SDRs
Who can receive an SDR?
What is any PACE employee?
What does NPA stand for?
What is National PACE Association?
How can a PACE staff member receive a grievance?
What is verbally or in writing?
Name the right: To receive all the care and services you need to improve or maintain your overall health condition, and to achieve the best possible physical, emotional, and social well-being.
What is the right to treatment?
Where would you find any PACE policy?
What is PolicyStat?
If a non-IDT member receives an SDR, who should they report this out to?
What is an IDT member or one-up supervisor if unsure?
What does SAA stand for?
What is State Administering Agency?
What is the timeframe for responses to, and resolution of, appeals after an appeal is received?
What is as expeditiously as the participant's health condition requires, but no later than 30 calendar days?
Name the right: To have someone help you if you have a language or communication barrier so you can understand all information given to you.
What is the right to information and assistance?
Where would you find MHS mandatory training?
What is Workday Learning?
Where should oral notifications of approval or denial be documented?
What is within the SDR template that is uploaded into the ppt's chart by Q/C?
What does PMPM stand for?
What is Per Member Per Month?
How long does a participant or their designated representative have to initiate an internal appeal?
What is 20 calendar days from the day they are notified of the denial/reduction (verbally or in writing, whichever happens first)?
Name the right: To be fully informed of your health status and how well you are doing, to make health care decisions, and to have all treatment options fully explained to you. This includes the right not to get treatment or take medications. If you choose not to get treatment, you must be told how this may affect your physical and mental health.
What is the right to participate in treatment decisions?
Where would you find the most up-to-date SDR training resources?
What is within TEAMS? PACE staff>General>SDR Resources
What is the timeframe for an SDR to be presented to a full IDT after being made?
What is 3 calendar days from the day the request is made?
What does PMPA stand for?
What is Per Member Per Annum?
Who can receive the information from a PPT or their DR on an appeal?
What is any PACE staff member? This does not need to be an Interdisciplinary Team (IDT) member.
Name the right: You have the right to talk with health care providers in private and to have your personal health care information kept private and confidential, including health data that is collected and kept electronically, as protected under State and Federal laws.
What is the right to have health information kept private?
Where would you find resources such a UKG time keeping, tip-sheets about grievances/appeals/heros, etc?
What is within TEAMS? New Employee Resources channel
Which of the following can submit a SDR?
1. PPT
2. HCPOA
3. Informal caregiver
4. IP
What is PPT, HCPOA (Designated representative) and informal caregiver (unpaid)?
What does CQPIP stand for?
What is Coordinated Quality Performance Improvement Plan?
After an individual has exhausted the internal appeal process, they have the right to an external appeal through what agency?
What is Medicare or Medicaid?
Name the right: To get all of your health care in a safe, clean environment and in an accessible manner.
What is the right to be treated with respect?
Where would you find a complete list of enrolled and disenrolled ppts with their assigned teams, next semi date, and other ppt identifiers?
What is attached to the email Jake sends out at the first of each month?