§ 1163.73. Hospital utilization review plan.
(a) Hospital utilization review plans shall provide for a utilization review committee that meets the requirements set forth in § 1163.74 (relating to requirements for hospital utilization review committees).
(b) Hospital utilization review plans shall describe the organization, composition and functions of the utilization review committee and specify the frequency of the meetings of the committee.
(c) Hospital utilization review plans shall provide for a review of each recipient’s admission to the hospital under § 1163.77 (relating to admission review requirements).
(d) Hospital utilization review plans shall provide for a review of potential outlier cases under § 1163.78a or § 1163.78b (relating to review requirements for day outliers; or review requirements for cost outliers).
(e) Hospital utilization review plans shall describe the methods that the utilization review committees use to select and conduct Medical Care Evaluation studies under § 1163.79 (relating to Medical Care Evaluation studies).
Source The provisions of this § 1163.73 adopted September 23, 1983, effective September 24, 1983, 13 Pa.B. 2881; amended June 22, 1984, effective July 1, 1984, 14 Pa.B. 2185. Immediately preceding text appears at serial pages (85054) to (85055).
Cross References This section cited in 55 Pa. Code § 1163.41 (relating to general participation requirements).
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