Assessment of an individual’s needs is a necessary first step to delivering the care and services to meet those needs. Who conducts assessments, how they are conducted, their frequency, appeal rights around assessments and many other issues must be considered. Currently, individuals may be subject to multiple assessments for different elements of their care; integrating assessment tools presents a challenge. Much work is needed, particularly in assessing needs for long term supports and services.
Risk assessment should be ongoing.
Here is an example of the risk assessment timelines in the states currently implementing a demonstration:
- California: For higher risk members, the plan must complete the Health Risk Assessment within 45 days of enrollment. For lower risk members, the plan must complete the HRA within 90 days of enrollment. (CA Contract at 46-47).
- Ohio: The plan must complete an initial Comprehensive Assessment within 15 days of enrollment for intensive level beneficiaries, 30 days for high level, 60 days for medium level; and within 75 days for the low and monitoring levels. A reassessment must be completed within 365 days of the initial Comprehensive Assessment completion date. (OH Contract at 34-35).
- Illinois: The plan completes a health risk assessment within 90 days after enrollment for high and moderate risk members. For members receiving HCBS waiver services or those in nursing facilities, the risk assessment must be face-to-face and completed within 180 days of enrollment. (IL Contract at 53).
- Virginia: The plan must complete the Health Risk Assessment for all Community Well individuals within 90 days of enrollment. For all vulnerable subpopulations, EDCD vulnerable subpopulations and Nursing Facility vulnerable subpopulations, the plan must complete the assessment within 60 days of enrollment. The EDCD and nursing facility subpopulation assessment must be face-to-face. (VA Contract at 255).
Use of a standardized assessment tool helps to ensure that beneficiaries have the same opportunities to access services that they need.
Wisconsin and Washington both have assessment tools that cover all long term services and supports and that have been cited as promising examples of long term assessment. (See p. 12).
- Wisconsin uses a long term care functional assessment screen for its integrated long-term care services. The tool has been in use for many years and updated several times.
- Washington’s CARE assessment tool is discussed on the state’s website and in the state’s long term care manual. The Northwest Justice has prepared a consumer piece about the tool.