Page 273 - Medicare Benefit Policy Manual

screening questions or standardized questionnaires designed for this purpose and
recognized by national professional medical organizations.

h. Establishment of the following:

(1) A written screening schedule for the individual, such as a checklist for the
next 5 to 10 years, as appropriate, based on recommendations of the United
States Preventive Services Task Force (USPSTF) and the Advisory
Committee on Immunization Practices (ACIP), and the individual’s health risk
assessment (as that term is defined in this section), the individual’s health
status, screening history, and age-appropriate preventive services covered by
Medicare.

(2) A list of risk factors and conditions for which primary, secondary, or
tertiary interventions are recommended or are underway for the individual,
including any mental health conditions or any such risk factors or conditions
that have been identified through an IPPE, and a list of treatment options and
their associated risks and benefits.

i. Furnishing of personalized health advice to the individual and a referral, as
appropriate, to health education or preventive counseling services or programs
aimed at reducing identified risk factors and improving self-management, or
community-based lifestyle interventions to reduce health risks and promote self-
management and wellness, including weight loss, physical activity, smoking
cessation, fall prevention, and nutrition.

j. Any other element determined appropriate through the National Coverage
Determination (NCD) process.

Health professional:

a. A physician who is a doctor of medicine or osteopathy (as defined in section
1861(r)(1) of the Social Security Act (the Act); or,

b. A physician assistant, nurse practitioner, or clinical nurse specialist (as defined
in section 1861(aa)(5) of the Act); or,

c. A medical professional (including a health educator, registered dietitian, or
nutrition professional or other licensed practitioner) or a team of such medical
professionals, working under the direct supervision (as defined in 42CFR
410.32(b)(3)(ii)) of a physician as defined in this section.

Health Risk Assessment means, for the purposes of the annual wellness visit, an
evaluation tool that meets the following criteria:

a. collects self-reported information about the beneficiary.