HCBS and PACE/MLTC Cabinets Work to Make Conflict-Free Trouble-Free

Effective Oct. 1, 2014, the Department of Health (DOH) is implementing Conflict-Free Assessment (CFA) for new Medicaid enrollees.

The federal Centers for Medicare and Medicaid Services (CMS) has mandated that DOH implement CFA as part of the current transition of the Medicaid system to managed care.  Under this mandate, CMS is seeking to ensure that there is a separation of responsibility between the determination that an individual is eligible for long term managed care services and the provision of those services.  

As currently envisioned by DOH, Maximus (aka Medicaid Choice) would be responsible for making the initial determination that an individual needs managed long term care services.  This means that the individual requires home and community-based services for more than 120 days and/or is at a nursing home level of care.  It is likely that Maximus will use the NY Uniform Assessment (UAS) as the assessment tool.  The managed care plan would in turn be responsible for care planning and determining the individual’s level of services.  The plan may use the initial Maximus UAS or complete their own, but in either case the plan remains responsible for ensuring the accuracy of the information used to determine the plan of care.

The LeadingAge NY Home and Community-Based Services and PACE/MLTC Cabinets are working together to build on previous collaborative efforts focused on the Balancing Incentive Program's “Conflict Free Case Management”  to develop recommendations about how best to implement the new version of CFA. 

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8383, ext. 151; or Patrick Cucinelli, pcucinelli@leadingageny.org, ext. 145