situation and reflects the need for inpatient psychiatric care;
  - (2) Be developed by a team of professionals specified under [§ 441.156](/cfr/42/441.156.md) in consultation with the beneficiary; and his parents, legal guardians, or others in whose care he will be released after discharge;
  - (3) State treatment objectives;
  - (4) Prescribe an integrated program of therapies, activities, and experiences designed to meet the objectives; and
  - (5) Include, at an appropriate time, post-discharge plans and coordination of inpatient services with partial discharge plans and related community services to ensure continuity of care with the beneficiary's family, school, and community upon discharge.
- (c) The plan must be reviewed every 30 days by the team specified in [§ 441.156](/cfr/42/441.156.md) to—
  - (1) Determine that services being provided are or were required on an inpatient basis, and
  - (2) **Recommend changes in the plan as indicated by the beneficiary's overall adjustment as an inpatient.**
- (d) The development and review of the plan of care as specified in this section satisfies the utilization control requirements for—
  - (1) Recertification under §§ [456.60(b)](/cfr/42/456.60.md?p=b), [456.160(b)](/cfr/42/456.160.md?p=b), and [456.360(b)](/cfr/42/456.360.md?p=b) of this subchapter; and
  - (2) Establishment and periodic review of the plan of care under §§ [456.80](/cfr/42/456.80.md), [456.180](/cfr/42/456.180.md), and [456.380](/cfr/42/456.380.md) of this subchapter.

## Notes

### Amendments

[43 FR 45229, Sept. 29, 1978, as amended at 46 FR 48560, Oct. 1, 1981; 61 FR 38398, July 24, 1996]

### Authority

Authority: 42 U.S.C. 1302.

### Source

Source: 43 FR 45229, Sept. 29, 1978, unless otherwise noted.

### Amendments

[43 FR 45229, Sept. 29, 1978, as amended at 46 FR 48560, Oct. 1, 1981; 61 FR 38398, July 24, 1996]