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Roll-Back of Independent Assessment Process Sought by LeadingAge NY, Other Advocates

In an Oct. 27th letter to the Department of Health (DOH), LeadingAge NY, other managed care and provider associations, and consumer advocates called for a significant reduction in the scope of the independent assessment process for Personal Care Services (PCS), Consumer Directed Personal Assistance Services (CDPAS), and Managed Long Term Care (MLTC). Highlighting substantial delays in scheduling assessments, poor quality assessments, and unsatisfactory call center service, the letter requested the elimination of independent clinical assessments and a delay in the launch of independent 'immediate need' and expedited initial assessments and independent reassessments. The letter was signed by LeadingAge NY, the Home Care Association of New York State, Medicaid Matters, the Coalition to Protect the Rights of New York’s Dually Eligible, the Coalition of MLTC and PACE Plans, the Coalition of NYS Public Health Plans, and the Health Plan Association.

The independent assessment process was proposed by the second Medicaid Redesign Team (MRT) and was enacted in the 2020 State Budget. It requires an assessment by the State's contractor (Maximus) in order to qualify for PCS, CDPAS, and MLTC. The assessment has two components: the community health assessment used for eligibility and care planning and the clinical assessment by a physician, physician assistant, or nurse practitioner. In cases that involve more than 12 hours of PCS or CDPAS daily, the process also requires a review by a clinical panel.

Launched in May 2022 for initial assessments, the independent assessment process has been plagued by lengthy delays in scheduling assessments, especially in-person assessments and clinical assessments. Plans and consumers have also raised concerns about the quality of assessments, citing internal inconsistencies, mistakes, and inaccurate coding. Immediate need assessments and expedited assessments are scheduled to be rolled out in December.

The letter calls for a roll-back of the process to eliminate the clinical assessments until there is sufficient capacity to enable them to take place within required timeframes. It also requests the suspension of independent assessment for individuals accessing services through the local departments of social services (LDSSs) (fee-for-service Medicaid beneficiaries). It seeks a further delay in the launch of independent reassessments and expedited and immediate need assessments, enhanced training and oversight of assessors, and greater transparency of assessment data. If scheduling and quality concerns cannot be remedied in the near future, the letter asks the State to reconsider the use of independent assessment in its entirety.

LeadingAge NY will keep members updated on developments in the independent assessment process. More information about the independent assessment process and regulations is available here.

Contact: Karen Lipson, klipson@leadingageny.org