LOC Redeterminations

Purpose

When a DCBS worker or a PCC disagrees with the LOC assigned to a child because they consider the LOC to be too high or too low, they may seek to have the LOC redetermined (SOP 7E.1.9(B) & 922 KAR 1:360).

Schedule

A DCBS worker or PCC may request that a LOC be redetermined at any time there is new information which indicates that the child has significantly more (or less) needs than the LOC indicates.

Protocol

• For an Initial LOC assignment and a Reassignment requested by a DCBS worker:
  • Complete section H on the DPP-886 that indicates the initial level and the name of the Clinical Reviewer.
  • Explain your reasons for the request in writing and attach any supporting documentation.
  • This may be faxed to CRP at: (859) 225-3565
• For a Reassignment requested by a PCC:
  • Complete the Redetermination section of the CRP–006 Notice of Level of Care Payment Authorization – Reassignment form
  • Explain your reasons for the request in writing and attach any supporting documentation
  • This may be faxed to CRP at: (859) 225-3565
• For a Utilization Review:
  • Complete the request for Redetermination section on the "Notice of Level Assignment" form
  • Explain your reasons for the request in writing and attach supporting documentation
  • This may be faxed to CRP at: (859) 225-3565
• The LOC will be faxed to the DCBS worker and PCC if applicable
• The effective date of the LOC change varies and is detailed elsewhere