Site Feedback

Website Feedback

This contact form is only for website help or website suggestions. If you have questions or comments regarding a published document please contact the publishing agency. Comments or questions about document content can not be answered by OFR staff. Please do not provide confidential information or personal data.

Title 42

Displaying title 42, up to date as of 7/16/2026. Title 42 was last amended 7/01/2026.
view historical versions
  1. Title 42 —Public Health
  2. Chapter IV —Centers for Medicare & Medicaid Services, Department of Health and Human Services
  3. Subchapter C —Medical Assistance Programs
  4. Part 456 —Utilization Control
  5. Subpart C   View Full Text
  • Details
  • Print
  • Search
  • Subscribe
  • Timeline
  • Go to Date
  • Published Edition
  • Developer Tools
eCFR Content

The Code of Federal Regulations (CFR) is the official legal print publication containing the codification of the general and permanent rules published in the Federal Register by the departments and agencies of the Federal Government. The Electronic Code of Federal Regulations (eCFR) is a continuously updated online version of the CFR. It is not an official legal edition of the CFR.

Learn more about the eCFR, its status, and the editorial process.

Title 42Public HealthPart / Section
Chapter IVCenters for Medicare & Medicaid Services, Department of Health and Human Services400 – 699
Subchapter CMedical Assistance Programs430 – 456
Part 456Utilization Control456.1 – 456.725
Subpart CUtilization Control: Hospitals456.50 – 456.145
§ 456.50Scope.
§ 456.51Definitions.
Certification of Need for Care456.60
§ 456.60Certification and recertification of need for inpatient care.
Plan of Care456.80
§ 456.80Individual written plan of care.
Utilization Review (UR) Plan: General Requirement456.100 – 456.101
§ 456.100Scope.
§ 456.101UR plan required for inpatient hospital services.
UR Plan: Administrative Requirements456.105 – 456.106
§ 456.105UR committee required.
§ 456.106Organization and composition of UR committee; disqualification from UR committee membership.
UR Plan: Informational Requirements456.111 – 456.113
§ 456.111Beneficiary information required for UR.
§ 456.112Records and reports.
§ 456.113Confidentiality.
UR Plan: Review of Need for Admission 456.121 – 456.129
§ 456.121Admission review required.
§ 456.122Evaluation criteria for admission review.
§ 456.123Admission review process.
§ 456.124Notification of adverse decision.
§ 456.125Time limits for admission review.
§ 456.126Time limits for final decision and notification of adverse decision.
§ 456.127Pre-admission review.
§ 456.128Initial continued stay review date.
§ 456.129Description of methods and criteria: Initial continued stay review date; close professional scrutiny; length of stay modification.
UR Plan: Review of Need for Continued Stay456.131 – 456.137
§ 456.131Continued stay review required.
§ 456.132Evaluation criteria for continued stay.
§ 456.133Subsequent continued stay review dates.
§ 456.134Description of methods and criteria: Subsequent continued stay review dates; length of stay modification.
§ 456.135Continued stay review process.
§ 456.136Notification of adverse decision.
§ 456.137Time limits for final decision and notification of adverse decision.
UR Plan: Medical Care Evaluation Studies456.141 – 456.145
§ 456.141Purpose and general description.
§ 456.142UR plan requirements for medical care evaluation studies.
§ 456.143Content of medical care evaluation studies.
§ 456.144Data sources for studies.
§ 456.145Number of studies required to be performed.
eCFR Content