To ensure consistency across programs and fiscal accountability, the Department of Aging and Disability Services (DADS) will expand utilization review (UR) activities to include the Deaf Blind with Multiple Disabilities (DBMD) program beginning May 12, 2014. DADS previously notified DBMD providers of plans for expansion on November 5, 2010, via DADS Information Letter No. 10-142.
Utilization management and review activities performed by UR nurses for the DBMD program may include:
• face-to-face visits with individuals selected for review based upon a random sample;
• face-to-face visits with individuals or desk reviews, to conduct prospective (pre-authorization)
reviews on plans of care, and where applicable, on plans of care that are near the individual
cost ceiling; and
• reviewing, as necessary, special situations when patterns and trends are identified.
