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Entitlement Program

Programs for people who have a federal right to benefits if eligibility criteria is met. Changes to the eligibility for these programs must be done through legislation and enrollment cannot be capped. Unlike discretionary funds, the federal government is required to spend the necessary funds for these programs

Utilization Review (UR)

Refers to the evaluation of the efficiency and need of health care services, including procedures and facilities, according to established criteria of the provisions of…