N.H. Code Admin. R. He-W 543.10
Utilization Review
Effective Sep 20, 2025(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94; amd by #6548, eff 7-26-97; ss by #7399, eff 11-2-00; ss by #7558, eff 10-1-01; ss by #9324, eff 11-21-08 (from He-W 543.09); ss by #12103, eff 2-9-17; amd by #12818, eff 7-1-1-19; ss by #14384, eff 9-20-25 (formerly He-W 543.11), EXPIRES: 9-20-35Former Division of Human Services
- (a) Evaluations of the quality, medical necessity, appropriateness of care, and length of stay determinations for all inpatient hospital services shall be made by the department in accordance with 42 CFR 456.100 and those sections of 42 CFR 456 described therein.
- (b) The department’s bureau of program integrity shall monitor utilization of hospital services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 447, 42 CFR 456, and He-W 520.
Source. (See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94; amd by #6548, eff 7-26-97; ss by #7399, eff 11-2-00; ss by #7558, eff 10-1-01; ss by #9324, eff 11-21-08 (from He-W 543.09); ss by #12103, eff 2-9-17; amd by #12818, eff 7-1-1-19; ss by #14384, eff 9-20-25 (formerly He-W 543.11), EXPIRES: 9-20-35