Utilization Review

The JAC Utilization Review and Rate Band Monitoring Program is accountable for the review and monitoring of accuracy as it relates to the Wayne County Department of Health, Veterans and Community Wellness policy adherence, level of care, service intensity and timelines allowed for juveniles and their families, and implemented by the Care managment organizations (CMOs).

Consistent review and oversight of each youth’s records ensure accurate and timely service delivery, treatment duration and reporting analysis related to legal determinations and treatment needs. This process also ensures transparency for payment, CMO service documentation, requirements per policy and that all assigned youth are accounted for and receiving the most appropriate level of care per security level, documentation of such provision and legal status of the youth. It measures the length of stay, reduces detention stays, and ensures treatment begins rapidly and that unnecessary costs are not approved.

The Wayne County “Preferred Provider Network” (PPN) is comprised of licensed residential vendors that have been selected for their expertise, quality of services, experience with the Wayne County juvenile services system and cost effectiveness. The PPN offers a continuum of residential care services and a specific scope of service and rate structure that has been tailored to the unique design of the Wayne County juvenile services system. All out-of-home placements must be initially processed through the PPN.

The JAC  PPN department manages access to vendors in the PPN and is responsible for review of CMO referrals for access to bed space in the PPN; ensuring that a CMO referral request is consistent with a juvenile’s security level on a  JCAR, the JAC’s Social History Assessment Report, and any Court ordered requirements.  The PPN department additionally maintains census and provider bed availability reports and tracks youth data received from provider census reports.