HRA timeliness rules by program
Initial and annual HRA windows for Medicaid managed care and special needs plans, and how to track them per member.
Resources
Practical help for teams that run member outreach.
Guides written for quality, outreach and compliance teams, a glossary of the terms that come up in every HRA meeting, and straight answers to common questions.
Guides
Playbooks and checklists.
Placeholder: these guides are planned and not yet written. Titles show the intended library.
Texting members within TCPA and carrier rules
Consent, quiet hours, opt-outs and 10DLC registration, in the order you’ll need them.
Writing HRA questions members can answer
Plain language, one idea per question and answer choices that work on a small screen.
Measuring outreach against a holdout group
How to set up a fair comparison so completion lift holds up in review.
Getting a state-specific HRA approved
What to gather before submitting a form for state Medicaid or NCQA review.
Following up partial HRAs by risk
How to rank and work the members who started but didn’t finish.
HRA glossary
The acronyms, in plain words.
- HRAHealth risk assessment
- A questionnaire about a member’s health, risks and needs. Medicaid managed care contracts and Medicare special needs plans require them within set windows.
- SNPSpecial needs plan
- A Medicare Advantage plan for people with specific needs. SNPs must complete an HRA within 90 days of enrollment and at least once a year after that.
- D-SNPDual eligible special needs plan
- A special needs plan for people who have both Medicare and Medicaid.
- ICPIndividualized care plan
- The care plan a special needs plan builds for each member, informed by their HRA.
- HEDISHealthcare Effectiveness Data and Information Set
- NCQA’s set of quality measures that health plans report, such as screening and follow-up rates.
- StarsMedicare Star Ratings
- CMS’s one-to-five-star rating of Medicare Advantage and Part D plans, built from quality, member experience and other measures.
- CAHPSConsumer Assessment of Healthcare Providers and Systems
- Standardized surveys of patient and member experience, used in Star Ratings.
- NCQANational Committee for Quality Assurance
- The organization that accredits health plans, maintains HEDIS and certifies some HRA tools.
- LOBLine of business
- A plan product such as Medicaid, Medicare Advantage, D-SNP or commercial. Forms and rules often differ by LOB.
- Category of aid
- The Medicaid eligibility group a member qualifies under. Some states ask for HRA completion reported by category of aid.
- SDOHSocial determinants of health
- Non-medical needs such as food, housing, transport and safety that affect health.
- Care gap
- A recommended service, such as a screening or eye exam, that a member has not received.
- TCPATelephone Consumer Protection Act
- The US law that governs automated calls and texts, including when consent is required.
- 10DLC10-digit long code
- The US carrier registration system for business texting from standard phone numbers.
- BAABusiness associate agreement
- The HIPAA contract a vendor signs before it handles a plan’s protected health information.
- FHIR Questionnaire
- The HL7 FHIR standard for forms. Answers are stored as a QuestionnaireResponse.
FAQ
Common questions.
HRA-specific questions are on the HRA page, and security questions on Trust and security.
Who is the platform for?
Health plans that run outreach surveys, starting with Medicaid managed care, Medicare Advantage and D-SNP teams responsible for HRAs. Provider-facing solutions are on the roadmap.
Do members need a smartphone?
The link works in any modern phone browser. Members without a smartphone, or who don’t open the link, can be reached by phone, email or mail, and staff can complete the same form with them.
Which languages are supported?
Forms can be published in each language your state approves, and members see the version that matches their language preference.
Can we embed the HRA in our own member app?
Yes. The member experience is headless, so the same forms, identity rules and care plans can run inside your app or portal through the API.
How do you handle members who text back instead of tapping the link?
Replies are read for opt-out and help keywords and acted on at once. Other replies can go to your team’s inbox or trigger a fresh link.
See an HRA campaign from list to care plan.
We’ll walk through the member experience on your own phone, then the admin side with your state’s form.