SDR 101
What does SDR stand for?
Service Determination Request
What type of notification is required for an SDR approval?
Oral
What is required prior to denying an SDR?
An in-person reassessment.
How can participants request an appeal?
Orally and in writing
Where must SDRs be documented?
In the participant's medical record
True or False: A request to place a service on hold is an SDR.
True
Any conditions relating to an approval must be explained to a participant/caregiver in _________________.
Understandable language
What are the two types of denials?
When notifying of an SDR denial, the staff member must describe the _________ and _________ process.
Standard and expedited appeal
Give 3 examples of words that may "trigger" a review for an SDR in the chart.
Want, Request, Would like, Need, Stop, Start, Change, Asking for, Desire
How can a service request be made?
Orally or in writing
Notification of approval must include any conditions of approval as well as _____________________.
An estimate of when the participant may receive the service.
What type of notification is required for any SDR denials?
Oral AND written notification
Who reviews appeal requests?
Objective third-party
Requests made during the _____________ process are not traditional SDRs and are documented differently.
Initial care planning
Within 3 calendar days of receipt
True or False: If an SDR assessment is needed for an approval, it must completed in-person.
False.
What four domains are required to be assessed in each SDR assessment?
Medical, physical, social, and emotional
What is the timeframe for an expedited appeal?
72 hours
What must be updated to reflect approved SDRs?
The care plan
How long does an extension add to the SDR review timeframe?
What are the requirements for a single-IDT member approval? Hint: 3 items
The request must be approved in full at the time the request is made
The IDT member must be able to provide conditions of approval if any
The IDT member must be able to provide the expected effectuation date at time of approval
If a participant has _____________, the IDT must inform them of their right to continue receiving the service, and the conditions for receiving disputed services.
Medicaid
What 2 things cause automatic appeals?
1. The IDT fails to process the SDR request timely
2. The IDT does not furnish services required by the revised plan of care
What must always be documented in the medical record to confirm the SDR process is completed?
Service effectuation