Administrative Rules of Montana
Department 37 - PUBLIC HEALTH AND HUMAN SERVICES
Chapter 37.106 - HEALTH CARE FACILITIES
Subchapter 37.106.18 - Licensure of Specialty Mental Health Facilities
Rule 37.106.1821 - SPECIALTY MENTAL HEALTH FACILITY: UTILIZATION REVIEW
Universal Citation: MT Admin Rules 37.106.1821
Current through Register Vol. 6, March 22, 2024
(1) A specialty mental health facility must have in effect a utilization review plan to review services furnished by the facility to patients, either through contracted services or by members of its medical staff to patients, in order to determine through semi-annual review, whether utilization of services was appropriate, established policies were followed, and any changes are needed.
(2) Such a review mechanism shall consider, during each semi-annual review period, at least the following:
(a) the utilization of facility services,
including at least the number of patients served and the volume of
services;
(b) sample facility cases
consisting of not less than 10% of both active and closed patient
records;
(c) review of the sample
cases to determine the medical necessity of the medical and professional
services furnished, including drugs and biologicals; and
(d) the facility's health care
policies.
Sec. 50-5-103, MCA; IMP, Sec. 50-5-103, MCA;
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