Utilization Control Amendments

Summary

Utilization Control Amendments - Amends Title XIX (Medicaid) of the Social Security Act to require each State to have in operation programs of control over utilization of: (1) inpatient services provided by hospitals; (2) services provided by skilled nursing facilities; (3) services provided by intermediate care facilities; and (4) services provided by mental hospitals. Requires such control programs to include: (1) certification by a physician that such services were required to have been given on an inpatient basis; (2) assurance that services provided were furnished under a plan established and periodically reviewed and evaluated by a physician; (3) adherence to existing cost control procedures established under Title XIX; and (4) except in the case of care provided by hospitals, annual review and evaluation of the professional management of each case by independent professional review teams. Provides for the reduction of the Federal share of Medicaid costs for each quarter during which one or more of such utilization control programs do not meet the requirements set forth in this Act.

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1 official file

• Introduced in House

  summary · EN · 17 June 1976

  Open at official source

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