Subpart F. Subpart F—Utilization Control: Intermediate Care Facilities

• § 456.350 - Scope.
• § 456.351 - Definition.

• Certification of Need for Care

  • SECTION § 456.360 - Certification and recertification of need for inpatient care.

• Medical, Psychological, and Social Evaluations and Admission Review

  • SECTION § 456.370 - Medical, psychological, and social evaluations.
  • SECTION § 456.371 - Exploration of alternative services.
  • SECTION § 456.372 - Medicaid agency review of need for admission.

• Plan of Care

  • SECTION § 456.380 - Individual written plan of care.
  • SECTION § 456.381 - Reports of evaluations and plans of care.

• Utilization Review (UR) Plan: General Requirement

  • SECTION § 456.400 - Scope.
  • SECTION § 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

• UR Plan: Administrative Requirements

  • SECTION § 456.405 - Description of UR review function: How and when.
  • SECTION § 456.406 - Description of UR review function: Who performs UR; disqualification from performing UR.
  • SECTION § 456.407 - UR responsibilities of administrative staff.

• UR Plan: Informational Requirements

  • SECTION § 456.411 - Beneficiary information required for UR.
  • SECTION § 456.412 - Records and reports.
  • SECTION § 456.413 - Confidentiality.

• UR Plan: Review of Need for Continued Stay

  • SECTION § 456.431 - Continued stay review required.
  • SECTION § 456.432 - Evaluation criteria for continued stay.
  • SECTION § 456.433 - Initial continued stay review date.
  • SECTION § 456.434 - Subsequent continued stay review dates.
  • SECTION § 456.435 - Description of methods and criteria: Continued stay review dates.
  • SECTION § 456.436 - Continued stay review process.
  • SECTION § 456.437 - Notification of adverse decision.
  • SECTION § 456.438 - Time limits for notification of adverse decision.