Comprehensive Health Risk Assessment. An assessment used to confirm the appropriate risk stratification level for the Enrollee and as the basis for developing the Plan of Care. Comprehensive Health Risk Assessment domains will include, but not be limited to, physical and behavioral health, social needs, functional status, wellness and prevention domains, caregiver status and capabilities, as well as the Enrollees’ preferences, strengths, and goals.
Comprehensive Health Risk Assessment. No later than 90 days after the individual’s enrollment in the STAR+PLUS MMP, all enrollees shall receive, and be an active participant in, a comprehensive health risk assessment. Assessment domains will include, but not be limited to, physical and behavioral health, social needs, functional status, wellness and prevention domains, caregiver status and capabilities, as well as the enrollees’ preferences, strengths, and goals. Relevant and comprehensive data sources, including the enrollee, providers, and family/caregivers, as appropriate, shall be used by the STAR+PLUS MMP. Results of the assessment will be used to confirm the appropriate risk stratification level for the enrollee and as the basis for developing the Plan of Care. As part of the comprehensive health risk assessment, the STAR+PLUS MMP will also conduct an assessment to determine eligibility for HCBS waiver services if the enrollee has an unmet need for at least one waiver service or if requested by the enrollee. A reassessment will be completed at least once every 12 months after the initial assessment completion date. A reassessment and/or updates to the Plan of Care (see section A.iii. below) must also be completed when there is a change in the enrollee’s health status or needs, a significant health care event, or as requested by the enrollee, his/her caregiver, or his/her provider. Mid-year reassessment and/or updates to the Plan of Care may be triggered by a hospital admission, transition between care settings, change in functional status, loss of a caregiver, change in diagnosis, or as requested by a member of the Service Coordination Team who observes a change that requires further investigation. Initial comprehensive assessments and annual reassessments will be completed in person for enrollees stratified to Level 1. Initial comprehensive assessments and annual reassessments may be completed telephonically for enrollees stratified to Level 2 unless an in-person assessment is requested by the enrollee, caregiver, or provider. All assessments will be conducted by qualified health professionals who possess an appropriate professional scope of practice, licensure, and/or credentials, and are appropriate for responding to or helping enrollees manage their service needs. Examples of health professionals who may complete portions of the assessment include registered nurse (RN), nurse practitioner (NP), licensed vocational nurses (LVNs), physician’s assistant (PA), or person with an undergrad...
