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Title 42

Displaying title 42, up to date as of 7/09/2026. Title 42 was last amended 7/01/2026.
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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 FUtilization Control: Intermediate Care Facilities456.350 – 456.438
§ 456.350Scope.
§ 456.351Definition.
Certification of Need for Care456.360
§ 456.360Certification and recertification of need for inpatient care.
Medical, Psychological, and Social Evaluations and Admission Review456.370 – 456.372
§ 456.370Medical, psychological, and social evaluations.
§ 456.371Exploration of alternative services.
§ 456.372Medicaid agency review of need for admission.
Plan of Care456.380 – 456.381
§ 456.380Individual written plan of care.
§ 456.381Reports of evaluations and plans of care.
Utilization Review (UR) Plan: General Requirement456.400 – 456.401
§ 456.400Scope.
§ 456.401State plan UR requirements and options; UR plan required for intermediate care facility services.
UR Plan: Administrative Requirements456.405 – 456.407
§ 456.405Description of UR review function: How and when.
§ 456.406Description of UR review function: Who performs UR; disqualification from performing UR.
§ 456.407UR responsibilities of administrative staff.
UR Plan: Informational Requirements456.411 – 456.413
§ 456.411Beneficiary information required for UR.
§ 456.412Records and reports.
§ 456.413Confidentiality.
UR Plan: Review of Need for Continued Stay456.431 – 456.438
§ 456.431Continued stay review required.
§ 456.432Evaluation criteria for continued stay.
§ 456.433Initial continued stay review date.
§ 456.434Subsequent continued stay review dates.
§ 456.435Description of methods and criteria: Continued stay review dates.
§ 456.436Continued stay review process.
§ 456.437Notification of adverse decision.
§ 456.438Time limits for notification of adverse decision.