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Annual Wellness Visit to Provide Personalized Preventive Plan Benefit

Annual Wellness Visit Benefit Overview

If the law requires that a beneficiary complete a health risk assessment, why is not listed as a required element of an AWV service?

The ACA requires that the AWV to provide a personalized preventive plan include a health risk assessment that the beneficiary completes prior to or as part of the visit and consideration of the results of the beneficiary-completed risk assessment. CMS is not requiring a health risk assessment as part of an AWV service for 2011, however, as the ACA stipulates that certain activities that must first be accomplished. The ACA specifically requires CMS and the Department of Health and Human Services (HHS), of which CMS is a component, to establish:

• Publicly available guidelines—which must “identify chronic diseases, injury risks, modifiable risk factors, and urgent health needs of the individual”—for health risk assessments that are developed in consultation with stakeholders by March 2011;
• Standards for a health risk assessment administered by telephone or through the Internet by March 2011; and
• A model risk assessment by August 2011 (though, the law also stipulates that any risk assessment model that meets the publicly available guidelines is acceptable).

In addition to the above requirements, the ACA also provides guidance for HHS to consider. The ACA states that HHS may enlist community-based entities to ensure that risk assessments are accessible to beneficiaries and to help beneficiaries complete them. It directs HHS to try to integrate risk assessments with health information technology, such as electronic health records and patient personal health records, and to attempt to use it to foster beneficiary self-management skills.

CMS states that it will incorporate a risk assessment into the AWV services as a required element once the above ACA-stipulations are met. ACP intends to participate in the efforts to shape the risk assessment element, working to ensure that it fosters improved beneficiary health while being practical for physicians.

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