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DOH Presents Independent Assessment Operational Training

On Jan. 14th, the Department of Health (DOH), along with staff from Maximus, the State’s Medicaid managed care enrollment broker and selected Independent Assessor (NYIA), held its first operational training webinar for frontline staff. The focus of the session was how plans and the IA would interact to initiate and compete an initial assessment. While the session covered both Mainstream Medicaid Managed Care enrollees in need of Community-Based Long-Term Services and Supports (CBLTSS) and prospective Managed Long Term Care (MLTC) members, and the processes are similar in many cases, the highlights below focus on MLTC. The IA process applies to Partially Capitated MLTC and Medicaid Advantage Plus (MAP) plans. Programs of All-Inclusive Care for the Elderly (PACE) are not subject to the IA.

DOH is seeking to implement the IA starting on March 1, 2022. We are tracking and sharing implementation information even as we believe that the IA provision should be repealed due to severe misalignment with the current system’s needs. It will make it more difficult for individuals to access needed care, exacerbate the workforce crisis, and only widen existing service access gaps.

Maximus walked through a hypothetical example of an individual dually eligible for Medicare and Medicaid seeking to enroll into MLTC to receive CBLTSS. The first step would be a call to the NYIA helpline. If the prospective member has Medicaid in place, the representative would schedule an assessment. If the individual does not yet have active Medicaid, they would be referred to the Local Department of Social Service (LDSS). To request an Immediate Needs Assessment, the LDSS would complete an Expedited/Immediate Need Assessment Request online, then place a three-way call with the prospective member, the LDSS, and NYIA.

When NYIA schedules an assessment for the prospective member, they would schedule both the Community Health Assessment (CHA) and the clinical appointment for the Practitioner’s Order (PO). The CHA would be completed by a Nurse Assessor, while the clinical appointment would be conducted by a Medical Doctor (MD), Doctor of Osteopathic Medicine (DO), Nurse Practitioner (NP), Physician's Assistant (PA), or Specialist Assistant who has no relationship with the prospective member. The individual may choose either Zoom video or in-person meeting modality. NYIA utilizes a Health Insurance Portability and Accountability Act (HIPAA)-compliant secure Zoom platform for its virtual appointments.

One or two days prior to the scheduled assessment, the Nurse Assessor will reach out to prepare the prospective member to use Zoom and remind them to have the necessary information (e.g., medication list, Medicare card) available. The Nurse Assessor will meet with the individual at the appointed time to complete and finalize the assessment in the Uniform Assessment System for New York (UAS-NY). The clinical appointment, already scheduled, will consist of an exam; conference with any other providers, if necessary; review of the CHA in the UAS-NY; a determination if the individual is self-directing or has an appropriate self-directing caregiver; and, ultimately, a determination on whether the prospective member is medically stable enough to safely receive CBLTSS at home. The practitioner will upload the PO form to the UAS-NY. NYIA has 14 calendar days to schedule, complete, and upload the CHA and PO. The prospective member is notified of the decision five to seven business days after it is entered into the NYIA system.

The MLTC plan enrollment process would not change. The MLTC would offer a Plan of Care. If the prospective member chooses the plan, the plan would submit the request to Maximus to enroll the person into their plan.

DOH indicated that there would be several ways that a plan would be made aware of new enrollees, including the UAS-NY, daily file feeds, as well as some ad hoc reporting that will be available to the plan. This issue is scheduled to be covered in depth in a future session.

The timeline to complete a Plan of Care for plans remains the same and begins once they know that the CHA and PO have been completed.

The slides from the session are available here. The next training session is scheduled for Wed., Jan. 26th from 10:30 a.m. to 12 p.m. The second training session will cover Communications, Notices, and Reporting for the Initial Assessment Process. Registration is required here.

LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841