Minnesota Administrative Rules

9505.0180 SURVEILLANCE AND UTILIZATION CONTROL PROGRAM.

Subpart 1.

[Repealed, 15 SR 2563]

Subp. 2.

Duty to implement.

The department shall carry out a program of a surveillance and utilization review under parts 9505.2160 to 9505.2245 and Code of Federal Regulations, title 42, part 455, and a program of utilization control under Code of Federal Regulations, title 42, part 456. These programs together constitute the surveillance and utilization control program.

Subp. 3.

Surveillance and utilization review.

The surveillance and utilization review program must have a post payment review process to ensure compliance with the medical assistance program and to monitor both the use of health services by recipients and the delivery of health services by providers. The process must comply with parts 9505.2160 to 9505.2245.

Subp. 4.

Utilization control.

The department shall administer and monitor a program of utilization control to review the need for, and the quality and timeliness of, health services provided in a hospital, long-term care facility, or institution for the treatment of mental diseases. A facility certified for participation in the medical assistance program must comply with the requirements of Code of Federal Regulations, title 42, part 456 for utilization control.

Statutory Authority:

MS s 256B.04

History:

12 SR 624; 15 SR 2563

Published Electronically:

August 12, 2008