[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-1-en-105":3,"doc-seo-244264-105":53,"doc-detail-244264-en":127},{"code":4,"msg":5,"data":6},0,"success",[7,14,19,24,29,34,39,44,49],{"id":8,"doc_module":9,"doc_module_name":10,"category_name":11,"show_sort_weight":12,"slug":13},11,1,"Template","Presentations",90,"presentations",{"id":15,"doc_module":9,"doc_module_name":10,"category_name":16,"show_sort_weight":17,"slug":18},12,"Resumes",80,"resumes",{"id":20,"doc_module":9,"doc_module_name":10,"category_name":21,"show_sort_weight":22,"slug":23},14,"Invoices",70,"invoices",{"id":25,"doc_module":9,"doc_module_name":10,"category_name":26,"show_sort_weight":27,"slug":28},15,"Posters",60,"posters",{"id":30,"doc_module":9,"doc_module_name":10,"category_name":31,"show_sort_weight":32,"slug":33},16,"Social Media",50,"social-media",{"id":35,"doc_module":9,"doc_module_name":10,"category_name":36,"show_sort_weight":37,"slug":38},17,"Forms",40,"forms",{"id":40,"doc_module":9,"doc_module_name":10,"category_name":41,"show_sort_weight":42,"slug":43},18,"Letters",30,"letters",{"id":45,"doc_module":9,"doc_module_name":10,"category_name":46,"show_sort_weight":47,"slug":48},21,"Paper Templates",5,"papers-templates",{"id":50,"doc_module":9,"doc_module_name":10,"category_name":51,"show_sort_weight":4,"slug":52},158,"General","general-158",{"code":4,"msg":54,"data":55},"ok",{"site_id":56,"language":57,"slug":58,"title":59,"keywords":60,"description":61,"schema_data":62,"social_meta":120,"head_meta":122,"extra_data":124,"updated_unix":126},105,"en","service-delivery-ia-template-issue-and-participant-extension-tracking","Service Delivery IA Template - Issue and Participant Extension Tracking","","Service delivery incident and remediation tracking template covering CMS audit identification, issue description, condition language, detailed narrative, and root cause analysis. Includes methodology to quantify impacted individuals, counts of affected participants, system and operational remediation initiation/completion dates, and outreach actions with statuses. Provides a second table to log participant extensions, reasons, benefit explanations, extension notification, appeal language presence, appeal requests and outcomes, approved service additions to the care plan, and emergency care details, with placeholders for additional requested data.",{"@graph":63,"@context":119},[64,80,102],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/service-delivery-ia-template-issue-and-participant-extension-tracking/244264/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/service-delivery-ia-template-issue-and-participant-extension-tracking/244264.png","ImageObject",442,249,{"name":88,"@type":89},"Seraphina","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-23","2026-09-12",true,{"@type":98,"interactionType":99,"userInteractionCount":101},"InteractionCounter",{"@type":100},"ViewAction",8,{"@type":103,"mainEntity":104},"FAQPage",[105,111,115],{"name":106,"@type":107,"acceptedAnswer":108},"What information does the template require for each identified issue?","Question",{"text":109,"@type":110},"It collects the issue’s brief and detailed descriptions, condition language, root cause analysis, the process used to determine affected participants, and the number of individuals impacted.","Answer",{"name":112,"@type":107,"acceptedAnswer":113},"How are system or operational remediation actions recorded?",{"text":114,"@type":110},"The template requires dates for remediation initiation and completion, along with actions taken to resolve the operational/system issue and actions to address negatively impacted individuals, including outreach descriptions and status.",{"name":116,"@type":107,"acceptedAnswer":117},"What participant-level details does the template capture for extensions and appeals?",{"text":118,"@type":110},"It records participant identity and extension reasons, whether notification was given, whether appeal language was included, appeal request dates and whether the participant appealed, whether services were added to the care plan, and emergency care occurrence and timing, plus placeholders for other