- (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).