1999 CFR Title 42, Volume 3

Title 42--Public Health CHAPTER IV--HEALTH CARE FINANCING ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES PART 466--UTILIZATION AND QUALITY CONTROL REVIEW
	466.1	Definitions.
	466.70	Statutory bases and applicability.
	466.71	PRO review requirements.
	466.72	Review of the quality of care of risk-basis health maintenance organizations and competitive medical plans.
	466.73	Notification of PRO designation and implementation of review.
	466.74	General requirements for the assumption of review.
	466.76	Cooperation with health care facilities.
	466.78	Responsibilities of health care facilities.
	466.80	Coordination with Medicare fiscal intermediaries and carriers.
	466.82	Continuation of functions not assumed by PROs.
	466.83	Initial denial determinations.
	466.84	Changes as a result of DRG validation.
	466.85	Conclusive effect of PRO initial denial determinations and changes as a result of DRG validations.
	466.86	Correlation of Title XI functions with Title XVIII functions.
	466.88	Examination of the operations and records of health care facilities and practitioners.
	466.90	Lack of cooperation by a health care facility or practitioner.
	466.93	Opportunity to discuss proposed initial denial determination and changes as a result of a DRG validation.
	466.94	Notice of PRO initial denial determination and changes as a result of a DRG validation.
	466.96	Review period and reopening of initial denial determinations and changes as a result of DRG validations.
	466.98	Reviewer qualifications and participation.
	466.100	Use of norms and criteria.
	466.102	Involvement of health care practitioners other than physicians.
	466.104	Coordination of activities.