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8. LTSS/SRT Guide

An SRT, or “Service Request Tool” is completed after a Comprehensive Needs Assessment visit so that PHW may review all current/continuing services as well as any requested changes to services by the ptp or SC

This includes:

  • New Service Requests
  • Terminating service requests
  • Increase Requests
  • Decrease Requests

Who completes the SRT?

First draftSecond/official draft
Service Coordinators complete the first SRT in the Docusign Packet to be reviewed by the QA department.The QA department completes the official SRT in Envolve to be submitted to PHW.

Docusign SRT

The Docusign SRT is completed by Service Coordinators. It is the last bundle of documents in the Docusign/PCSP packet.

There are 2 main components of SRT; General Info and Request Details

General Info

This page requires 3 bits of information

  1. When was the most current plan of care uploaded?
    • The date of the assessment goes in automatically. Leave it as it is.
  1. Select additional health insurance coverage:
    • Check off the boxes of the participant’s insurances.
  1. Date Enrollee/Enrollee’s Authorized Representative made request?
    • The date of the assessment goes in automatically. Leave it as it is.

Request Details

Requests 1-6

These requests are activated automatically by the services in the Service Plan.

By selecting “New Service” beside the service in the Service Plan, it will automatically trigger the request in the SRT

The following information has to be supplied:

  • What HCBS benefit is being requested? – The type of service will automatically fill in based on the Service Plan entry.
  • Enter the requested NEW total amount – The amount will automatically fill in based on the Service Plan entry.
  • Requested Units of Measure – put in the type of unit. This depends on the type of services (meals, hours, units, etc.)
  • Requested Frequency – The frequency will automatically fill in based on the Service Plan entry.
What is the reason for the request?

This should be a short and sweet description for why the participant is requesting the service.

This section should contain the participant’s own words! But you should also consider the following:

  • The participant’s health status (how they feel, existing or new diagnoses, recent hospitalizations, and/or injuries).
  • Formal/Informal support that is currently available
  • Specifics about the request and why the participant wants it.
    • **For Home Modifications, this is where you put in the actual item being requested. NOT in the Service Plan.**
    • **If the participant is requesting Respite Care, put in the dates**
Describe the CC’s findings

This should be a detailed explanation the coordinator has for the request as a result of the assessment.

If this request is not affecting the PAS hours, then you should also add “No change in PAS is requested at this time.”

Requests 7&8

These requests need to be manually activated. Which you can do in order to change existing services and/or when there is a request to change PAS hours.

Select Yes if you need to activate the request, No if you do not.

The following information has to be supplied:

  • Select whether the service is an Increase, Decrease, or Termination

Note: If you are requesting a decrease in PAS hours, based on the SPG tool, regardless of the participant’s request, select Decrease.

  • What HCBS benefit is being requested? – Select the type of service. Note: PAS is only available on Request #8.
  • Enter the requested NEW total amount – Put in the amount that the Participant is requesting, regardless of your evaluation.
    • Therefore if the participant wants an increase, put in that value, whether or not it is supported by the SPG tool.
  • Requested Units of Measure – put in the type of unit. This depends on the type of services (meals, hours, units, etc.)
  • Requested Frequency – Put in the appropriate frequency, based on the service.
What is the reason for the request?

Same as all of the other requests, this is where you describe the participant’s reasoning for the service change

Use the participant’s own reasonings. Especially if it is about PAS hour changes

Describe the CC’s findings

This should be a detailed explanation the Service Coordinator has for the request as a result of the assessment. Even if the PAS hours from the assessment does not meet the participant’s request.

Consider/include the following:

  • Participant’s request
  • “SPG suggested total hours weekly: ###. SPG suggested additional hours weekly: ###. Weekly total combined hours: ###. According to SPG ### hours of PAS a week is adequate to assist with ADL’s and IADL’s.”
  • Other service currently being used.
  • Amount of informal support available
  • Health findings from the InterRAI and discussion with Nurse Irene.
  • If the explanation is getting long, its recommended that you provide a brief sentence summary of the what the participant is requesting vs. what the SPG tool reflects.
Examples
Ptp wants to keep hours, but SPG tool reflects decrease
Ptp wants increase in PAS, but SPG tool reflects decrease

On the final page you need to select if an SRT is needed or not, and sign.


Envolve SRT

The SRT is officially submitted by QA or Supervisors.

Log into Envolve, bring up the participant the SRT is for, then select ” Fill Out Now” beside LTSS Service Request_PA.


General Info

Provide the following information:

  • What is your role? – Always Select “Other” then type in Service Coordination where it asks to explain
  • When was the most current plan of care uploaded? – Date that QA uploaded the PCSP, InterRAI, and all other documents from the visit.
  • Select additional Health Insurance coverage(s) – Select any/all health insurances that the participant has
  • Date Enrollee/Enrollee’s Authorized Representative made request? – The date the participant made the request, or when the assessment was completed.
  • How was the request received? – Always select Verbally

Request Details

  • Who initiated the request? – Select whomever it was that made the request.
    • If the request is for a decrease in PAS hours and the participant is NOT requesting an increase, then select Health Plan Rep
  • Select the request number and more questions will be revealed.
  • Is request standard or expedited? – You should always select Standard
    • Expedited requests are only for NPO requests and Respite Care
  • What HCBS benefit is being requested? – Choose the appropriate service.
    • PAS is Personal Care
      • If you select Personal Care then an additional question Is this request for a PDO service? Select Yes if the provider is Public Partnerships (PPL), select no for any other provider
  • What is the request type? – Choose the participant’s request
    • If the request is for a reduction in hours because of the SPG tool (and the participant is NOT requesting an increase) choose “Reduction
  • Did the member specify a start date for this service? – You only need a date for Respite Care, otherwise, leave it blank.
  • Enter the CURRENT authorized amount. – enter how much of the service the participant is currently authorized for (unless it is a new request, in that case leave it blank).
  • Current Units of Measure
  • Current Frequency
  • Enter the requested NEW total amount – Enter the participant’s requested amount
    • If this is a PAS decrease because of the SPG tool (and the participant is not requesting an increase) put in the current authorized amount.
  • Requested units of measure
  • Requested Frequency
  • Select the reason for the request? – Select the participant’s reasons for the request.
    • If this is a PAS decrease because of the SPG tool (and the participant is not requesting an increase) select “Plan of Care Review”
  • Describe the reason for the request – Either QA copies and pastes the explanation given by the SC in the Docusign SRT, or Supervisor provides details on the participant’s reason for the request.
    • Before saving a copy, increase the size of the text box so that all text is visible
  • Describe the CC’s findings – Either QA copies and pastes the explanation given by the SC in the Docusign SRT, or Supervisor provides details on the SC’s reason for the request.
    • Before saving a copy, increase the size of the text box so that all text is visible
  • Are you the Reviewer for the request? – Always state No

Before submitting to Envolve, be sure to save a copy to be uploaded in Function Portal


Annual Visits

PHW requires that SRTs be completed for EVERY Annual Comprehensive Needs Assessment. Even if there are no changes or new requests.

SRT with no changes

  • If there are no changes or new requests during the Annual visit, submit an SRT with “New Request” selected for What is the Request type?
  • If there are any requested changes, then follow the instructions above!
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