{"data":{"id":"us/42-cfr-485.66","jurisdiction":"us","citation":"42 CFR 485.66","heading":"Condition of participation: Utilization review plan.","body":"The facility must have in effect a written utilization review plan that is implemented annually, to assess the necessity of services and promotes the most efficient use of services provided by the facility.\n(a) Standard: Utilization review committee. The utilization review committee, consisting of the group of professional personnel specified in § 485.56(c), a committee of this group, or a group of similar composition, comprised by professional personnel not associated with the facility, must carry out the utilization review plan.\n(b) Standard: Utilization review plan. The utilization review plan must contain written procedures for evaluating—\n(1) Admissions, continued care, and discharges using, at a minimum, the criteria established in the patient care policies;\n(2) The applicability of the plan of treatment to established goals; and\n(3) The adequacy of clinical records with regard to—\n(i) Assessing the quality of services provided; and\n(ii) Determining whether the facility's policies and clinical practices are compatible and promote appropriate and efficient utilization of services.","path":["Title 42—Public Health","CHAPTER IV—CENTERS FOR MEDICARE \u0026 MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES","SUBCHAPTER G—STANDARDS AND CERTIFICATION","PART 485—CONDITIONS OF PARTICIPATION: SPECIALIZED PROVIDERS","Subpart B—Conditions of Participation: Comprehensive Outpatient Rehabilitation Facilities"],"source_url":"https://www.ecfr.gov/api/versioner/v1/full/2026-08-25/title-42.xml","current_through":"2026-08-25","vintage":"","retrieved_at":"2026-08-27T02:26:11Z","sha256":"f084da7f8963105e1bb861cc27d760f0a8ca9da7eb8439ddfb4f05b1af31cc97","source_id":"us-cfr","stale":true,"prev":"us/42-cfr-485.64","next":"us/42-cfr-485.68"},"notice":"GroundRules: Original legal text. Not legal advice."}