Health Risk Assessment (HRA) Process Posted for Comment

Cal MediConnect health plans must complete a Health Risk Assessment (HRA) for each new enrollee. This process serves as the basis for further assessment needs that may include, but are not limited to, mental health, substance use, chronic physical conditions, incapacity in key activities of daily living, dementia, cognitive status, and the capacity to make informed decisions.

The State is seeking stakeholder comment on the proposed HRA process. The proposal (below) lays out a procedure for health plans to primarily attempt to complete the HRA in person or by telephone. After those attempts, the HRA may be completed by mail or web-based mail.

DHCS leaders will host a call to discuss the proposal with stakeholders. This 60 minute call is scheduled for Tuesday, April 23, 2013 from 2-3pm.

  • Call-in: To register for the call, please sign up here.

Please submit comments on the HRA Process by Tuesday, April 30. Please submit them to info@calduals.org using the following template:

10 comments

  1. Vicky Scott

    As the mother and co-24/7 caregiver of our son, who is a severe, traumatic brain injury, I have no confidence that this new plan will be beneficial to him. We have a pcp and a neurologist who knows our son and understands TBI and the problems associated with this condition. My understanding is that the organizations chosen for our area are not equipped for someone like our son. We are deeply concerned about the future level of care and benefits for our son. We feel like his future is in jeopardy.

    • Vicky,

      You can opt out on the Medicare side and I suggest you do so. I’m not sure about the Medi-Cal side though. Does your son have Medi-Cal and Medicare?

    • I am so sorry to say as a disabled person who has circumvented the system for fifteen years now as a Medi/Medi patient I have no confidence in the new system either. It was highjacked by insurance companies.

  2. Richard VanGorder RN MSN CPHN

    If the HRA is a state requirement then is the state going to inform the beneficiaries that they must have this assessment performed? Member choice is important but member responsibility and accountability are also important and the beneficiaries must understand what is expected of them.
    Please make sure these enrollees are aware of their responsibility to have the HRA completed.
    And doing it over the telephone is not acceptable – it has to be done in person by the care/case manager.

  3. make sure all the notices are ada compliant
    and that the website is compliant

    • CA dual eligible resident

      CWhat notices? The ACO notices we received AFTER many were already enrolled by default & they used info fraudulently using the doctors names to tell us that our doctor wanted us to enroll. The HIPAA Act was already violated & the company had already been indicted for selling patient information, had hired felons etc.

      See article on VCStar
      website re: ACO Fraud

    • CA dual eligible resident

      What notices? The ACO notices we received AFTER many were already enrolled by default & they used info fraudulently using the doctors names to tell us that our doctor wanted us to enroll. The HIPAA Act was already violated & the company had already been indicted for selling patient information, had hired felons etc.

      See article on VCStar
      website re: ACO Fraud

  4. CA dual eligible resident

    Insurance companies, Medi-Cal HMOs, Medicare ACOs (who enrolled many by default without in many cases any notification & in many cases lying to Medicare enrolled people by stating their doctors requested they join when these same doctors were not aware the ACOs were using their names in order to illegally obtain medical information in direct violation of the HIPAA Act & patient privacy) were found to have no cost savings.

    There seems to be more money to be made in information & paper shuffling than in healthcare.

    Dual eligibles with Medicare & Medi-Cal would be FAR better served & costs would be less to everyone, including doctors hospitals & other care providers if one bill was sent to Medicare who already have the needed information on file.

    The Affordable Healthcare Act has become a cash grab for paper shufflers while patients loose more doctors who are dropping patients on any HMO weather it is Medicare or otherwise a system where doctors are told what they can and cannot do as their ratings and thus pay will be reduced by a ratings system created by and/or procured by actuaries and anyone with no medical training who will do what they have to to justify their jobs to pay their bills.

    Dual eligibles are by: seniors and disabled people with often complex health issues whose care least needs to be further complicated by having to have their doctors being told they cannot properly treat them or be paid less because they are treating are among the most: I’ll. Stress of dealing with complex paperwork having to change doctors to those less knowledgeable providing these people with substandard care cloaking it as being “cost effective” as these people suffering autoimmune and other complex health challenges by not adequately treating them or inappropriately treating them based on manipulation not medical science .

    EMR & EHR programs are replacing medical care & making inaccurate records.

    Allowing our medical system to become so complex is turning our healthcare into third world status.

    We need to let our doctors practice medicine and get insurers & paper shufflers out of our healthcare.

    • You articulated the problem very well. I sure hope some of us will be picked to form a patients board of some kind that could become a permanent part of this new system, otherwise we are in real trouble.

  5. My anecdotal evidence of ths program benefitting only the HMOs, while negatively impacting individuls who participate in it, is based on the following: I’ve spoken to 12 nursing home DONs, 11 nursing home admins, 10 primary doctors 12 psychiatrists and 10 psychologists. None of these individuals are in favor of this program. We all feel it will be catastrophic for patients who take on an HMO on the Medicare side. It will also have a huge negative impact on providers. Here’s the good news: I’ve spoken to 20 of my patients thus far and not a single one wants to change the way they are receiving medical and psychological services. They all have told me that they will opt out of this program. I believe that most individuals will opt out when they realize that they won’t be able to see their doctor unless said doctor is affiliated with an HMO. Every provider must notify their patients of the November letters being sent by the State. This passive enrollment for this program is unethical in my opinion. HMOs are really playing dirty and practicing illegal methods to gain patients. I know of one facility where LA Care took over an entire assisted living facility by signing up the entire house of about 60 individuals. They convinced the people, many of whom are chronically mentally ill, to sign up with them. This is wrong, unethical and illegal. This is what we will be up against as providers. Please pass this on. Thanks for the opportunity to express my opinion.

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