US · guidance
CMS SOM App. A, Tag A-0652
§482.30 Condition of Participation: Utilization Review
The hospital must have in effect a utilization review (UR) plan that provides for review of
services furnished by the institution and by members of the medical staff to patients
entitled to benefits under the Medicare and Medicaid programs.
Interpretive Guidelines §482.30
If the hospital does not satisfy one of the exception criteria at §482.30(a), it must have a UR plan
in effect which provides for review of services provided to Medicare and Medicaid beneficiaries.
Survey Procedures §482.30
The manner and degree of noncompliance with one or more of the UR standards is considered
when determining whether there is condition-level compliance or non-compliance.
History
Rev. 137, Issued: 04-01-15, Effective: 03-27-15, Implementation: 03-27-15
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
91354a3f3394c6f4fcd8b2bb7cce76e98ccc75d80f3a54398c4c56ddfeecda02
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