data.","https://schema.org",{"og:url":78,"og:type":121,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":123,"canonical":78},"index,follow",{"doc_id":125,"site_id":56},244264,1790262495,{"code":4,"msg":5,"data":128},{"doc_id":125,"user_id":129,"nickname":88,"user_avatar":130,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":131,"file_id":132,"file_url":133,"file_type":134,"file_size":135,"view_count":101,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":73,"language":136,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":137,"faqs":138,"seo_title":139,"seo_description":61,"update_tm":140,"read_time":9},962075114101,"https://ap-avatar.wpscdn.com/avatar/e000253a75eb197efd?x-image-process=image/resize,m_fixed,w_180,h_180&k=1780044092746381165","OMB Control Number: 0938-TBD (Expires: TBD)  \n\n| Date Identified\u003Cbr>(MM/DD/YY)\u003Cbr>(Completed By The CMS Audit Lead) | Brief Description Of Issue\u003Cbr>(Completed By The CMS Audit Lead) | Condition Language\u003Cbr>(Completed By The CMS Audit Lead) | Detailed Description of the Issue\u003Cbr>(Explain what happened)\u003Cbr>(Remaining fields to be Completed by PACE\u003Cbr>Organization) | Root Cause Analysis for the Issue\u003Cbr>(Explain why it happened) | Methodology-Describe the process that was\u003Cbr>undertaken to determine the \\# of individuals (e.g.\u003Cbr>participants) impacted | \\# of Individuals Impacted | Action Taken to Resolve System/ Operational\u003Cbr>Issues | Date System/ Operational\u003Cbr>Remediation Initiated\u003Cbr>(MM/DD/YY) | Date System/ Operational\u003Cbr>Remediation Completed\u003Cbr>(MM/DD/YY) | Actions Taken to Resolve Negatively Impacted\u003Cbr>Individuals Including Outreach Description and\u003Cbr>Status | Date Individual\u003Cbr>Outreach and\u003Cbr>Remediation Initiated\u003Cbr>(MM/DD/YY) | Date Individual\u003Cbr>Outreach and\u003Cbr>Remediation Completed\u003Cbr>(MM/DD/YY) |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |\n|  |  |  |  |  |  |  |  |  |  |  |  |  |\n\n\n| Participant\u003Cbr>First Name | Participant Last\u003Cbr>Name | Participant ID | Reason for Extension | Explain Why the\u003Cbr>Extension Was Beneficial\u003Cbr>to Participant | Notification of Extension\u003Cbr>Given to Participant? | Was Appeal Language\u003Cbr>Included in the Letter?\u003Cbr>(Y/N) | Did the Participant\u003Cbr>Appeal? (Y/N) | Date of the Appeal\u003Cbr>Request\u003Cbr>(MM/DD/YY) | Was the Approved\u003Cbr>Service Added to\u003Cbr>the Care Plan? (Y/N) | If Yes, Provide the\u003Cbr>Date it Was Added.\u003Cbr>(MM/DD/YY) | Was Emergency Care\u003Cbr>Provided? (Y/N) | When Was\u003Cbr>Emergency Care\u003Cbr>Provided? | {Other Data\u003Cbr>Requested} | {Other Data\u003Cbr>Requested} | {Other Data\u003Cbr>Requested} |\n| --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- | --- |","cbCaipoDFLrSOLcv","https://ap.wps.com/l/cbCaipoDFLrSOLcv","pdf",47921,"English","# Issue and Remediation Overview\n## Required Audit Fields\n## Root Cause and Impact Assessment\n# Participant Extension and Appeals Log\n## Extension Details and Benefit Rationale\n## Notification, Appeals, and Care Plan Updates\n## Emergency Care Information","[{\"question\":\"What information does the template require for each identified issue?\",\"answer\":\"It collects the issue’s brief and detailed descriptions, condition language, root cause analysis, the process used to determine affected participants, and the number of individuals impacted.\"},{\"question\":\"How are system or operational remediation actions recorded?\",\"answer\":\"The template requires dates for remediation initiation and completion, along with actions taken to resolve the operational/system issue and actions to address negatively impacted individuals, including outreach descriptions and status.\"},{\"question\":\"What participant-level details does the template capture for extensions and appeals?\",\"answer\":\"It records participant identity and extension reasons, whether notification was given, whether appeal language was included, appeal request dates and whether the participant appealed, whether services were added to the care plan, and emergency care occurrence and timing, plus placeholders for other data.\"}]","Service Delivery IA Template - Issue and Participant Extension Tracking | PDF",1789214645]