Special Needs Plans Health Risk Assessment Tool (HRAT)

20.2.3 - Special Needs Plans Health Risk Assessment Tool (HRAT) (Rev. 117, Issued: 08-08-14, Effective: 08-08-14, Implementation: 08-08-14) At any time that a SNP is required to submit a SNP application, it is required to submit a copy of the HRAT in HPMS as a part of its SNP application. The timeline for submitting the tool will mirror the timeline for SNP application submission/MA application for the current contract year. There is no template available in HPMS for the health risk assessment submission. CMS reviews and approves all new health risk assessment tools and notifies SNPs that submitted deficient tools. Note that CMS requires SNPs to conduct a comprehensive HRA within 90 days of the effective date of enrollment of each beneficiary, and a re-assessment at least every 365 days in accordance with established timeframes for reporting purposes. A detailed description of the process for conducting the HRAs must be included as part of MOC Element 2 (Care Coordination) Element B (HRA Tool) in Section 20.2.1 of this chapter. This description must include when and how the initial HRA and annual reassessments are conducted for each beneficiary, e.g., conducted by phone interview, face-to-face, or written form completed by the beneficiary and/or caregiver. Direct beneficiary and/or caregiver input is necessary and expected in order to assess the individual’s perception of his/her health status and health care needs. Information obtained via the HRAT, in addition to objective assessments subsequently performed by qualified providers, contribute to the effective development and continuous update of the enrollee’s individualized care plan. Timely completion of HRAs is a Part C reporting requirement and, for the first time, in CY 2015, will be incorporated as part of the CMS Five-Star Quality rating system. Please note that only completed HRAs that comprise direct beneficiary and/or caregiver input will be considered valid for purposes of fulfilling the Part C reporting requirements. This means, for example, that HRAs completed only using claims and/or other administrative data, would not be acceptable. For details regarding the HRA reporting timeframes and deadlines, please see the current Medicare Part C Plan Reporting Requirements Technical Specifications document at: http://www.cms.gov/Medicare/Health- Plans/HealthPlansGenInfo/ReportingRequirements.html.