42 CFR §456.232
The UR plan must provide that—
- (a)The committee develops written medical care criteria to assess the need for continued stay.
- (b)The committee develops more extensive written criteria for cases that its experience shows are—
- (1)Associated with high costs;
- (2)Associated with the frequent furnishing of excessive services; or
- (3)Attended by physicians whose patterns of care are frequently found to be questionable.