StacksVerified U.S. regulatory reference

42 CFR §485.66

Verified against eCFR.gov as of June 20, 2026View official text on eCFR.gov ↗
The facility must have in effect a written utilization review plan that is implemented annually, to assess the necessity of services and promotes the most efficient use of services provided by the facility.
  1. (a)Standard: Utilization review committee. The utilization review committee, consisting of the group of professional personnel specified in § 485.56(c), a committee of this group, or a group of similar composition, comprised by professional personnel not associated with the facility, must carry out the utilization review plan.
  2. (b)Standard: Utilization review plan. The utilization review plan must contain written procedures for evaluating—
    1. (1)Admissions, continued care, and discharges using, at a minimum, the criteria established in the patient care policies;
    2. (2)The applicability of the plan of treatment to established goals; and
    3. (3)The adequacy of clinical records with regard to—
      1. (i)Assessing the quality of services provided; and
      2. (ii)Determining whether the facility's policies and clinical practices are compatible and promote appropriate and efficient utilization of services.