SDRs
Who can receive an SDR?
What is any PACE employee?
How can a PACE staff member receive a grievance?
What is verbally or in writing?
Where would you find any PACE policy?
What is PolicyStat?
What is a grievance defined as?
What is a complaint expressing dissatisfaction with services or care furnished?
What agency is our State Administering Agency?
What is DSHS? Dept of Social and Health Services
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 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 would you find MHS mandatory training?
What is Workday Learning?
One individual on the IDT may fill how many separate roles on the IDT where they meet applicable licensure/qualification requirements?
What is two roles?
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?
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)?
Where would you find the most up-to-date SDR training resources?
What is within TEAMS? PACE staff>General>SDR Resources
What is a designated representative?
What is an individual who is officially authorized to act on behalf of another person or group in a specific matter or process?
What level of care must someone meet to be eligible for PACE?
What is nursing facility?
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?
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.
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
What is fraud?
Knowingly submitting, or causing to be submitted, false claims or making misrepresentations of fact to obtain a Federal health care payment for which no entitlement would otherwise exist?
What disciplines are required to complete in-person assessments for the initial plan of care?
What are the 8 disciplines: PCP, MSW, RN, PT, OT, RD, AC, HCC?
Who can make a service determination request?
What is PPT, HCPOA (Designated representative) and informal caregiver (unpaid)?
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?
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?
What is Medical Necessity in the PACE program?
This refers to the requirement that care must address the medical, physical, emotional, and social needs of participants in a holistic and person-centered approach?
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?