§ 1163.472. Concurrent hospital review.
(a) For cost reimbursed services, the Department reviews the need for a recipient’s admission and continued hospitalization through its Concurrent Hospital Review (CHR) process and approves or disapproves the stay unless a hospital has been granted an exemption by the Department.
(b) For cost reimbursed services, each hospital shall follow the instructions in the Department’s Manual for Concurrent Review of Inpatient Hospital Services. The provisions of the Department’s Manual shall take precedence over the hospital’s Utilization Review Plan.
Cross References This section cited in 55 Pa. Code § 1163.457 (relating to payment policies relating to out-of-State hospitals); and 55 Pa. Code § 1163.458 (relating to payment policies relating to same-calendar-day admissions and discharges).
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