{"id":62,"date":"2025-07-16T13:48:58","date_gmt":"2025-07-16T13:48:58","guid":{"rendered":"http:\/\/box5846.temp.domains\/~bluesid3\/?page_id=62"},"modified":"2025-07-16T15:40:10","modified_gmt":"2025-07-16T15:40:10","slug":"requests-made-prior-to-initial-plan-of-care","status":"publish","type":"page","link":"http:\/\/box5846.temp.domains\/~bluesid3\/requests-made-prior-to-initial-plan-of-care\/","title":{"rendered":"Requests Made prior to Initial Plan of Care"},"content":{"rendered":"\n<p class=\"has-vivid-cyan-blue-color has-text-color has-link-color wp-elements-23581a0de0054d96d58b88ff901120c0 wp-block-paragraph\"><a href=\"https:\/\/www.ecfr.gov\/current\/title-42\/part-460\/subpart-G#p-460.121(b)(2)\">42 CFR 460.121(b)(2)<\/a><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Recently, regulatory changes were made to account for requests made prior to the creation of an initial plan of care. Regulators reasoned that it was unfair to expect a PACE Organization to conduct a service determination request on a participant who has not completed initial assessments and plans of care, thus a &#8220;carve out&#8221; exception was made for this scenario. In the case that a participant requests a service prior to the finalization of the initial plan of care (often during an initial assessment), the IDT must:<\/p>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Document the request when made, <em>and<\/em> in the initial plan of care<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Include the request in the initial plan of care discussion with the IDT<\/li>\n<\/ul>\n\n\n\n<ul class=\"wp-block-list\">\n<li>Document that the request will or will not be provided (with a rationale if denied) in the initial plan of care<\/li>\n<\/ul>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">*An IDT may still choose to process an SDR prior to the Initial Plan of Care, and may consider doing so if a denial is likely in order to provide appeal rights. <\/p>\n\n\n\n<p class=\"wp-block-paragraph\"><\/p>\n","protected":false},"excerpt":{"rendered":"<p>42 CFR 460.121(b)(2) Recently, regulatory changes were made to account for requests made prior to the creation of an initial plan of care. Regulators reasoned that it was unfair to expect a PACE Organization to conduct a service determination request on a participant who has not completed initial assessments and plans of care, thus a [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":0,"menu_order":0,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-62","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"http:\/\/box5846.temp.domains\/~bluesid3\/wp-json\/wp\/v2\/pages\/62","targetHints":{"allow":["GET"]}}],"collection":[{"href":"http:\/\/box5846.temp.domains\/~bluesid3\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"http:\/\/box5846.temp.domains\/~bluesid3\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"http:\/\/box5846.temp.domains\/~bluesid3\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"http:\/\/box5846.temp.domains\/~bluesid3\/wp-json\/wp\/v2\/comments?post=62"}],"version-history":[{"count":6,"href":"http:\/\/box5846.temp.domains\/~bluesid3\/wp-json\/wp\/v2\/pages\/62\/revisions"}],"predecessor-version":[{"id":88,"href":"http:\/\/box5846.temp.domains\/~bluesid3\/wp-json\/wp\/v2\/pages\/62\/revisions\/88"}],"wp:attachment":[{"href":"http:\/\/box5846.temp.domains\/~bluesid3\/wp-json\/wp\/v2\/media?parent=62"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}