TITLE 42 - PUBLIC HEALTH

CHAPTER IV - CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES

SUBCHAPTER C - MEDICAL ASSISTANCE PROGRAMS

PART 456 - UTILIZATION CONTROL

subpart f - UTILIZATION CONTROL: INTERMEDIATE CARE FACILITIES

456.360 - Certification and recertification of need for inpatient care.

  (a) Certification. (1) A physician must certify for each applicant or recipient that ICF services are or were needed.

  (2) The certification must be made at the time of admission or, if an individual applies for assistance while in an ICF, before the Medicaid agency authorizes payment.

  (b) Recertification. (1) A physician, or physician assistant or nurse practitioner (as defined in 491.2 of this chapter) acting within the scope of practice as defined by State law and under the supervision of a physician, must recertify for each applicant or recipient that ICF services are needed.

  (2) Recertification must be made at least (i) Every 12 months after certification in an institution for the mentally retarded or persons with related conditions; and (ii) Every 60 days after certification in an ICF other than an institution for the mentally retarded or persons with related conditions.

[46 FR 48561, Oct. 1, 1981, as amended at 50 FR 33034, Aug. 16, 1985]