Patient Intake or Reassessment MA Risk Classification Tool
This is available to AHCA members.
This simple tool is designed to be utilized at critical decision-making times - Prior to Accepting the Admission – Upon a Significant Change in Care Needs – and – Upon Contract Initiation and Renewal
- Like the SNF PDPM pre-admission process - providers should ask the MA plan and admitting hospital about information necessary to assure that the SNF is able to meet the patient’s care needs. Special attention should be paid to those patient characteristics and clinical need factors associated with high-cost care needs to best assure that the SNF can provide the necessary level of care as well as receive an appropriate MA plan rate.
- Additionally, some SNF patients admitted for care under MA plan coverage may experience a change in status and require an updated care plan. Special attention should be made to assess whether the change in care needs is sufficient to justify a request for the MA plan to adjust the patient’s assigned rate ‘Level’.
- This tool can provide a quick analysis of the overall risk associated with the proposed reimbursement ‘Levels’.
This tool differentiates patient care needs for nursing, therapy, and non-therapy ancillary services into high or low categories necessary for evaluation of MA levels payment risk in the rural or urban patient-level risk calculator tool.