DOH has published revised proposed regulations governing independent assessments and eligibility for PCS and CDPAS covered by Medicaid. Comments are due on March 13^th.

These comments follow a broader set of recommendations submitted in August and focus on the text of the regulations, as opposed to contractual and implementation issues.

LeadingAge NY and other associations representing MLTC plans met with DOH on Sept. 1^st to discuss the proposed regulations governing eligibility for personal care and CDPAS and the independent assessment process. In a second meeting that day, DOH reviewed proposed amendments to the MLTC contract to align the contract with COVID-19 emergency policies.

The recommendations include a phased implementation, provisions to improve the validity of independent assessments and independent medical evaluations, a mechanism to resolve disputes between managed care plans or social services districts and the independent assessor, strict timeframes to ensure prompt enrollment and timely response to changes in condition, and accommodations for PACE programs.

In a meeting with representatives of MLTC plans, DOH described initial plans for implementing independent assessment and independent physician reviews and the 30-month transfer of asset lookback for community-based long term care.

DOH has provided a preview of proposed regulations to implement the changes in eligibility for personal care and CDPAS, the assessment processes, and other initiatives required as a result of the MRT II process and budget legislation.

In a series of webinars for managed care plans, DOH described its plans for implementing the independent assessor and physician panel initiatives for MLTC, MLTC enrollment caps and withholds, encounter data withholds, and new electronic notice and prior authorization standardization policies.

Session will offer background and practical information on FIDA.