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DOH Holds Webinar Fleshing Out Independent Assessor Process

The Department of Health (DOH) held a webinar on Dec. 21st setting forth details of the New York Independent Assessor (NYIA) process slated for roll-out in March 2022. Topics covered on the webinar included:

  • NYIA Overview
    • NYIA
    • NYIA Independent Practitioner Panel (IPP)
    • NYIA Independent Review Panel (IRP)
    • Program of All-Inclusive Care for the Elderly (PACE) Exemption
  • Transition Timelines
  • NYIA Processes
    • Initial Assessments
    • Immediate Need
    • Reassessments
    • IRP
  • Community Health Assessment (CHA) Variance Resolution Process
  • Communications
  • Resources and Next Steps 

Slides from the presentation will soon be made available. Additional webinars will be held during the month of January to prepare for this major systems change. Frontline staff of plans, DOH, and Maximus staff will participate in the webinars, and there will be opportunity for interaction, questions and answers, and fleshing out operational issues during the presentations. Questions, in the meantime, can be posed to independent.assessor@health.ny.gov. DOH looks forward to using plan questions to help their planning and communication processes.

This process will commence on March 1, 2022, with Maximus as the entity carrying out the new process. This replaces the Conflict-Free Evaluation and Enrollment Center (CFEEC) and will serve as the process for determination of services and eligibility for Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS). 

The IPP will authorize PCS/CDPAS. The IPP will carry this out after review of a member’s CHA, conference with other providers, and after other determinations are made. Practitioners signing orders will include MDs, Doctors of Osteopathy, Nurse Practitioners, Physician Assistants, and Specialist Assistants. This process will replace the previously required physician order.

Minimum eligibility requirements adopted in the State Budget will not change at this time. This will be set aside for a later date. Also, the new process does not change who carries out reassessments for Adult Day Health Care (ADHC), PACE, and the Assisted Living Program (ALP). The new IA process will not change the assessment tool, the CHA.

The NYIA will perform the CHA and the Clinical Appointment to evaluate individuals for a Practitioners Order (PO). This assessment will be performed every 12 months unless a change in condition occurs.

The webinar laid out the operational hours of the Maximus call center and the hours for the CHA and Clinical Appointment process. The assessment process is to be carried out within 14 days for a standard case and within six days for expedited cases.

The IRP will review high-need cases that exceed 12 hours a day on average. The IRP will review an individual's CHA, PO, and Plan of Care (POC) and develop recommendations as to whether the proposed POC is reasonable and appropriate. Their recommendation includes suggested changes in scope, type, amount, or duration of services but cannot specify recommended number of hours.

PACE will not be impacted by the IA requirements.

The webinar included discussion of transition timelines. Implementation will include all initial assessment activities for individuals seeking Managed Long Term Care (MLTC) eligibility enrollment, fee-for-service (FFS), and mainstream Medicaid managed care enrollment seeking community-based long-term services and supports (CBLTSS). The roll-out will also include all reassessments, including routine annual and non-routine due to sudden change in condition or return to community assessments.

The webinar set forth processes for initial assessments and expedited assessments, the latter entailing a three-way call between the member, Maximus, and the plan to be completed within six days of request.

For reassessments starting March 1st, the IA will conduct all routine and non-routine reassessments in addition to initial CHA assessments. For routine reassessments, the IA will send a reassessment reminder notice 65 days prior to the due date to tell members to contact the IA to schedule their annual CHA reassessment. For non-routine assessments, the MLTC can initiate the assessment process through a three-way call to the IA Operational Support Unit (OSU). Plans will receive reports of their members who have been scheduled for CHA reassessments.

DOH recognizes that plans are continuing to address the pandemic-related backlog of reassessments. As reassessments transition to the IA, DOH will notify plans to cease scheduling and conducting all adult reassessments, both routine and non-routine. It is anticipated that the plans will need to cease scheduling assessments on Feb. 14, 2022 and should be completed with all scheduled assessments by the end of March 2022.

On March 1st, all reassessment dates in the Uniform Assessment System (UAS) will be redistributed over a 12-month period starting May 1, 2022. All reassessments, both routine and non-routine, will be conducted by the IA after March 1, 2022. Plans will align their authorization dates for individuals under their care with these new assessment dates to ensure continuity of care.

The webinar reviewed the process for the IRP. For cases over 12 hours, plans must submit a POC for review by the IRP and complete an IRP request form for the IRP to conduct its review. Further details are provided.

The webinar addressed the CHA variance resolution process. Factual disputes will result in the current CHA being unfinalized and changed. Clinical disputes will result in a second CHA being conducted. The CHA variance resolution process between the IA and plan does not impact the timeframe for service authorization. For members, the fair hearing process will still be available. The CHA variance resolution process is only for plan and IA disputes.

The webinar covered critical interactions between plans and the IA, including maintenance of timely and accurate enrollment records in the UAS platform and attestation of consumer records after POC and consumer agreements are finalized. Maximus will include regular reporting in their Move-it platform on scheduled assessments and outcomes. DOH will provide instructions to plans outlining the process for accessing reports. Plans can call the NYIA OSU for interactions such as requests for the immediate need assessments, non-routine assessments, and CHA variance requests. Forms for these processes will be available on the Maximus site. Upon completion, these forms should be submitted via a secure weblink to the NYIA.

DOH is in the process of establishing an NYIA webpage, which will be housed hereThe site will include the recording and slides from the Dec. 21st presentation and upcoming webinars. 

Contact: Meg Everett, meverett@leadingageny.org, or Karen Lipson, klipson@leadingageny.org. Both can be reached at 518 867-8383.