Common use of Utilization Decision Clause in Contracts

Utilization Decision. i. For utilization decisions other than the expedited decisions described below in Paragraph I.B.4e.ii., County shall provide notice as expeditiously as the client’s mental health condition requires and within fourteen (14) calendar days following receipt of the request for service, with a possible extension of up to fourteen (14) additional calendar days, if the client or Contractor requests an extension; or if County identifies a need for additional information. ii. In cases in which Contractor or County determines that following the standard timeframe could seriously jeopardize the client’s life or health or ability to attain, maintain, or regain maximum function, the County will make an expedited utilization decision and provide notice as expeditiously as the client’s mental health condition requires and no later than three (3) working days after receipt of the utilization request. The County may extend the three (3) working day time period by up to fourteen (14) calendar days if the client requests an extension, or if the County identifies a need for additional information. iii. The County shall notify the Contractor of any decision to deny a utilization request, or to approve a service in an amount, duration, or scope that is less than requested.