A service determination request must be identified and processed when a request is made to initiate, modify, or continue a service, so long as the request is made after the initial plan of care is finalized. Service determination requests can be made orally or in writing, and can come from the participant, the participant’s representative, or a caregiver.
Unless it is considered an immediate approval, the PACE employee or contractor has 72 hours to present the request to the IDT. The IDT must provide an in person assessment and provide notification to the participant within 72 hours. An assessment is not required for an approval. The SDR is considered complete when notification is provided.