Section 85.15 - Notification of adverse finding

85.15 Notification of adverse finding.

When an adverse finding is made, the utilization review agent must immediately notify the appropriate area office of the Department of Health, Office of Health Systems Management, Long-Term Care Unit. The utilization review agent must immediately forward to the area office a copy of the most recently completed patient review forms (PRI and SCREEN) and criteria for level of care as contained in subdivision (i) of section 86-2.30 and section 400.12 of this Title, a copy of the psychosocial evaluation completed by the facility's qualified social worker indicating the patient's or resident's response to possible transfer, the information supplied by the attending physician, if any, concerning the patient's or resident's current clinical status and ability to accept transfer, and the utilization review agent physician's statement of the change in the patient's or resident's medical condition or other circumstances justifying the adverse finding.
 

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