CMS-10630 PACE Supplemental Questions

OMB Control Number: 0938-TBD (Expires: TBD)
PACE_SupplementalQuestions

Question #

Question

1

What timeframe does your organization adhere to when processing grievances? Please
include the page (or a screenshot of the page) of your polices and procedures that is
relevant.

2

How does your organization communicate the resolution of grievances to participants?

3

List the emergency medications (name, dosage and quantity) that your organization keeps
readily available on site at all times.
Note: List drug name as written on the product label.

4

What emergency or disaster preparedness trainings must staff receive? How frequently are
these trainings administered?

5

What vaccinations do you require your personnel with direct participant contact to receive?

6

How do drivers communicate with your organization while transporting participants?

7

Include the name(s) of your organization’s electronic medical record system, if applicable.

8

Can we access your medical records remotely?

9

Please describe when your organization deems a service delivery request as received by the
IDT. Please attach the portion of the policy or procedure that discusses receipt of a service
delivery request.

Response