Utilization Control Amendments

Summary

Utilization Control Amendments - Amends Title XIX (Medicaid) of the Social Security Act to require the States to establish methods and procedures for safeguarding against unnecessary utilization of health care and services and to conduct medical and independent professional review of health facilities participating in the Medicaid program to determine their compliance with the requirements of that program. Requires the States, through appropriate agencies, to: (1) review the written plans of care of each patient in skilled nursing facilities, mental institutions, and intermediate care facilities; (2) conduct periodic inspections of such facilities to evaluate (a) the care provided in such institutions; (b) the adequacy of the services provided in such institutions, (c) the necessity for continued care for patients in such facilities, and (d) the feasibility of providing such patients with alternative institutional or noninstitutional health care; and (3) make a full report on their findings with recommendations to the State agencies responsible for supervising the State Medicaid plan. Requires that the States establish utilization review procedures whereby hospital services are furnished under a plan established and reviewed by a physician and admissions and continued stays are screened by trained personnel who have no financial interest in the hospital and do not directly provide health care to hospital patients. Authorizes the Secretary of Health, Education, and Welfare to reduce payments to States which fail to establish and implement a program of utilization review as required by this Act.

This text is taken from the official record. PoliticalRepo does not editorialize.

Timeline

No timeline events have been ingested for this record yet.

Votes

No vote records are attached yet.

Versions

No version snapshots stored. Document URLs remain at the source.

Documents

1 official file

• Introduced in House

  summary · EN · 29 June 1977

  Open at official source

Sponsors

No sponsors or actors listed by the source.

Related records

No cross-record relationships stored yet.