In North Carolina, Comprehensive Assessments are a critical tool enabling holistic and effective care for Medicaid beneficiaries. This measurement tool goes beyond traditional clinical evaluations by including social and behavioral needs. In conjunction with patient goals, information gathered using this tool helps care managers create Care Plans. By focusing on both health needs and social determinants of health, patient outcomes are significantly improved.
Key Components of the Comprehensive Assessments
A Comprehensive Assessment must be completed for all assigned high-risk members by a care manager. This person-centered assessment includes health care needs, functional and accessibility needs, strengths and supports, and patient goals.
Organizations providing Tailored Care Management must begin the Comprehensive Assessment within 30 days of a member enrolling in a Tailored Plan. The document must be completed within 60 days of enrollment for a high acuity member or 90 days for a medium/low acuity member. A reassessment of the evaluation occurs when a patient has an unplanned care transition and/or change in status.
The Comprehensive Assessment must include:
- Patient’s immediate care needs, current services, and other State/Local services currently used
- Physical and dental health conditions
- Current and past mental health and substance use status and/or disorders
- Physical, intellectual, or developmental disabilities
- Medications prescribed and taken
- Available informal, caregiver, or social supports
- Four priority health-related resource domains (housing, food, transportation, and interpersonal safety)
- Ongoing conditions that require treatment or regular care monitoring
Benefits for Patients and Providers
- Improved Health Outcomes: By focusing on the whole patient and addressing a wide range of needs that impact health, care teams can create effective Care Plans that lead to better health outcomes and improved quality of life for members.
- Enhanced Care Coordination: Comprehensive Assessments facilitate better communication and coordination among healthcare professionals, ensuring patients receive comprehensive and continuous care.
- Compliance with Medicaid Requirements: Helps meet all necessary NC Medicaid guidelines and requirements, which is essential for reimbursement and program eligibility.
Comprehensive Assessments provide an in-depth understanding of a patient’s health status and needs. By capturing medical and non-medical factors that impact health, these assessments allow Care Managers to address all aspects of a patient’s health, facilitating high-quality, holistic care for North Carolina Medicaid members.
About the Author
