Health Risk Assessment

 Health Risk Assessment Form
 
Health Risk Assessment (Word)
(Spanish - Arabic)

Health Risk Assessment
(PDF)
(Spanish - Arabic)
 
 DCH-1315

For Healthy Michigan Plan beneficiaries enrolled in a health plan, the Department has developed a standard Health Risk Assessment to be completed annually. The beneficiary and provider each have separate sections to fill out.

Health plans can add questions to Sections 1-3 when they mail this Health Risk Assessment to beneficiaries. Section 4 is standardized on all Health Risk Assessments. It does not matter which Health Risk Assessment is completed, as long as one is completed annually.

Each health plan providing services to Healthy Michigan Plan members has an incentive for providers who complete and return the Health Risk Assessment form for their Healthy Michigan Plan patients. These incentives will vary by health plan. Contact the plans you participate with for details.

 HRA Report

 
Health Risk Assessment Report
 

 

Health Risk Assessment Completion Instructions
Sections 1-3 of the Health Risk Assessment form will be completed by the beneficiary. If Sections 1-3 have not already been completed, have the beneficiary complete it during their office visit. Beneficiaries are not required to answer all of the questions in Sections 1-3 for the Health Risk Assessment to be considered complete.

Primary care providers complete Section 4. Fill in the Member Results, select a Healthy Behavior in discussion with the beneficiary and complete the Primary Care Provider Attestation. All three parts of section 4 must be complete for the attestation to be considered complete.

Submission Instructions
Primary care providers give the beneficiary a copy of their completed Health Risk Assessment and submit the completed Health Risk Assessment to the beneficiary’s health plan. Each health plan has its own submission instructions. The health plans you participate with will provide you with submission information.

Further information regarding the HRA was communicated to providers in letter L 14-22.