12.1. The New York State Office for People With Developmental Disabilities (OPWDD) desires to retain the services of independent (i.e., no firms) per diem licensed registered nurses to perform IURs. These reviews are conducted for individuals residing in an Intermediate Care Facility (ICF) that is certified and/or operated by OPWDD. Such ICFs (i.e., ICFs in Federal regulation) are eligible to receive Federal Medicaid funds under Title XIX of the Social Security Act. 12.2. The purpose of the Independent Utilization Review (IUR) is to determine if the individual requires or continues to require the ICF/Developmental Disability (DD) level of care. This SOI will be posted on both the NYS OPWDD Procurement Opportunities webpage at https://opwdd.ny.gov/procurementopportunities, and on the NYS Contract Reporter (NYSCR) website at https://www.nyscr.ny.gov/, as required by Economic Development Law 4-C, titled “The Procurement Opportunities Newsletter.” 12.3. The IUR is a review of each person’s record. The review determines if a person is in need of active treatment services in order to determine their eligibility for initial or continued placement at the ICF/DD level of care. The determination is based on the criteria established by the OPWDD. The IUR consists of two components: • The First Step Review is a record review of each person by a nurse knowledgeable in the treatment of Intellectual Disabilities/Developmental Disabilities to determine if the continued stay of the person is appropriate. If the person is deemed appropriate for continued stay, the review is concluded for that given person. If, however, the First Step Review determines that the person is unsatisfactory (inappropriately placed) for continued stay, the OPWDD review team must notify the facility that the person is found to be unsatisfactory at the First Step Review and that a Second Step Review is necessary. • Registered Nurses will conduct the First Step Review in ICFs and Developmental Centers as assigned. The required forms, internal to OPWDD (UR11, UR11a, UR12, UR3) for recording the completion of the review must be completed in full. • The Second Step Review process reviews those people who received a First Step "Unsatisfactory Determination". Physicians (licensed to practice in New York State) will conduct Second Step IURs, as part of a team, as assigned. The second step review process could require input and additional review from the IUR nurse.
