Adverse Dertermination
Understanding Adverse Determinations
Test your knowledge about adverse determinations and their implications in service delivery. This quiz will help you understand the key concepts related to adverse determinations, including definitions, timelines, and processes.
- Learn about service reductions and denials.
- Discover filing appeals and the related timelines.
- Assess your understanding of current regulations.
What Is An Adverse Determanation?
A reduction, termination or complete denial of services.
An increase an approval of services.
A dertermination made by an SCA.
How many days does it take for an SC to draft an Adverse Dertermination/Denial Summary?
3 Days
Same Day
1 Week
14 Days
How many days does reduced hours goes into effect?
10 Calendar Days
2 Calendar Days
7 Calendar Days
1 Calendar Day
If denied in FULL, when does it goes into effect?
ASAP
Within 10 days
Why does an SC visits a participant within 10 days of decision?
To give a mini assessment
To get an updated PCSP signed
How many days does a participant have to file an appeal?
10 days
2 weeks
48 hours
Service reduction or denial is made when...
A participant doesn't file an appeal
The participant files an appeal
What happens if a participant files an appeals?
Services are terminated ASAP
The SC waits until the appeal procces is over and maintain current services.
What are the types of Adverse Derterminations?
SC recommended Medical Necessity Reduction/Denial
Participant request reduction or Discontinuation
SC recommend reduction after temp increase
Service not a covered benefit
Home/Vehicle Mod/ Pest Eradication Denial
No reduction or discontinuation can be done before COC (July 1st)
True
False
What can be done during COC?
Reduction sooner or asked and denied an increase during COC
Increase asap because it was never denied
Idk
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