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IPRO Desk Audit Findings on the UAS-NY

The Department of Health (DOH) held another Nursing Home Transition & Diversion (NHTD)/Traumatic Brain Injury (TBI) stakeholders meeting on May 3rd. The meeting focused primarily on the Uniform Assessment System for New York (UAS-NY) and the ongoing studies to test its validity.

Audit representatives from Island Peer Review Organization (IPRO) gave a presentation of their findings from a recent study of the UAS-NY to validate data collected from previous assessments. The audit looked at assessments of 360 TBI participants in 2015, whose Nursing Home Level of Care (NH-LOC) score of five or greater was not evident from previous assessments. Out of the pool of 360, the audit sample consisted of 96 participant records from across the nine Regional Resource Development Centers (RRDCs). Each record contained 44 elements; in all, a total of 4,224 elements were reviewed (see slide three).

Because IPRO staff did not have access to the individuals, their families, or their service coordinators as a UAS-NY assessor would, the IPRO team reviewed service plans for the individuals, comments on the assessments, and documents from the individual’s home care agency, if available. The results of the audit included an analysis of whether IPRO’s assessment of an individual’s information agreed with what the original UAS-NY assessor had decided. Of the audit sample, IPRO agreed with 87.7 percent of the UAS-NY scores, disagreed with 9.3 percent of the scores on the basis that the individual needed a greater level of care, and disagreed with 3 percent of the scores on the basis that the individual needed a lower level of care (see slides seven and eight). While the overall agreement rate is high, IPRO explained that in the areas of disagreement, the disparities between the UAS-NY assessment and IPRO’s assessment were significant. These areas of disagreement supporting a higher level of acuity were in cognitive skills, short term memory, procedural memory, meal preparation, managing medications, bathing, personal hygiene, and dressing (see slides 10-18).

As a result of their findings, IPRO outlined several recommendations. IPRO recommended that UAS-NY assessors have as much case history as possible on an individual to review prior to conducting the assessment. IPRO also recommended that if an individual does not have a high enough NH-LOC score, a separate clinical assessment should be conducted to determine service needs. Lastly, IPRO recommended additional training for assessors, focusing particularly on the areas where there was the greatest disagreement.

In addition to the IPRO audit, the University of Michigan and interRAI, the creator of the assessment tool, are currently studying the UAS in terms of its ability to assess for cognitive disabilities. DOH stated that they are waiting for the results of this study, which should be completed shortly. DOH again stated their commitment to making any changes to the UAS-NY recommended by the study.

David Hoffman, Director, Bureau of Community Integration and Alzheimer’s Disease, explained that the UAS-NY is conducted after an individual is deemed eligible for Medicaid and has selected a service coordinator. Hoffman stated that in the future, if an individual’s UAS-NY score is less than five, he or she will be able to have a second UAS-NY conducted, preferably by RRDC staff. Some of the stakeholders attending the meeting were not supportive of having participants undergo the second UAS-NY. They stated that it could be traumatizing to the participants and thought it would be a waste of Medicaid monies. DOH also stated that if the individual scores less than a five on the second UAS-NY, he or she may have a separate clinical assessment conducted by a specialist. Stakeholders voiced that the clinical assessment should be used in lieu of the second UAS-NY. DOH shared that they are creating a form for the specialist to complete to certify that the individual has a NH-LOC. Stakeholders voiced their concern that finding a specialist to conduct the assessment is a challenge and is further complicated by the Medicaid reimbursement being so low.

DOH staff shared that future meetings will include panel discussions from service coordinators and care managers from plans.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871