SDRs
Who can receive an SDR?
What is any PACE employee?
What does NPA stand for?
What is National PACE Association?
Why do we complete monthly and annual benchmarking?
What is to allow for comparisons across PACE organizations, provide a standardized approach to performance measurement within PACE and demonstrate the value of care delivered by PACE organizations?
How can a PACE staff member receive a grievance?
What is verbally or in writing?
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 quality metric do we monitor for utilization?
What is hospital admits, hospital days, ED visits and specialist utilizations?
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?
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?
What quality metric do we monitor for quality and safety?
What is number of falls, falls with injury, advanced care planning, diabetes control and poly pharmacy?
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)?
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?
What quality metric do we monitor for participant satisfaction?
What is participant satisfaction surveys and grievances?
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.
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?
What quality metric do we monitor for immunizations?
What is influenza and pneumococcal vaccines?
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?