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Independent Assessor to Begin Reassessments for MLTC, Personal Care, and CDPAS in 2024

The NY Independent Assessor Program (NYIAP) will begin conducting routine and non-routine reassessments of Medicaid beneficiaries enrolled in Managed Long Term Care (MLTC) or receiving personal care or Consumer Directed Personal Assistance Services (CDPAS) in 2024, according to a Department of Health (DOH) memorandum issued on Oct. 2nd. Implementation of NYIAP reassessments will be phased in on a regional or county basis.

Since May 2022, the NYIAP (Maximus) has been conducting initial assessments of Medicaid beneficiaries, age 18 and older, seeking to enroll in MLTC or to receive personal care or CDPAS. The responsibility for conducting reassessments has remained with managed care plans and local departments of social services (LDSSs) during this initial phase. Routine and non-routine reassessments will now shift, as planned, to the NYIA.

The launch schedule for NYIAP reassessments will vary based on the type of reassessment (routine or non-routine) and the county in which the individual resides. Until the launch date for the NYIAP reassessments, LDSSs and managed care plans will remain responsible for all reassessments of individuals receiving personal care and/or CDPAS.

Individuals due for a routine reassessment will receive letters and reminder phone calls from the NYIAP. For routine reassessments due in March 2024, mailings will begin in January, in the counties indicated in the chart below. Individuals will be directed to contact the NYIAP to schedule a reassessment and clinical exam appointment.

Similarly, individuals seeking a non-routine reassessment (e.g., change in condition, return from hospital, consumer-requested) should be referred to the NYIAP in accordance with the chart below.

Individuals seeking to enroll in Programs of All-Inclusive Care for the Elderly (PACE programs) are eligible for direct enrollment via a PACE assessment. Under the PACE direct eligibility policy, reassessments of PACE enrollees also continue to be conducted by PACE programs, rather than the NYIAP. In addition, NYIAP reassessments only apply to adults age 18 and over. LDSSs and managed care plans still remain responsible for all assessments, initial and reassessment, of individuals under age 18 until further notice.

A summary of the IA process and regulations is available here. MLTC policy guidance regarding the initial assessment process is set forth in MLTC Policy 22.01. Information for LDSSs regarding the initial assessment process for fee-for-service personal care and CDPAS cases is available in 22 OHIP ADM-01.

Contact: Karen Lipson, klipson@leadingageny.org