5400, Reporting Implementation of the Utilization Review Findings

Revision 17-1; Effective March 15, 2017

After the case worker implements the Utilization Review (UR) findings, the region must complete the Completed by Region items in the Findings/Summary section of the UR tool to indicate the following:

  • Date of regional exception to SO: If applicable, enter the date the exception was sent to state office for review and decision.
  • CM action complete date: Enter the date the case worker completed the UR recommended change. This should be the date the change was entered in the Service Authorization System Online (SASO) and the notice was sent to the individual receiving services.
  • Effective date of action: Enter the date the UR change is effective. This should be the same effective date entered in SASO and on the notice to the individual receiving services.
  • Regional Comments/Reason for Exception: Enter any regional observations or conclusions. If an exception was filed, note the rule and policy basis for the exception, and the outcome of the state office review.

The completed UR tool must be returned by email to the referring UR unit manager within five business days of implementation of the UR recommended change. A copy of the Baseline Information and Findings page(s), not the entire tool, and all service planning documents completed by the UR nurse must be filed in the case folder.