MISC
Where does funding from PACE participants come from other than Medicare and Medicaid?
What is participants? Out-of-pocket.
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?
Who can make a service determination request?
What is the participant, their designated representative or unpaid caregiver?
What does the acronym PACE stand for?
What is Program of All-Inclusive Care for the Elderly?
What is the age of eligibility?
What is 55 years of age or older?
When should the IDT develop a comprehensive plan of care for a new enrollee?
What is within 30 days of enrollment?
How can a PACE staff member receive a grievance?
What is verbally or in writing?
What 3 requests define a SDR? A request to...
What is the request to initiate, modify or continue a discontinued/reduced service?
What does the acronym CMS stand for?
What is Center for Medicare and Medicaid Services?
What level of care must someone meet to be eligible for PACE?
What is nursing facility?
What agency is our State Administering Agency?
What is DSHS? Dept of Social and Health Services
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?
What is the timeframe to notify the participant or their designated representation of the IDT's decision?
What is no later than 3 calendar days after the date the interdisciplinary team receives the request?
What does the acronym SAA stand for?
What is State Administering Agency?
To be eligible for PACE, someone must live within the service areas of the PACE organization. How are these services areas geographically defined?
What is by designated zip codes?
What platform can you view our policies on?
What is PolicyStat?
What is a grievance defined as?
What is a complaint expressing dissatisfaction with services or care furnished?
For what determination outcome is an in-person assessment required?
What is if the interdisciplinary team expects to deny or partially deny a service determination request?
What does the acronym IDT stand for?
What is Interdisciplinary Team?
An individual must be able to live in a community setting without jeopardizing their what?
What is their health or safety?
What is the term for a fixed amount, regardless of changes in the participant's health status that is an all-inclusive payment for Medicare benefits provided to participants?
What is capitated payments?
A participant is expressing dissatisfaction with PACE but declined to file a grievance. How should this be captured in HeRO?
What is as a complaint?
The team members performing the reassessment must evaluate whether the requested service is necessary to meet the participant's _______ (needs)?
What is medical, physical, emotional, and social needs?
What does the acronym SDR stand for?
What is Service Determination Request?
What counties does PNW PACE Partners accept enrollees in?
What is Pierce and South King counties?