Pennsylvania Code
Title 55 - HUMAN SERVICES
Part III - MEDICAL ASSISTANCE MANUAL
Chapter 1163 - INPATIENT HOSPITAL SERVICES
Subchapter A - ACUTE CARE GENERAL HOSPITALS UNDER THE PROSPECTIVE PAYMENT SYSTEM
UTILIZATION CONTROL
Section 1163.73 - Hospital utilization review plan

Universal Citation: 55 PA Code ยง 1163.73

Current through Register Vol. 54, No. 44, November 2, 2024

(a) Hospital utilization review plans shall provide for a utilization review committee that meets the requirements set forth in § 1163.74 (relating to requirements for hospital utilization review committees).

(b) Hospital utilization review plans shall describe the organization, composition and functions of the utilization review committee and specify the frequency of the meetings of the committee.

(c) Hospital utilization review plans shall provide for a review of each recipient's admission to the hospital under § 1163.77 (relating to admission review requirements).

(d) Hospital utilization review plans shall provide for a review of potential outlier cases under § 1163.78a or § 1163.78b (relating to review requirements for day outliers; or review requirements for cost outliers).

(e) Hospital utilization review plans shall describe the methods that the utilization review committees use to select and conduct Medical Care Evaluation studies under § 1163.79 (relating to Medical Care Evaluation studies).

This section cited in 55 Pa. Code § 1163.41 (relating to general participation requirements).

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