Section He-W 543.11 - Utilization Review(a) Evaluations of the quality, medical necessity, appropriateness of care, and length of stay determinations for all inpatient hospital services at in-state and border hospitals shall be made by the QIO in accordance with 42 CFR 456.100 and those sections of 42 CFR 456 described therein.(b) The department's program integrity unit shall monitor utilization of hospital services to identify, prevent, and correct potential occurrences of fraud, waste, and abuse, in accordance with 42 CFR 455, 42 CFR 447, 42 CFR 456, and He-W 520.N.H. Admin. Code § He-W 543.11
(See Revision Note at chapter heading He-W 500); ss by #5897, eff 9-19-94; amd by #6548, eff 7-26-97; ss by #7399, eff 11-2-00; ss by #7558, eff 10-1-01; ss by #9324, eff 11-21-08 (from He-W 543.09 )
Amended by Volume XXXVII Number 10, Filed March 9, 2017, Proposed by #12103, Effective 2/9/2017, Expires 2/9/2027.The amended version of this section by New Hampshire Register Volume 39, Number 28, eff. 7/1/2019 is not yet available.