What is the Health Risk Screening Tool (HRST)?

The HRST is a HIPAA-compliant, web-based tool developed by IntellectAbility to proactively identify health risks and destabilization in at-risk populations, particularly people with Intellectual and Developmental Disabilities (IDD). It uses a simple 22-item scale that assigns a score, resulting in a Health Care Level (HCL) from 1 to 6, indicating the person's degree of health risk.

How does the HRST scoring process work?

Users answer objective Yes/No questions for each of the 22 Rating Items, which generates a numerical score. These scores are calculated using a proprietary algorithm to assign one of six Health Care Levels (HCLs), with Level 6 indicating the highest risk. The final HCL triggers suggested action steps, known as Service and Training Considerations, to guide supporters in mitigating the identified risks.

How often must an HRST screening be updated?

An HRST screening is required to be completed at a minimum of once every 365 days (annually). However, it is critical to update the screening within 14 calendar days of any health status change, such as a hospitalization, emergency room visit, fall, or seizure activity, to track health risk movement and ensure timely care.

Who benefits most from the HRST?

The HRST benefits people with IDD by identifying often-missed health risks and underlying conditions before they become emergencies. It also helps provider agencies and support staff by informing person-centered plans, addressing continuity of care concerns amid staff turnover, and assisting with resource allocation based on objectively quantified health acuity.

Why is the HRST considered a 'screening tool' and not an 'assessment tool'?

The HRST is a screening tool because its purpose is to quickly evaluate the possible presence of a health problem using objective, often Yes/No questions, which is typically completed by trained support personnel. An assessment is a separate, more in-depth process typically performed by a clinician (like an RN) to define the nature of a problem, determine a diagnosis, and develop a specific treatment plan. The HRST serves as the critical early warning system.

A Valid, Reliable, and Objective Data Source

What is the HRST?

The Health Risk Screening Tool (HRST®) is a validated health risk screening and stratification instrument designed for people with intellectual and developmental disabilities (IDD) and other at-risk populations. It enables organizations to identify, quantify, and proactively manage health risks that can lead to destabilization, adverse outcomes, avoidable suffering, and premature mortality.

The HRST is a proprietary, HIPAA-compliant, web-based instrument that applies a standardized methodology to generate a Health Care Level (HCL)—a clinically reliable measure of risk severity that correlates with healthcare needs and care acuity. This allows providers to prioritize interventions, allocate resources appropriately, and ensure individuals receive the level of care their condition requires.

By systematically evaluating risk factors across body systems and functional domains, the HRST provides a reliable, defensible framework for identifying people at highest risk and informing care decisions. Originally developed and validated for IDD populations, the HRST’s clinical methodology is applicable across other high-risk populations, including people with traumatic brain injury (TBI), physical disabilities, and aging populations receiving long-term services and supports (LTSS).

The result is improved consistency in care delivery, enhanced clinical oversight, and reduced exposure to preventable health complications and outcomes.

The HRST is not an electronic health record (EHR). While EHR systems document health information and services, the HRST provides a validated methodology for identifying and stratifying health risk—delivering clinical insight that complements and enhances the use of EHR data.

How the HRST Works

22-Item Scale

The HRST uses a simple 22-item scale designed to discover who is at the greatest risk of illness and health destabilization. Rating items encompass 22 specific areas of risk, including risks associated with eating, ambulation, self-abuse, aggression, bowel function, skin integrity, nutrition, falls, and 14 other areas.

The HRST tracks changes across Rating Items over time, revealing developing patterns of risk that can signal the likelihood of a significant health event. This longitudinal sensitivity extends the value of the HRST beyond identifying immediate risk to supporting predictive insight and modeling of health risk.

Answer Yes/No Questions

Each Rating Item is completed by answering a structured series of objective yes/no questions that guide the user through a standardized decision pathway, resulting in a score from 0 to 4.

This approach removes subjectivity and ensures consistent, reliable results across raters, settings, and levels of experience. Independent analysis using a large state dataset has demonstrated strong reliability and stability of HRST scores over time.

