| (a) Treatment providers and payors shall provide for utilization review in accordance with the provisions of this subchapter and of Chapter 19, Subchapter R of this title (relating to Utilization Review Agents). Both payor and treatment provider shall make available a qualified credentialed counselor to discuss the appropriateness of treatment, including levels of care, should this become necessary. (b) Since utilization review as proposed in these standards must be accomplished in a timely manner, information provided telephonically must be supported by documentation in the patient record and available on request for review. (c) A payor shall not require an individual to have failed an episode of outpatient therapy as a qualification for admission to inpatient therapy if the individual otherwise meets the criteria for admission to inpatient therapy. |
