Independent Assessment for Expedited Personal Care Launched

The Department of Health (DOH) launched, on Dec. 1, 2022, the independent assessment process for adults seeking Medicaid coverage of personal care or consumer directed personal assistance services (CDPAS) based on an immediate need for services. The new process applies to adults age 18 and over who are not enrolled in a Medicaid managed long term care (MLTC) plan. The process was detailed in a General Information System (GIS) message, GIS 22 MA/09, to local departments of social services (LDSSs).

Under the new process, adults with an immediate need for personal care or CDPAS must have a New York Independent Assessor (NYIA) Independent Practitioner Panel (IPP) appointment and obtain a Practitioner Order from the IPP. To document immediate need, applicants now have the option of providing a Practitioner Statement of Need form (DOH-5779) in lieu of a Physician’s Order form (DOH-4359 or HCSP-M11Q). The Practitioner Statement of Need requires less documentation from the practitioner and can be completed by a medical doctor (MD), doctor of osteopathic medicine (DO), nurse practitioner (NP), or physician assistant (PA).

Once the individual seeking services submits the completed Immediate Needs Packet as outlined in the Attestation of Need (see DOH-5786, formerly OHIP-0103), the LDSS is instructed to immediately refer the individual to the NYIA to schedule a community health assessment and clinical appointment, which should be completed in an expedited timeframe. The LDSS will initiate a three-way call with the NYIA Operational Support Unit (OSU), the LDSS, and the individual.

This process was originally scheduled to commence on July 1, 2022 (see 22 OHIP/ADM-01), but was delayed due to NYIA staffing shortages.

The NYIA process for individuals seeking to enroll in an MLTC plan or to receive personal care or CDPAS through a mainstream managed care plan or fee-for-service Medicaid has been plagued by delays and concerns about the quality of assessments. LeadingAge NY has been working with other associations and consumer representatives to document the issues and advocate for reform or roll-back of the process. Most recently, we joined a letter to DOH and the Governor's staff raising concerns and seeking improvements in the process.

We will keep members informed of developments in the NYIA process as they arise. 

Contact: Karen Lipson, klipson@leadingageny.org