Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1151 - INPATIENT PSYCHIATRIC SERVICES
UTILIZATION CONTROL
Section 1151.72 - Inpatient psychiatric facility utilization review plan
Current through Register Vol. 54, No. 12, March 23, 2024
(a) Each inpatient psychiatric facility participating in the MA Program shall have in effect a written utilization review plan which provides for the review of each recipient's need for inpatient psychiatric services. Each provider's utilization review plan shall provide for a utilization review committee which meets the requirements under § 1151.73 (relating to requirements for inpatient psychiatric utilization review committees).
(b) Each utilization review plan shall describe the organization, composition and functions of the utilization review committee and specify the frequency of the meetings of the committee.
(c) Each utilization review plan shall provide for a review of each recipient's admission to the inpatient psychiatric facility under § 1151.75 (relating to admission review requirements).
(d) Each utilization review plan shall provide for a review of each recipient's continued stay in the inpatient psychiatric facility under § 1151.76 (relating to continued stay review requirements).
(e) Each utilization review plan shall describe the methods the utilization review committee uses to select and conduct medical care evaluation studies under § 1151.77 (relating to medical care evaluation studies).
The provisions of this § 1151.72 amended under sections 201 and 443.1(1) of the Public Welfare Code (62 P. S. §§ 201 and 443.1(1)).
This section cited in 55 Pa. Code § 1151.61 (relating to payment conditions: general); and 55 Pa. Code § 1151.67 (relating to payment conditions related to the recipient's continued need for care).
