GroundRules
42 CFR 456.411: Beneficiary information required for UR.
Where this section sits in the code
- Title 42—Public Health
- CHAPTER IV—CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES
- SUBCHAPTER C—MEDICAL ASSISTANCE PROGRAMS
- PART 456—UTILIZATION CONTROL
- Subpart F—Utilization Control: Intermediate Care Facilities
The UR plan must provide that each beneficiary's record include information needed to perform UR required under this subpart. This information must include, at least, the following:
(a) Identification of the beneficiary.
(b) The name of the beneficiary's physician.
(c) The name of the qualified Intellectual Disability professional (as defined under § 442.401 of this subchapter), if applicable.
(d) Date of admission, and dates of application for and authorization of Medicaid benefits if application is made after admission.
(e) The plan of care required under § 456.372;
(f) Initial and subsequent continued stay review dates described under §§ 456.433 and 456.434.
(g) Reasons and plan for continued stay, if the attending physician or qualified Intellectual Disability professional believes continued stay is necessary.
(h) Other supporting material that the UR group believes appropriate to be included in the record.
Collected 2026-08-27T02:26:11Z. Source file · JSON