To request a review of a child or youth’s authorized service level, whether scheduled or nonscheduled, the caseworker must do both the following:

• Forward a complete clinical record for the previous 30 days to the third-party contractor.
• Coordinate the submission of all other required documentation to the third-party contractor.

The complete clinical record includes:

• IMPACT Form 2089 Service Level Authorization Request (for nonscheduled reviews only).
• Information on any medical problems experienced or disabilities existing within the previous 30 days.
• For children or youth with primary medical needs, an evaluation from a physician, physician’s assistant, or nurse practitioner, with the diagnosis and the prescribed services.
• Progress and therapy notes (individual therapy, speech, occupational, or physical therapy) and school records for the previous 30 days.
• Serious incident reports and seclusion reports for the previous 30 days.
• All relevant up-to-date items from the case file from within the previous 30 days, including the narrative from the monthly summary in IMPACT.

A caseworker may request a nonscheduled review of a service level when any of the following occur:

• An authorized service level will expire within 14 calendar days and the third-party contractor is not scheduled to conduct a utilization review within the next 30 days.
• An authorized service level has expired.
• The caseworker determines that the child or youth’s needs have changed.