§485.66. Condition of participation: Utilization review plan.
42 C.F.R. § 485.66
The facility must have in effect a written utilization review plan that is implemented annually, to assess the necessity of services and promotes the most efficient use of services provided by the facility.
Standard: Utilization review committee. The utilization review committee, consisting of the group of professional personnel specified in § 485.56(c), a committee of this group, or a group of similar composition, comprised by professional personnel not associated with the facility, must carry out the utilization review plan.
Standard: Utilization review plan. The utilization review plan must contain written procedures for evaluating—
Admissions, continued care, and discharges using, at a minimum, the criteria established in the patient care policies;
The applicability of the plan of treatment to established goals; and
The adequacy of clinical records with regard to—
Assessing the quality of services provided; and
Determining whether the facility's policies and clinical practices are compatible and promote appropriate and efficient utilization of services.
Notes, amendments, and revision history
Amendments
[48 FR 56293, Dec. 15, 1982. Redesignated at 50 FR 33034, Aug. 16, 1985, as amended at 84 FR 51826, Sept. 30, 2019]
Authority
Authority: 42 U.S.C. 1302 and 1395(hh).
Source
Source: 48 FR 56293, Dec. 15, 1982, unless otherwise noted. Redesignated at 50 FR 33034, Aug. 16, 1985.
Amendments
[48 FR 56293, Dec. 15, 1982. Redesignated at 50 FR 33034, Aug. 16, 1985, as amended at 84 FR 51826, Sept. 30, 2019]