Utilization Review

Purpose

The purpose of a Utilization Review (UR) is to insure that children's current needs are accurately reflected in their assigned levels of care (LOCs) and to periodically review children's progress in care. For children placed in DCBS foster homes, it is the responsibility of the DCBS worker to apply for a renewed LOC (SOP 7E.1.9(B)). For children in a PCC placement, it is the PCC provider's responsibility to renew the LOC in order to continue LOC funding for the placement.

Schedule

• Foster care placements (PCC & DCBS) require that the LOC be reviewed every six months.
• PCC residential placements require that the LOC be reviewed after the first six months and every three months thereafter. The Residential Application for Level of Care (ALP) must be submitted every three months.
• ALPs must be received by CRP on or before the UR due date. If the UR due date falls on a weekend or holiday and the ALP is mailed, the ALP, including the CBCL if due, must be received no later than the last business day prior to the weekend or holiday in order to be considered "on time". UR dates are provided on-line through the Youth Information List and also on the Monthly Census Report. For registered users, the Youth Information List can be accessed at https://kyapp.bluegrass.org/crp/. To register as a user, contact Tye Reece by e-mail or by phone (859-455-7452 ext. 228).
• For PCC funding, the effective dates for LOCs that have been changed as a result of a UR vary according to 922 KAR 1:360 and are summarized on the PCC Payment Dates.

Protocol

• Foster Care (DCBS & PCC) placements will submit:
  • The "Foster Care Application for LOC Payment" (ALP) (CRP-003).
  • Additional documentation as necessary to provide an accurate assessment of children's current needs.
  • CBCL for children with IQ or above or the Reiss (every 12 months) for children with an IQ below 70.
• PCC Residential placements will submit:
  • The "Residential Application for LOC Payment" (ALP) (CRP-001)
  • Additional documentation as necessary to provide an accurate assessment of children's current needs.
  • CBCL for children with IQ or above or the Reiss (every 12 months) for children with an IQ below 70.

Results of URs are communicated by fax to the DCBS worker and/or PCC on the "Notice of Level Assignment" form.

If you would like help writing ALPs, please review the appropriate guidelines at Writing Effective ALPs (PCC Residential) or Writing Effective ALPs (PCC Foster Care).