When it comes to New York’s Health Equity Reform (NYHER) 1115 Waiver Program, the difference between an assessment and a screening is significant—although the words are similar.
Screening
This is an interview that a medical provider conducts with a patient using a set of questions (the screening tool) about possible health-related social needs (HRSN). The first question gains the patient’s consent to participate and to share their results. Positive responses to screening questions trigger an assessment.
Per NYHER, medical providers must screen every Medicaid patient annually.
Assessment
This is the formal review of positive HRSN screening responses, including follow-up questions for the patient. It is completed by a healthcare provider or social care navigator who may record formal diagnoses of social needs using Z codes.
What is a Z Code?
It is the official designator assigned to challenges in the conditions where a patient is born, lives, learns, or works that affect their health. Z codes are published in the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM), which is the standardized system used by healthcare providers to designate diseases and medical conditions.
Per NYHER, the lead social care network (SCN) or one of their qualified partners must complete an assessment for any positive responses to screening questions.
Referral
When Z codes are recorded during an assessment, the provider or navigator refers the patient to the lead SCN to identify if the patient is eligible—through social services or community-based organizations (CBOs)—for help to address diagnosed HRSN.
By implementing screening and assessment requirements, NYHER is working to to address patients’ HRSN. Each referral means that a patient is getting help to improve conditions that limit their health outcomes—and helping more patients individually improves health equity statewide.
