| 10 |
ADVERSE EVENTS RISK: Current H-code in EMEDNY (HARP Eligible/Enrolled) |
Adults |
N |
| 11 |
ADVERSE EVENTS RISK: Current POP flag in PSYCKES |
Adults |
N |
| 12 |
ADVERSE EVENTS RISK: Current Quality or HH+ flag in PSYCKES or equivalent from RHIO or MCO |
Adults |
N |
| 13 |
ADVERSE EVENTS RISK: Member currently involved with mandated preventive services. Must specify date issued services and provider of service |
Children |
Y |
| 14 |
ADVERSE EVENTS RISK: Member recent inpatient/ED/psychiatric hospital/Detox within the last 6 months. Must specify name of institution and date of release |
Children |
Y |
| 15 |
ADVERSE EVENTS RISK: Member recent out of home placement (foster care, relative, RTF, RTC, etc.) within the last 6 months. Must specify name of institution and date of release |
Children |
Y |
| 16 |
ADVERSE EVENTS RISK: Member recently diagnosed with a terminal illness/condition within the last 6 months. Must specify condition and date diagnosed |
Children |
Y |
| 17 |
ADVERSE EVENTS RISK: Member received an initial Disability Determination (SSI or DOH Disability Certificate/letter) within the last 6 months |
Children |
N |
| 18 |
ADVERSE EVENTS RISK: Released from Jail/Prison/Juvenile detention, involved with Probation, PINS, Family Court within the last 6 months. Must specify name program and date of release/court/probation |
Children |
Y |
| 19 |
HEALTHCARE RISK: Member (or guardian) is unable to appropriately navigate the healthcare system for the member's chronic conditions |
Both |
Y |
| 20 |
HEALTHCARE RISK: Member does not have a healthcare provider or specialist to treat a chronic health condition |
Both |
N |
| 21 |
HEALTHCARE RISK: Member has not seen their provider (e.g., PCP, BH, etc.) in the last year |
Both |
N |
| 22 |
READMISSION/RECIDIVISM RISK: Released from inpatient Medical, Psych, or Detox within the last 6 months. Must specify name of institution and date of release |
Adults |
Y |
| 23 |
READMISSION/RECIDIVISM RISK: Released from Jail/Prison or other justice program within the last 6 months. Must specify name program and date of release |
Adults |
Y |
| 24 |
SOCIAL DETERMINANTS RISK: Current Intimate Partner Violence/Current Family Violence in the home of the member |
Both |
N |
| 25 |
SOCIAL DETERMINANTS RISK: Currently cannot access food due to financial limitations or ability to shop or access food site, dietary restrictions, etc. |
Both |
N |
| 26 |
SOCIAL DETERMINANTS RISK: Currently homeless (HUD 1, 2, or 4) & for Transitional Age Youth, has no stable living arrangement (living with different friends/family) |
Both |
N |
| 27 |
SOCIAL DETERMINANTS RISK: Member has fewer than 2 people identified as a support by the member |
Both |
N |
| 28 |
SOCIAL DETERMINANTS RISK: Member has had a change in guardianship/caregiver within the last 6 months |
Both |
N |
| 29 |
SOCIAL DETERMINANTS RISK: Member is concurrently HH appropriate due to caregiver/guardian enrolled in HH |
Children |
Y |
| 30 |
SOCIAL DETERMINANTS RISK: Member (or caregiver, if Member is a child) does not have needed benefits (SSI, SNAP, etc.) |
Both |
N |
| 31 |
SOCIAL DETERMINANTS RISK: Recent institutionalization or nursing home placement of member's primary support person |
Adults |
N |
| 32 |
TREATMENT NON-ADHERENCE RISK: Member/care team member report of non-adherence…Must specify WHICH medication(s) and/or treatment(s) are involved |
Both |
Y |
| 33 |
TREATMENT NON-ADHERENCE RISK: PSYCKES flag related to non-adherence or equivalent from RHIO or MCO |
Both |
N |
| 34 |
Direct referral from MCO, Local Government Units (LGU), or Single Point of Access (SPOA) |
Both |
N |
| 35 |
Direct referral from Adult Protective Services |
Adults |
N |
| 36 |
Direct referral from Child Protective Services/Preventive Services Program |
Children |
N |
