§ 1163.474. Requirements for hospital utilization review committees.
(a) Each hospital shall have a utilization review committee composed of two or more physicians, and assisted by other professional personnel as required under 42 CFR 456.106 (relating to organization and composition of UR committee; disqualification from UR committee membership). Committee members need not be members of the hospital medical staff.
(b) A member of the hospital utilization review committee may not participate in the review of a patient’s case if he is or was responsible for the care of that patient.
(c) A member of the hospital utilization review committee may not have a direct or indirect financial interest in any hospital.
Source The provisions of this § 1163.474 adopted June 22, 1984, effective July 1, 1984, 14 Pa.B. 2185.
Cross References This section cited in 55 Pa. Code § 1163.457 (relating to payment policies relating to out-of-State hospitals); 55 Pa. Code § 1163.458 (relating to payment policies relating to same-calendar-day admissions and discharges); and 55 Pa. Code § 1163.473 (relating to hospital utilization review plan).
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