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DOH Provides Guidance on Independent Assessment Process to LDSS Offices

In an Administrative Directive (22 OHIP/ADM-01) to Local Departments of Social Services (LDSSs) dated April 20, 2022, the Department of Health (DOH) formally communicated the New York Independent Assessment (NYIA) process for initial assessments that Districts should follow once it goes into effect on May 16, 2022. Other than the delay of the start date from May 1st to May 16th, the process is mostly as described in training sessions that DOH has held, slides from which are posted on the NYIA page of the DOH website here. The process to be followed by LDSSs is substantively similar to that required of Medicaid Managed Care plans.

The ADM clarifies that individuals who initiated the process for Personal Care Services/Consumer Directed Personal Assistance Services (PCS/CDPAS) through the LDSS prior to May 16, 2022 can be assessed under the process in place prior to May 16, 2022. For example, if an individual called the LDSS for an assessment on May 12, 2022 and was scheduled to have an assessment conducted by the LDSS on May 20, 2022, that individual should still be assessed by the LDSS.

At this time, the LDSS will continue to perform:

  • pediatric Community Health Assessments (CHAs) to authorize PCS/CDPAS for children aged 0-17 years;
  • routine annual reassessments for authorizing PCS and/or CDPAS for all ages; and
  • non-routine reassessments as necessary, including return from institutionalization assessments, significant change in condition assessments, and assessments at the individual’s request for all ages.

DOH envisions issuing separate ADMs that will detail (a) the NYIA reassessment process for adults (aged 18 and over); and (b) the NYIA assessment process for the pediatric population.

While the NYIA will be responsible for performing the independent CHA and Practitioner’s Order (PO), the LDSS remains responsible for developing the individual’s plan of care (POC) and authorizing PCS and/or CDPAS. In developing the POC and authorization of services, the LDSS must review the NYIA CHA and PO and determine that PCS and/or CDPAS are appropriate, medically necessary, and can reasonably maintain the individual’s health and safety in their home. As part of this process, the LDSS continues to be responsible for (a) reviewing other available services and supports to determine whether they meet the individual's needs and if they are cost-effective; (b) determining frequency of nursing supervision; (c) determining the individual’s preferences and social and cultural considerations for the receipt of care; (d) heightened documentation requirements for 24-hour cases; and (e) confirming the willingness and availability of any informal supports identified in the CHA. The LDSS remains ultimately responsible for the authorization of services and must record in the POC the level, amount, frequency, and duration of services that the LDSS authorizes and send notice of service authorization.

The Immediate Need process will shift to the IA process on July 1, 2022. Under the Immediate Need process, the care planning process must typically conclude and the LDSS must authorize services within seven business days of receiving the NYIA CHA and PO. For high-needs cases forwarded to the Independent Review Panel (IRP), the seven business-day timeframe for authorization will be pended until receipt of the IRP recommendation.

The LDSS will continue to have no more than 12 calendar days from receipt of the Attestation of Need and Practitioner Statement of Need, and when applicable a completed Medicaid application, to refer the individual to the NYIA for an Immediate Need CHA and clinical appointment, review the outcome, develop a POC, and authorize PCS and/or CDPAS as needed. The LDSS shall provide such services to individuals not exempt or excluded from membership in a Medicaid Managed Care Organization (MMCO) until they can be enrolled.

The full text of the ADM to LDSS offices is available here.

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