U.S. Code of Federal Regulations

Regulations most recently checked for updates: Aug 27, 2025

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

CERTIFICATION OF NEED FOR CARE
§ 456.160 - Certification and recertification of need for inpatient care.
§ 456.150 - Scope.
§ 456.151 - Definitions.

MEDICAL, PSYCHIATRIC, AND SOCIAL EVALUATIONS AND ADMISSION REVIEW
§ 456.170 - Medical, psychiatric, and social evaluations.
§ 456.171 - [Reserved]

PLAN OF CARE
§ 456.180 - Individual written plan of care.
§ 456.181 - Reports of evaluations and plans of care.

UTILIZATION REVIEW (UR) PLAN: GENERAL REQUIREMENTS
§ 456.200 - Scope.
§ 456.201 - UR plan required for inpatient mental hospital services.

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

UR PLAN: INFORMATIONAL REQUIREMENTS
§ 456.211 - Beneficiary information required for UR.
§ 456.212 - Records and reports.
§ 456.213 - Confidentiality.

UR PLAN: REVIEW OF NEED FOR CONTINUED STAY
§ 456.231 - Continued stay review required.
§ 456.232 - Evaluation criteria for continued stay.
§ 456.233 - Initial continued stay review date.
§ 456.234 - Subsequent continued stay review dates.
§ 456.235 - Description of methods and criteria: Continued stay review dates; length of stay modification.
§ 456.236 - Continued stay review process.
§ 456.237 - Notification of adverse decision.
§ 456.238 - Time limits for final decision and notification of adverse decision.

UR PLAN: MEDICAL CARE EVALUATION STUDIES
§ 456.241 - Purpose and general description.
§ 456.242 - UR plan requirements for medical care evaluation studies.
§ 456.243 - Content of medical care evaluation studies.
§ 456.244 - Data sources for studies.
§ 456.245 - Number of studies required to be performed.
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