The HRST can be used for objective, reliable rate setting, exceptional rate determination, criteria for clinical services and decisions of Level of Care eligibility. Whether at the state or the provider level, the need exists for effective allocation of resources. The HRST directly aligns the level of service to the person’s legitimate need.
Equitable Resource Allocation
The HRST gives the ability to accurately look at the health status of individuals in a region or served by a provider or case managers, among others. The HRST Health Care Levels are based on quantifiable and objective criteria. Cost can be allocated for persons who truly need a higher rate, rather than assuming that high rates are needed for persons simply because they are in wheelchairs or look like they are medically complex. Conversely, the HRST identifies individuals, such as those with behavioral challenges, who are often not identified as requiring the level of support they do need.
State resources are valuable and limited. Some regions require educational support for community providers and families; other regions require intensive medical/nursing/therapy supports for the individuals themselves. The HRST allows the state and provider administrative staff to view the state as a whole with appropriate allocation of resources based on an objective, comprehensive screening of individual needs.
Proactive Approach = Lower Morbidity = Reduced Cost
The HRST screens for health risks on a regular, routine and acute-event basis. The screenings detect health issues early before they develop into a health crisis. This, in many instances, avoids the extreme cost of additional medications, staffing, professional services, ER visits and hospital admissions.
Allowing an individual to destabilize for a period of time before treatment often results in the person requiring a higher level of health care at significantly increased cost. An example is a person who goes from eating by mouth to having a gastrostomy or jejunostomy tube. This increases the cost of eating to double or quadruple the costs of eating orally. In addition, the person’s risk for GI bleeding increases substantially, which increases the likelihood of requiring 24-hour nursing care.
Early identification of health risks + early intervention = improved outcomes for the individual + lower health care costs.
The Centers for Medicare & Medicaid Services (CMS) will reimburse 50% of the cost for the services that the HRST provides through Medicaid Administration Match. CMS requires that systems be in place for monitoring the health and safety of individuals receiving services and the Health Risk Screening Tool (HRST) assists in fulfilling this requirement.
As an example, the State of Georgia Department of Behavioral Health and Developmental Disabilities (DBHDD) is the operating agency for the Home and Community Based Waiver Programs for individuals with developmental disabilities. Georgia DBHDD uses Medicaid Administration Match for its operational functions of the waiver. The HRST is part of the annual assessment of individuals with developmental disabilities, and it is part of the level of care determination and Individual Service Plan development for approximately 15,000 individuals.