PSS3/BH
When a member has a clinical conversation with a CM and declines services on the same day before the CM Triage Assessment (first 11 questions up to “Will you be treating this member as High Risk/Complex?”) is completed, what assessment must be done?
What is completing a Behavioral Health (BH) Needs Assessment?
What must the CM do once the CM has received medical director's review back?
What is -The CM will document in notes from the discussion with member including a synopsis of the discussion, feedback provided from the Medical Director.
How many ADLs must be assessed?
What are six basic ADLs?
The PSS‑3 must be initiated and completed during these first member contacts, not to exceed 30 days.
What is the first 1–2 outreaches?
When a member triages as Intense/Complex and is engaged, when should the CM send the consult?
What is upon identification of referral criteria, per CM judgment, or after completing the full CM Triage (not later than 60 days from engagement)?
True or False: Only one SDOH needs to be assessed.
What is False? (Multiple SDOH must be assessed.)
After the initial completion, how often must the PSS‑3 be repeated for eligible members?
What is every 90 days?
If no frequency is specified by the MD on the initial consult, what is the default timing?
What is every three months if the member is still engaged and additional outreach is scheduled?
Give an example of a social determinant of health that may affect care adherence.
What is transportation, housing, food access, safety, financial strain, etc.?
What must happen if a CM is unable to complete the PSS‑3 within the first 1–2 outreaches?
What is documenting attempts and ensuring it is completed within the 30‑day window?
If a CM has been unable to reach the member—even if initially engaged—should the case go to the Medical Director?
What is no, because inability to reach the member is not a reason to send to MD?
What is included in “clinical history” documentation?
What are disease onset, key events, meds, and treatment history?