1. Regulations
  2. title 42
  3. chapter IV-i2
  4. part 456
  5. subpart B
  6. § 456.22

Collapse to view only § 456.22 - Sample basis evaluation of services.

§ 456.21 - Scope.

This subpart prescribes utilization control requirements applicable to all services provided under a State plan.

AUTHORITY: 42 U.S.C. 1302.

SOURCE: 43 FR 45266, Sept. 29, 1978, unless otherwise noted.

CITE AS: 42 CFR 456.21

§ 456.22 - Sample basis evaluation of services.

To promote the most effective and appropriate use of available services and facilities the Medicaid agency must have procedures for the on-going evaluation, on a sample basis, of the need for and the quality and timeliness of Medicaid services.

AUTHORITY: 42 U.S.C. 1302.

SOURCE: 43 FR 45266, Sept. 29, 1978, unless otherwise noted.

CITE AS: 42 CFR 456.22

§ 456.23 - Post-payment review process.

The agency must have a post-payment review process that—

(a) Allows State personnel to develop and review—

(1) Beneficiary utilization profiles;

(2) Provider service profiles; and

(3) Exceptions criteria; and

(b) Identifies exceptions so that the agency can correct misutilization practices of beneficiaries and providers.

AUTHORITY: 42 U.S.C. 1302.

SOURCE: 43 FR 45266, Sept. 29, 1978, unless otherwise noted.

CITE AS: 42 CFR 456.23