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 A—General Provisions

42 C.F.R. § 456.5

Evaluation criteria

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The agency must establish and use written criteria for evaluating the appropriateness and quality of Medicaid services. This section does not apply to services in hospitals and mental hospitals. For these facilities, see the following sections: §§ 456.122 and 456.132 of subpart C; and § 456.232 of subpart D.

[43 FR 45266, Sept. 29, 1978, as amended at 61 FR 38399, July 24, 1996]
Notes of Decisions
Cited in 1 case, 2007–2007 · leading case: Doc's Clinic, APMC v. DHH, 984 So. 2d 711 (La. Ct. App. 2007).
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Doc's Clinic, APMC v. DHH, 984 So. 2d 711 (La. Ct. App. 2007). · cites it 2× “Citing 42 C.F.R. § 456.5 and 456.6, Doc's submits that DHH "is responsible for establishing a plan for the review by professional health personnel" and to develop and use "written criteria" for evaluating the appropriateness and quality of Medicaid services.”
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