42 C.F.R. § 456.122 Evaluation criteria for admission review.
Title 42 - Public Health
The UR plan must provide that— (a) The committee develops written medical care criteria to assess the need for admission; and (b) The committee develops more extensive written criteria for cases that its experience shows are— (1) Associated with high costs; (2) Associated with the frequent furnishing of excessive services; or (3) Attended by physicians whose patterns of care are frequently found to be questionable.
Title 42: Public Health
PART 456—UTILIZATION CONTROL
Subpart C—Utilization Control: Hospitals
UR Plan: Review of Need for Admission
§ 456.122 Evaluation criteria for admission review.
