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 1163.74 - Requirements for hospital utilization review committees

Universal Citation: 55 PA Code ยง 1163.74

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

(a) A hospital shall have a utilization review committee composed of two or more physicians, and assisted by other professional personnel as required under 42 CFR 456.106 (relating to organization and composition of UR committee; disqualification from UR committee membership). Committee members need not be members of the hospital medical staff.

(b) A member of the hospital utilization review committee may not participate in the review of a patient's case if he is or was responsible for the care of that patient.

(c) A member of the hospital utilization review committee may not have a direct or indirect financial interest in any hospital.

This section cited in 55 Pa. Code § 1163.73 (relating to hospital utilization review plan).

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