C.F.R. » Title 42 » CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES › SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS › PART 456—UTILIZATION CONTROL › Subpart F—Utilization Control: Intermediate Care Facilities

42 C.F.R. § 456.401

State plan UR requirements and options; UR plan required for intermediate care facility services

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(a) The State plan must provide that—

(1) UR is performed for each ICF that furnishes inpatient services under the plan;

(2) Each ICF has on file a written UR plan that provides for review of each beneficiary's need for the services that the ICF furnishes him; and

(3) Each written ICF UR plan meets requirements under §§ 456.401 through 456.438.

(b) The State plan must specify the method used to perform UR, which may be—

(1) Review conducted by the facility;

(2) Direct review in the facility by individuals—

(i) Employed by the medical assistance unit of the Medicaid agency; or

(ii) Under contract to the Medicaid agency; or

(3) Any other method.

Notes of Decisions
Cited in 2 cases, 1981–1988 · leading case: Meyer v. Colorado Dep't of Soc. Servs., 758 P.2d 192 (Colo. Ct. App. 1988).
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Meyer v. Colorado Dep't of Soc. Servs., 758 P.2d 192 (Colo. Ct. App. 1988). · cites it 2× “For example, 42 C.F.R. 456.401(b) allows participating states to specify methods of review which may be conducted by the care facility; by direct review in the facility; by individuals who are employed by the medi *195 cal assistance unit of the medicaid agency or who are under…”
Lind v. Wells Cnty. Soc. Serv. Bd., 311 N.W.2d 547 (N.D. 1981). “sues: (1) Whether or not the Social Service Board provided timely and adequate notice as required by the federal regulations and by due process concepts; (2) Whether or not the following federal regulations were violated during the process by which it was determined that Mildred…”
— 42 C.F.R. § 456.401(b) — 1 case
Meyer v. Colorado Dep't of Soc. Servs., 758 P.2d 192 (Colo. Ct. App. 1988). “For example, 42 C.F.R. 456.401(b) allows participating states to specify methods of review which may be conducted by the care facility; by direct review in the facility; by individuals who are employed by the medi *195 cal assistance unit of the medicaid agency or who are under…”
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