Utilization Review (UR) Plan Monitoring
Under 42 CFR 456.100 – 456.145, all hospitals must have a written utilization review (UR) plan that provides for review of each recipient’s need for the services that the hospital furnishes. AFMC will obtain and maintain a copy of the UR plan from 100 percent of Alabama and border city hospitals annually. Under program requirements, 50 percent of these plans will be reviewed on an annual basis so that every hospital plan is reviewed every two years to ensure that each hospital’s plan meets federal requirements.
AFMC maintains a hospital database of hospital contact’s name, title, phone number, physical address and e-mail address. Hospitals will receive a written and e-mail request for a copy of the hospital’s UR plan. Written and/or e-mail reminders will be sent to hospitals on a scheduled basis until all plans are received.
Upon receipt, each UR plan will be reviewed to determine that each element of CFR 456.100 – 456.145 is met. Hospitals will receive written notification of review results, and If deficiencies are identified, will be given an opportunity to submit corrected plans. Results of the UR plan review will be reported to the Alabama Medicaid Agency each year, as required under the contract.
Reimbursement for Medical Record Duplication
All providers, upon either verbal or written request from Alabama Medicaid Agency (AMA) or Arkansas Foundation for Medical Care (AFMC), the AMA Inpatient Hospital Quality Assurance Program contractor, shall furnish free of charge a copy of any requested record. If the provider has no copies, the provider must allow the person requesting the copy to check out the original for copying. The provider may require that a receipt be given for any original record removed from their premises.
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