Section 140.512  Utilization Control

Each intermediate care facility for the mentally retarded (ICF/MR) shall have a written Utilization Review (UR) Plan on file that provides necessary information about each client that is necessary for the Department or its designee to perform UR; see 42 CFR 456.401 - 456.438 (1989). The Individual Program Plans that are written for each client residing in the facility can satisfy this requirement.

a)         The Department or its designee shall conduct medical and utilization reviews (UR) in conjunction with the Inspection of Care (IOC) Program, to insure the quality of care provided to residents of ICF/MR facilities.

b)         Inspections of Care of ICFs/MR shall be conducted in accordance with the provisions of 42 CFR 456, Subparts F and I (1989) to evaluate:

1)         The care being provided to clients;

2)         The adequacy of services available in a particular facility;

3)         The necessity and desirability of continued placement in a particular facility;

4)         The feasibility of alternative solutions to continued placement in a particular facility;

5)         The facility's Utilization Review Plan; and

6)         The written plan of care for each client.

c)           Inspections of Care of nursing facilities (skilled care and intermediate care facilities) shall be conducted to evaluate all items indicated above with the exception of subsection (b)(5) above.

(Source:  Amended at 16 Ill. Reg. 6849, effective April 7, 1992)