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Title 7 . Health and Social Services
Chapter 43 . Hearings
Section 430. Utilization review

7 AAC 43.430. Utilization review

(a) As a condition for participation in the medical assistance programs, hospitals must have in effect a utilization review plan approved by the U.S. Department of Health and Human Services if utilization review is performed by a federally contracted professional review organization (PRO). The written plan submitted by the hospital or the PRO on behalf of the hospital must include detailed provisions described in 42 C.F.R. 456.50 - 456.145.

(b) The approved utilization review plan must be implemented through the PRO or a hospital that has been delegated review authority by the PRO.

(c) As a condition for participation in the medical assistance programs, hospitals shall participate in an assessment of health care services to program recipients. The division or its representative will conduct an annual on-site assessment. The assessment will be planned in advance and in coordination with the hospital.

History: Eff. 8/18/79, Register 71; am 6/28/85, Register 94; readopt 8/7/96, Register 139

Authority: AS 47.05.010

AS 47.07.050

Editor's note: Effective 8/7/96, Register 139, the Department of Health and Social Services readopted 7 AAC 43.430 in its entirety, without change, under AS 47.05 and AS 47.07. Executive Order No. 72 transferred certain rate-setting authority to the department.

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Last modified 7/05/2006