Missouri WISEMAN Program Manual
SOCIAL DETERMINANTS OF HEALTH ASSESSMENT AND FOLLOW UP
REQUIREMENTS
A WISEWOMAN screening, whether Risk Reduction Counseling or Annual, require a Social Determinants of Health Assessment (purple) form be completed in its entirety. The following topics are addressed in the assessment: internet access, food security, transportation, childcare, housing, safety, and medication adherence. Once the participant’s responses have been reviewed, if referrals are made for social services, the social service ID’s will need to be documented on the claim. Social Service ID consists of two letters representing recipient’s state, tribal organization, or territory, last two digits from the current year, four-digit code denoting it is a social service (i.e., “SSID”), a two-digit numeric code indicating type of social service referral. See Social Service ID “Cheat Sheet”. The Social Determinants of Health Assessment (purple) form then must be entered into MOHSAIC. Before a WISEWOMAN screening, whether Risk Reduction Counseling or Annual, will be reimbursed, this form must also be entered into MOHSAIC and be approved for reimbursement.
Social service referrals should be followed up on utilizing the Social Determinants of Health Referral and Follow Up (Bottom portion of purple claim only) form. Please note in the claim if participant was able to access resources or if resources were unable to be accessed. A participant may have up to 4 Social Determinants of Health Follow Ups per year. These can be completed over the phone or in-person. Additional referrals may be made during this time as well. Once a Social Determinants of Health Referral and Follow Up has been completed, this must be entered into MOHSAIC.