Children's Review Program
A program of bluegrass.org
Funded in Whole from Federal and Cabinet for Health and Family Services Funds

Redetermination/Appeal Process for Levels of Care

To obtain the most accurate level of care, it is important to submit all relevant information at the time of initial level assignment, as well as for routine level reviews.

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).

Request a Redetermination of Level from the Gatekeeper

When submitting a request for Redetermination, include the following:
  • The most recent level of care assignment form (DPP-886, CRP-2, CRP-5, or CRP-6) with the redetermination section completed. Please print or write legibly.
  • A letter/narrative that identifies new evidence (since the last level of care assignment) supporting a higher or lower level of care, or an explanation of why the writer believes the previous level does not meet regulatory criteria.
  • Supporting documentation such as incident reports detailing the behavioral issues may be included when further clarification is warranted. Most of the time a well written letter/narrative will suffice.

If the redetermination is being requested on a level established by a previous redetermination, include the above information with the most recent level of care assignment prior to the previous redetermination request with the redetermination section completed.

A new CBCL, progress report, or 886A/886 is not required.

The redetermination letter/narrative and any supporting documentation can be faxed to (859) 225-3565 or mailed to Children's Review Program, Attn: Redetermination Request, 1351 Newtown Pike, Building 3, Lexington, KY 40511-1278.

Appeal to the Gatekeeper: If the redetermination is denied, the requester can appeal to the CRP administration staff for review. To do this, send a cover letter indicating the request for appeal and providing the basis for the appeal. Because this is an appeal, only the information submitted with the original Request for Redetermination will be considered. The appropriate time to submit new evidence is with the Request for Redetermination.

Attention: Nina Begley
Children's Review Program
1351 Newtown Pike, Building 3
Lexington, KY 40511-1278
Fax (859) 225-3565

A written response will be provided within 10 working days of the receipt of the request.

Seek an Informal Dispute Resolution from CHFS. If the appeal to CRP is denied, the requester can appeal to CHFS by filing an informal dispute resolution as outlined in Section 14 of 922 KAR 1:360. This informal dispute resolution request will be reviewed by DCBS and DCBS will render the decision. Please remember when making an informal dispute resolution to include all of the documentation provided to CRP for the review team to determine whether or not a level change is justified. The informal dispute resolution will be based on information previously submitted for the redetermination of level. If new information is available, please seek a redetermination of level.

Requests for an informal dispute resolution can be sent to:
David Gutierrez, LCSW
Branch Manager, Family Violence Prevention Branch
Department for Community Based Services
275 East Main Street 3E-A
Frankfort, KY 40621
Fax: 502-564-4653
email: David.Gutierrez@ky.gov

Remember to send all supporting documentation that was previously provided to CRP.

Request an Administrative Hearing. If an agency is still not satisfied with the decision after receiving a response from their informal dispute resolution request, then the agency may request an administrative hearing as outlined in 922 KAR 1:320.