U.S. Code of Federal Regulations

Regulations most recently checked for updates: Aug 27, 2025

All TitlesTitle 42Chapter IVPart 456Subpart C - Subpart C—Utilization Control: Hospitals

CERTIFICATION OF NEED FOR CARE
§ 456.60 - Certification and recertification of need for inpatient care.
§ 456.50 - Scope.
§ 456.51 - Definitions.

PLAN OF CARE
§ 456.80 - Individual written plan of care.

UTILIZATION REVIEW (UR) PLAN: GENERAL REQUIREMENT
§ 456.100 - Scope.
§ 456.101 - UR plan required for inpatient hospital services.

UR PLAN: ADMINISTRATIVE REQUIREMENTS
§ 456.105 - UR committee required.
§ 456.106 - Organization and composition of UR committee; disqualification from UR committee membership.

UR PLAN: INFORMATIONAL REQUIREMENTS
§ 456.111 - Beneficiary information required for UR.
§ 456.112 - Records and reports.
§ 456.113 - Confidentiality.

UR PLAN: REVIEW OF NEED FOR ADMISSION 1
§ 456.121 - Admission review required.
§ 456.122 - Evaluation criteria for admission review.
§ 456.123 - Admission review process.
§ 456.124 - Notification of adverse decision.
§ 456.125 - Time limits for admission review.
§ 456.126 - Time limits for final decision and notification of adverse decision.
§ 456.127 - Pre-admission review.
§ 456.128 - Initial continued stay review date.
§ 456.129 - Description of methods and criteria: Initial continued stay review date; close professional scrutiny; length of stay modification.

UR PLAN: REVIEW OF NEED FOR CONTINUED STAY
§ 456.131 - Continued stay review required.
§ 456.132 - Evaluation criteria for continued stay.
§ 456.133 - Subsequent continued stay review dates.
§ 456.134 - Description of methods and criteria: Subsequent continued stay review dates; length of stay modification.
§ 456.135 - Continued stay review process.
§ 456.136 - Notification of adverse decision.
§ 456.137 - Time limits for final decision and notification of adverse decision.

UR PLAN: MEDICAL CARE EVALUATION STUDIES
§ 456.141 - Purpose and general description.
§ 456.142 - UR plan requirements for medical care evaluation studies.
§ 456.143 - Content of medical care evaluation studies.
§ 456.144 - Data sources for studies.
§ 456.145 - Number of studies required to be performed.
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