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 1163.79 - Medical Care Evaluation studies

Universal Citation: 55 PA Code ยง 1163.79

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

(a) The hospital utilization review committee shall conduct Medical Care Evaluation (MCE) studies under this section.

(b) MCE studies shall identify and analyze medical or administrative factors related to patient care rendered in the hospital and, when indicated, make recommendations for changes that would be beneficial to patients, staff, the hospital and the community.

(c) MCE studies shall include analysis of at least:

(1) Admissions.

(2) Length of stay.

(3) Diagnostic categories.

(4) Ancillary services, including drugs and biologicals.

(5) Professional services performed in the hospital.

(d) At least one MCE study shall be in progress at any time.

(e) At least one MCE study shall be completed each calendar year.

(f) The results of each MCE study shall be documented.

(g) Documentation shall be made describing how the MCE study results have been used to institute improvements in the quality of care and to promote the efficient and effective use of hospital facilities.

This section cited in 55 Pa. Code § 1163.73 (relating to hospital utilization review plan); and 55 Pa. Code § 1163.75 (relating to responsibilities of the hospital utilization review committee).

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