Subpart D. Subpart D—Utilization Control: Mental Hospitals

• § 456.150 - Scope.
• § 456.151 - Definitions.

• Certification of Need for Care

  • SECTION § 456.160 - Certification and recertification of need for inpatient care.

• Medical, Psychiatric, and Social Evaluations and Admission Review

  • SECTION § 456.170 - Medical, psychiatric, and social evaluations.
  • SECTION § 456.171 - [Reserved]

• Plan of Care

  • SECTION § 456.180 - Individual written plan of care.
  • SECTION § 456.181 - Reports of evaluations and plans of care.

• Utilization Review (UR) Plan: General Requirements

  • SECTION § 456.200 - Scope.
  • SECTION § 456.201 - UR plan required for inpatient mental hospital services.

• UR Plan: Administrative Requirements

  • SECTION § 456.205 - UR committee required.
  • SECTION § 456.206 - Organization and composition of UR committee; disqualification from UR committee membership.

• UR Plan: Informational Requirements

  • SECTION § 456.211 - Beneficiary information required for UR.
  • SECTION § 456.212 - Records and reports.
  • SECTION § 456.213 - Confidentiality.

• UR Plan: Review of Need for Continued Stay

  • SECTION § 456.231 - Continued stay review required.
  • SECTION § 456.232 - Evaluation criteria for continued stay.
  • SECTION § 456.233 - Initial continued stay review date.
  • SECTION § 456.234 - Subsequent continued stay review dates.
  • SECTION § 456.235 - Description of methods and criteria: Continued stay review dates; length of stay modification.
  • SECTION § 456.236 - Continued stay review process.
  • SECTION § 456.237 - Notification of adverse decision.
  • SECTION § 456.238 - Time limits for final decision and notification of adverse decision.

• UR Plan: Medical Care Evaluation Studies

  • SECTION § 456.241 - Purpose and general description.
  • SECTION § 456.242 - UR plan requirements for medical care evaluation studies.
  • SECTION § 456.243 - Content of medical care evaluation studies.
  • SECTION § 456.244 - Data sources for studies.
  • SECTION § 456.245 - Number of studies required to be performed.