---
kind: "section"
citation: "42 C.F.R. § 485.66"
title: "42"
number: "485.66"
heading: "Condition of participation: Utilization review plan."
url: "https://uscodex.org/cfr/42/485.66"
---

# §485.66. Condition of participation: Utilization review plan.


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.

- (a) **Standard: Utilization review committee.** The utilization review committee, consisting of the group of professional personnel specified in [§ 485.56(c)](/cfr/42/485.56.md?p=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.
- (b) **Standard: Utilization review plan.** The utilization review plan must contain written procedures for evaluating—
  - (1) Admissions, continued care, and discharges using, at a minimum, the criteria established in the patient care policies;
  - (2) The applicability of the plan of treatment to established goals; and
  - (3) **The adequacy of clinical records with regard to—**
    - (i) Assessing the quality of services provided; and
    - (ii) Determining whether the facility's policies and clinical practices are compatible and promote appropriate and efficient utilization of services.

## Notes

### 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]