US · guidance
CMS SOM App. U, Tag R235
§403.746 Condition of Participation: Utilization Review
The RNHCI must have in effect a written utilization review plan to assess the
necessity of services furnished. The plan must provide that records be maintained
of all meetings, decisions, and actions by the utilization review committee.
Interpretive Guidelines: §403.746
Determine that the RNHCI has a written utilization review plan to assess the necessity of
services furnished by the RNHCI and its staff to Medicare and Medicaid patients. Verify
through review of records and reports, and interviews with the Utilization Review (UR)
chairperson and/or members, that UR activities are being performed as described in the
plan.
Survey Procedures:
• Review the minutes of the UR committee to verify that they include procedures
for evaluating admissions as stated in §403.746(a).
History
Rev. 239; Issued: 04-24-26; Effective: 04-24-26; Implementation: 04-24-26
Provenance
- Source
- cms.gov
- Retrieved
- 2026-07-22
- Edition
- som-2026-07-22
- Content hash
c016e33b631774b0a56339e0d06f780aeee04dba0088c7fae45a346c516dfd09
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