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UNOFFICIAL 1737-36 §§1395, 1396; Pub. L. No. 100-203; 42 C.F.R. §§431.10, 435.1009, 456.1, 483.1) (Imp: Pub. L. No. 100-203; 42 C.F.R. §§435.1009, 442.1, 456.1, 456.250, 483.1, 483.20, 483.25, 483.75)

§17-1737-35 Utilization control for ICF-MRs. (a) This section defines the utilization control process which shall be administered in accordance with state and federal regulations to achieve optimal quality control of the utilization of services provided under the state plan.

(b) The provisions for the utilization control for ICF-MRs are as follows: (1) A written certification or recertification statement that the client require a specific level of care is required as follows: (A) Admission certification shall be provided by a physician or a nurse practitioner or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician, on admission or not more than sixty days prior to authorization of medicaid payment for the provision of long-term institutional services to the client; (B) A recertification statement shall be provided by a physician or a physician assistant under the supervision of a physician or a nurse practitioner or a clinical nurse specialist who is not an employee of the facility but is working in collaboration with a physician, no more than twelve months following certification and thereafter no more than twelve months intervals until discharge from the ICF-MR; (C) The written certification and recertification statements shall be placed on a form designed either by the facility or the department specifically for certification and recertification documentations, and said form shall be placed in each client's active medical record; and (D) The written certification and recertification statements shall clearly