1997 Session

Budget Amendments - HB1600 (Committee Approved)

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Utilization Review

Item 153 #5h

Item 153 #5h

First Year - FY1997 Second Year - FY1998
Education: Elementary and Secondary
Comprehensive Services for At-Risk Youth and Families FY1997 $0 FY1998 $175,000 GF

Page 126, line 10, strike "$101,824,581" and insert "$101,999,581".
Page 127, line 31, after "item" insert:
"or participate in voluntary utilization review pursuant to C. 5. of this item".
Page 127, after line 40, insert:
"5.  The State Executive Council shall work with the Department of Medical Assistance Services to amend the Department's existing preauthorization and utilization management contract with a qualified medical review organization in order to provide utilization management of residential placements provided to youth under the Comprehensive Services Act.  A payment of $175,000 the second year from the general fund shall be transferred to the Department of Medical Assistance Services for such utilization management services.  It shall be optional for local Community Planing and Management Teams (CPMT) to participate in the state-wide contract for utilization review.  However, if a CPMT participates in the state-wide utilization review program, such participation meets the requirement for supplemental funding specified in paragraph C.4. of this Item.  Any CPMT performing its own utilization review shall also be deemed to meet the requirements of paragraph C.4. of this Item.  The Department of Medical Assistance Services, in cooperation with representatives of the Virginia Association of Counties, the Virginia Municipal League, the State Executive Council, and the State Management Team, shall develop the criteria and guidelines to be followed by the  utilization management provider."

(This amendment provides funding to allow for utilization review of residential placement services for children under the Comprehensive Services Act (CSA). The function would be funded by the state to assist local governments in controlling the costs of CSA.)