Examination by a team composed of physicians and other appropriate health personnel of the conditions and need for care, including a medical evaluation.
Review, required by Medicaid, by a team composed of physicians and other appropriate health and social service personnel of the condition and need for care, including a medical evaluation, of each inpatient in a long-term care facility. By law, the team must review the: care being provided in the facilities; adequacy of the services available in the facilities to meet the current health needs and promote the maximum physical well-being of the patients; necessity and desirability of the continued placement of such patients in the facilities; and feasibility of meeting their health care needs through alternate institutional or non-institutional services. Medical review differs from utilization review in that it requires evaluation of each individual patient and an analysis of the appropriateness of his specific treatment in a given institution, whereas utilization review is often done on a sample basis, with special attention to certain procedures, conditions or lengths of stay.