Section 456.122 - Evaluation criteria for admission reviewThe UR plan must provide that-
(a) The committee develops written medical care criteria to assess the need for admission; and(b) The committee develops more extensive written criteria for cases that its experience shows are- (1) Associated with high costs;(2) Associated with the frequent furnishing of excessive services; or(3) Attended by physicians whose patterns of care are frequently found to be questionable.