The MMC plan must continue to notice members of its decisions to deny or authorize services, even where those decisions are based in part on the CHA, PO, or IRP recommendation performed by the NYIA. P)yvg>Fi endstream endobj 66 0 obj <>>> endobj 67 0 obj <>/Font<>/ProcSet[/PDF/Text]/Properties<>>>/Rotate 0/TrimBox[18.0 18.0 630.0 810.0]/Type/Page>> endobj 68 0 obj <>stream The MMC plan remains ultimately responsible for the authorization of services and must record in the plan of care (POC) the level, amount, frequency and duration of services that they authorize, and send notice of service authorization to the enrollee. For information about your request for an assessment or general inquiries, please call: NYIA Operations Support Unit Phone: 1-855-665-6942 TTY: 1-888-329-1541. The CSR will proceed with scheduling a CHA and a clinical appointment upon verifying the consumer's identity, contact information, preferred assessment modality (telehealth or face-to-face) and, if needed, the location of an in-person visit. Phone:1-855-665-6942 If the member refuses to have a new CHA conducted, the refusal to cooperate with a new assessment pursuant to a CHA Variance request does not constitute non-compliance with the assessment process and may not be used as a basis to deny, reduce or terminate services. Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, James V. McDonald, M.D., M.P.H., Acting Commissioner, Multisystem Inflammatory Syndrome in Children (MIS-C), COVID-19 Excelsior Pass/Excelsior Pass Plus, Addressing the Opioid Epidemic in New York State, Drinking Water - Boiling Water and Emergency Disinfection Info, Health Care and Mental Hygiene Worker Bonus Program, Learn About the Dangers of "Synthetic Marijuana", Maternal Mortality & Disparate Racial Outcomes, NYSOH - The Official Health Plan Marketplace, Help Increasing the Text Size in Your Web Browser, the Community Health Assessment (CHA) in the UAS-NY, New Yorks comprehensive assessment for State Plan CBLTSS, conducted by a Registered Nurse; and, a clinical exam, conducted by a clinician on an Independent Practitioner Panel (IPP) under the New York Independent Assessor (NYIA); and. Where the MMC plan requests that NYIA OSU provide materials or written testimony to be presented by the MMC plan or entered into the record at the hearing, such materials shall also become part of the evidence packet. These members will also be instructed to contact their MMC plan for next steps. endobj Services covered through New York's 1915(c) Waivers, including the Nursing Home Transition and Diversion (NHTD), Traumatic Brain Injury (TBI) and the Office for People with Developmental Disabilities (OPWDD) Comprehensive Waiver, will not require a NYIA CHA. Questions can be sent to independent.assessor@health.ny.gov. The NYIA process will take the place of CHAs currently conducted by the Local Departments of Social Services (LDSS) and Managed Care Organizations (MCO). 3 0 obj Make sure you manually sign (by hand) any forms that have a signature area. If the IRP process extends beyond required timeframes, the MMC plan must provide services in accordance with the proposed POC on a temporary basis, pending review of the IRP recommendation. The Department has contracted with Maximus Health Services, Inc. (Maximus) to implement the New York Independent Assessor (NYIA), which includes the independent assessment, independent practitioner panel and independent review panel processes, leveraging their existing Conflict Free Evaluation and Enrollment Center (CFEEC) infrastructure and experience. JUNE 17, 2022 UPDATE To Immediate Needs/Expedited Assessment Implementation Date. 0 5 The new NYIA process will involve a Community Health Assessment ("CHA") or Independent Assessment ("IA") by a registered nurse as well as a second step, consisting of an Independent Practitioner Panel ("IPP") which includes an examination by a clinician - a clinical appointment ("CA") to determine the number of home care hours to be provided to applicants for Medicaid-covered individuals seeking personal care services (PCS), consumer directed personal assistance services . Also, eligibility for Personal care and CDPAP services and enrollment in MLTC will soon require the need for assistance for THREE Activities of Daily Living (ADLs) or dementia. Changes in the member's need for services unrelated to a significant change in condition (such as availability of informal supports) do not require a new CHA but need to be documented in the POC and the MMC plan must consider and make any authorization changes. Annual reassessments and requests for increases by MLTC, managed care plans and local districts will not be done through the New York Independent Assessor system yet. These documents are used by the MMC plan to develop a Plan of Care (POC) to address the members identified needs and authorize services. TheNew York Independent Assessor (NYIA) programhas been established for New York State Medicaid members who want to receive community-based long-term services and supports. 