Health Care Level Assigned

Based on the numerical total of the 22 Rating Items and a proprietary algorithm, a Health Care Level is assigned. Health Care levels can range from 1-6.

The HRST Health Care Level (HCL) has been demonstrated to be a reliable predictor of mortality and a direct measure of clinical acuity. It quantifies not only what risks are present, but the level of support, oversight, and resource allocation required to safely maintain health and prevent decline. Acuity-informed care is the difference between reactive crisis response and proactive, cost-contained health management.

Action Steps

Based on the risks identified through the screening, the HRST generates Service and Training Considerations that guide next steps across the support team.

These considerations are structured discussion points, not requirements or recommendations. They identify areas that may warrant further evaluation, clinical involvement, or changes in support, while allowing the team to apply professional judgment based on the person’s needs.

Service Considerations highlight potential evaluations and interventions across clinical disciplines, while Training Considerations equip supporters with the knowledge and specific skills and actions needed to recognize, respond to, and monitor risk. This is where identified risk is translated into coordinated, proactive support—helping prevent escalation, avoidable harm, and the downstream clinical and financial consequences of unmanaged risk.

See How the HRST Works in Practice

Turning Risk Identification into Prevention

Proven at Scale Across States and Providers

26 States Use Our Program

130,000+ Currently Being Monitored

2,000+ Private Provider Agencies

Who uses the HRST?

State IDD Agencies

State developmental disabilities agencies use the HRST to ensure people with IDD receive supports and services matched to their actual risk level and clinical acuity, not historical assumptions or administrative categories. The HRST satisfies DOJ settlement agreement requirements, supports waiver-level-of-care determinations, and provides the documented clinical rationale regulators and auditors require. It is also used to inform equitable resource allocation and support rate-setting methodologies aligned to clinical need.

State Medicaid Agencies

The HRST gives state Medicaid programs a validated, defensible framework to stratify IDD and LTSS populations by clinical acuity and expected utilization, enabling more accurate capitation rate development, actuarial justification, value-based payment structuring, performance-based contracting, and managed care oversight. It provides the clinical intelligence infrastructure that MCO contract accountability requires.

Managed Care Organizations (MCOs)

For health plans managing IDD and complex LTSS populations, the HRST operates as a predictive clinical risk engine – surfacing mortality risk, morbidity risk, clinical instability, and acuity level before costs escalate. Earlier identification enables earlier intervention, reduced avoidable ED utilization, fewer inpatient admissions, and measurable improvement in quality metrics and star ratings.

Provider Agencies

For direct service provider organizations, the HRST translates complex health risk into actionable acuity levels that drive staffing decisions, care planning, and clinical oversight. It identifies developing patterns of risk before they become crises, reducing unnecessary hospitalizations, protecting the people supported from preventable harm, and equipping teams with the clinical confidence to advocate for the resources each person truly needs.

A Valid, Reliable, and Objective Data Source

What is the HRST?

How the HRST Works

22-Item Scale

Answer Yes/No Questions

Each Rating Item is completed by answering a structured series of objective yes/no questions that guide the user through a standardized decision pathway, resulting in a score from 0 to 4.

This approach removes subjectivity and ensures consistent, reliable results across raters, settings, and levels of experience. Independent analysis using a large state dataset has demonstrated strong reliability and stability of HRST scores over time.

Health Care Level Assigned

Based on the numerical total of the 22 Rating Items and a proprietary algorithm, a Health Care Level is assigned. Health Care levels can range from 1-6.

Action Steps

Based on the risks identified through the screening, the HRST generates Service and Training Considerations that guide next steps across the support team.

These considerations are structured discussion points, not requirements or recommendations. They identify areas that may warrant further evaluation, clinical involvement, or changes in support, while allowing the team to apply professional judgment based on the person’s needs.

See How the HRST Works in Practice

Turning Risk Identification into Prevention

Proven at Scale Across States and Providers

26 States Use Our Program

130,000+ Currently Being Monitored

2,000+ Private Provider Agencies

Who uses the HRST?

State IDD Agencies

State Medicaid Agencies

Managed Care Organizations (MCOs)

Provider Agencies

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