U.S. Code of Federal Regulations

Regulations most recently checked for updates: Sep 16, 2025

All TitlesTitle 42Chapter IVPart 456Subpart F - Subpart F—Utilization Control: Intermediate Care Facilities

CERTIFICATION OF NEED FOR CARE
§ 456.360 - Certification and recertification of need for inpatient care.
§ 456.350 - Scope.
§ 456.351 - Definition.

MEDICAL, PSYCHOLOGICAL, AND SOCIAL EVALUATIONS AND ADMISSION REVIEW
§ 456.370 - Medical, psychological, and social evaluations.
§ 456.371 - Exploration of alternative services.
§ 456.372 - Medicaid agency review of need for admission.

PLAN OF CARE
§ 456.380 - Individual written plan of care.
§ 456.381 - Reports of evaluations and plans of care.

UTILIZATION REVIEW (UR) PLAN: GENERAL REQUIREMENT
§ 456.400 - Scope.
§ 456.401 - State plan UR requirements and options; UR plan required for intermediate care facility services.

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

UR PLAN: INFORMATIONAL REQUIREMENTS
§ 456.411 - Beneficiary information required for UR.
§ 456.412 - Records and reports.
§ 456.413 - Confidentiality.

UR PLAN: REVIEW OF NEED FOR CONTINUED STAY
§ 456.431 - Continued stay review required.
§ 456.432 - Evaluation criteria for continued stay.
§ 456.433 - Initial continued stay review date.
§ 456.434 - Subsequent continued stay review dates.
§ 456.435 - Description of methods and criteria: Continued stay review dates.
§ 456.436 - Continued stay review process.
§ 456.437 - Notification of adverse decision.
§ 456.438 - Time limits for notification of adverse decision.
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