CMS: Service Determination Requests

Primary Data Source: CareHub

Field	Data Type	Description	Source
Participant First Name	Text	Participant’s first name.	CareHub
Participant Last Name	Text	Participant’s last name.	CareHub
Medicare Beneficiary Identifier	Text	MBI of the participant if available. “NA” if the participant is not a Medicare beneficiary. Dashes removed.	CareHub
Participant ID	Text	Pace Organization member ID for the participant.	CareHub
Person who Submitted the Service Determination Request	Text	Options: participant designated representative caregiver	CareHub: As entered in SDR module
Date Service Determination Request Made	Date	In the format of MM/DD/YYYY.	CareHub: As entered in SDR module
Date Service Determination Request Brought to the full IDT	Date	In the format of MM/DD/YYYY. “NA” if the SDR was immediately approved by a member of the IDT or if it was never brought to the full IDT.	CareHub: As entered in SDR module (IDT meeting details)
Extension	Text	“Y” if the PACE organization took an extension. “N” otherwise.	CareHub: If “Apply SDR Extension” was entered.
Extension Date	Date	Date the extension was entered in the format of MM/DD/YYYY.	CareHub: If “Apply SDR Extension” was entered.
Extension Notification Date	Date	Date the IDT notified the participant of an extension in the format of MM/DD/YYYY.	CareHub: If “Apply SDR Extension” was entered.
Category of the Request	Text		CareHub: As entered in SDR module
Description of the Request	Text		CareHub: As entered in SDR module
Date of the first assessment completed in response to the service determination request	Date	In the format of MM/DD/YYYY. “NA” if not assessment was completed in response to the SDR.	CareHub: Using data from the linked assessment (first assessment marked as completed)
Date of the last assessment completed in response to the service determination request	Date	In the format of MM/DD/YYYY. “NA” if no assessment was completed in response to the SDR.	CareHub: Using data from the linked assessment (last assessment marked as completed)
How many assessments were completed in response to the service determination request?	Text	“NA” if no assessments were completed in response to the SDR.	CareHub: Using data from the linked assessment (count of assessments)
Assessment(s) In-person	Text	“Y” if all assessments were completed in-person. “N” if any assessments were completed not in-person. “NA” otherwise.	case                 when sdr.sdr_assessment_id is null                     or not assessment.is_assessment_complete                     or assessment_is_virtual.assessment_id is null                     then 'NA'                 when assessment_is_virtual.is_virtual                     then 'N'                 else 'Y'             end as assessment_in_person
Request Disposition	Text	Options: Approved Denied Partially Denied Withdrawn
Immediate Approval	Text	“Y” if a member of the IDT was able to approve the SDR in full at the time the request was made. “N” otherwise.
For Immediate Approvals, which IDT member approved the request?	Text	Options PCP RN MSW Home Care Coordinator OT PT Dietician Recreational Therapist/Activities Coordinator Personal Care Attendant Transportation Center Manager Other NA (only if the request was not immediately approved)
Reason for Denial	Text	Explanation if the request was denied or partially denied. “NA” if the request was approved or withdrawn.
Date of Oral Notification	Date	In the format of MM/DD/YYYY. “NA” if oral notification was not provided or documented.
Date of Written Notification	Date	In the format of MM/DD/YYYY. “NA” if the request was denied, withdrawn, or if there was no documentation of the service.