Section 435.411 - Utilization Review(A) The hospital must determine the medical or administrative necessity of each continued inpatient hospital stay of a member in accordance with the level-of-care criteria in 130 CMR 435.409 and 435.410. For those members requiring a less-than-hospital level of care, the hospital must determine the appropriate care in accordance with the MassHealth agency's medical eligibility criteria in 130 CMR 456.000: Long Term Care Services.(B) The MassHealth agency may designate an agent to determine the medical or administrative necessity of each inpatient hospital stay.Amended by Mass Register Issue 1302, eff. 12/18/2015.