General
UM stands for
Utilization Management
Step one and when it should take place
About a month before UM is due, discuss extending services with family including whether they continue to meet medical necessity for services or if they are ready to take a break or transfer to lower level of care
The two assessments to be completed in SmartCare
PSCs and CANS
The "admission date" in Area A refers to
The date the client was enrolled in the program
"Official" PSC score threshold indicating impairment
28 (though we may approve UMs with lower scores on a case by case basis)
UMs are due under these circumstances
The client will be receiving services beyond 6 months post-enrollment or beyond 6 months post-previous UM
Step two and when it should take place
Complete PSCs with caregiver after they and clinician agree to appropriateness of extension either same day of agreement or shortly after
The same date as the PSCs
How many expected outcomes should be checked off in Area H
No more or fewer than one
Who may approve UMs
PD or APD
UMs are not needed under this circumstance
The client will close from services prior to or by 6 months post-enrollment
Step three and when it should take place
Complete the CANS assessment separately from client/caregiver either same day as PSC or soon after, along with other SmartCare forms. May also complete UM form at this time
Where I can find client's intake date
How to complete Area E Updated Client Plan and/or Problem List
Check the box and ensure that you are updating the client's problem list as clinically indicated
Where the UM form gets submitted
APD UM folder in the admin area
Staff responsible for completing the UM process
Step four and when it should take place
Present client to treatment team for extension the Wednesday after discussing with family AND prior to UM due date. Complete a non-billable note in SmartCare documenting treatment team presentation
The additional SmartCare document that must be completed and dated the same as the PSC.
CSI Standalone
Where CANS number of "high need" and "help is needed" items can be found to complete Area C
CoSD CANS Assessment Summary
What to do if another program has recently completed PSCs and CANS
Do not complete either and utilize the data from the other program's assessments to complete the UM form
Step five and when it should take place
Complete UM form if not already done so and submit to where it needs to go
What goes in the progress note when completing PSCs
"T utilized PSCs to guide clinical assessment of client's current symptoms and behaviors as well as to elicit discussion with caregiver regarding progress client has made in therapy and identification and update of treatment goals moving forward." NOT "Caregiver completed PSCs"
The date that goes next to your name on the second page of the UM form
May be the same date as PSCs to keep it streamlined, but MUST be prior to UM due date
The client and/or caregiver are reporting symptoms and behaviors that significantly impair client's functioning in at least two domains of life. PSC score may help justify medical necessity but is not a comprehensive measure.