Health Care Financing Administration--Medicare and Medicaid; utilization review. Proposed rule

These regulations would revise utilization review procedures for hospitals that participate in the Medicare and Medicaid programs and establish procedures for facilities or programs that provide inpatient psychiatric services to Medicaid recipients under 21 years of age. They would establish standards for conducting review of the health care provided to patients eligible under the two programs, as required by sections 1861, 1902 and 1903 of the Social Security Act. These requirements would apply only to hospitals; proposed revisions of procedures for skilled nursing facilities (SNFs) and intermediate care facilities (ICFs) would be published later. The intent of the regulations is to ensure that services paid for under Medicare or Medicaid are medically necessary and appropriate.