0 _[&K)1E(,@h~d66 QJ,U. 65 0 obj <> endobj This is Attorney Advertising. Using Reader 11 or later, you will be able to save your completed forms. For a small number of income tax forms, there is an enhanced fill-in file provided. Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, James V. McDonald, M.D., M.P.H., Acting Commissioner, Multisystem Inflammatory Syndrome in Children (MIS-C), COVID-19 Excelsior Pass/Excelsior Pass Plus, Addressing the Opioid Epidemic in New York State, Drinking Water - Boiling Water and Emergency Disinfection Info, Health Care and Mental Hygiene Worker Bonus Program, Learn About the Dangers of "Synthetic Marijuana", Maternal Mortality & Disparate Racial Outcomes, NYSOH - The Official Health Plan Marketplace, Help Increasing the Text Size in Your Web Browser, Consumer Directed Personal Assistance Regulations, MMC Guidance - Process for Expedited Request for Assessment and the New York Independent Assessor (NYIA) -, MMC Guidance - ADDITIONAL REVISION Implementation Date for New York Independent Assessor (NYIA) to Conduct Assessments for Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS) on an Expedited Basis -, MMC Guidance - REVISED Implementation Date for New York Independent Assessor (NYIA) to Conduct Assessments for Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS) on an Expedited Basis -. Clinical Appointment - The IPP clinician will conduct a clinical exam, review the CHA and any supporting documents, and issue a Practitioner Order (PO) for PCS and/or CDPAS. March 4, 2022 - Letter Announcing May Implementation Dates for Additional PCS/CDPAS Regulatory Changes. A sample of the form is attached to this guidance document. TTY:1-888-329-1541, Monday to Friday, 8 a.m. to 7 p.m. <> reviewing other available services and supports to determine cost effectiveness; determining frequency of nursing supervision; determining the member's preferences and social and cultural considerations for the receipt of care; heightened documentation requirements for 24-hour cases; and. This page is made available by the lawyer for educational purposes only as well as to give you general information and a general understanding of the law, not to provide specific legal advice. NYIA Operations Support Unit Phone: 1-855-665-6942 TTY: 1-888-329-1541. This assessor will replace the Conflict-Free Evaluation. We will send you a notification of the changes in a letter between January and June. When you have completed the form, remember to save your information, then print and sign manually as usual. MMC plans will continue to conduct reassessments for adults aged 18 and over, and initial assessments and reassessments for children aged 4-17, until further notice. Am I Eligible for Community Based Long Term Services and Supports? Simply click your left mouse button in the field you want and the cursor will return. The MMC plan will be notified via secure email. Our state-specific browser-based blanks and complete guidelines eradicate human-prone errors. See 18 NYCRR 505.14(b)(2)(v) and 505.28(d)(5). The IPP is comprised of qualified, independent clinicians including Medical Doctors (MDs), Doctors of Osteopathy (DOs), Nurse Practitioners (NPs) and Physician or Specialty Assistants (PAs). If the IPP clinician determines the individual is not medically stable, then the MMC plan may not authorize PCS and/or CDPAS. Both the appellant and the MMC plan may call NYIA as a witness to any case regarding the challenge of a determination of services where the MMC plan relied on the CHA, PO, or IRP recommendation provided by NYIA. 02. Caution:When using a public computer (library, computer cafe, etc. The NYIA will schedule both a CHA and a Clinical Appointment for the member and both will be completed within 14 days of contact with the NYIA. Requirements for authorizing continuous PCS and/or CDPAS or live-in 24-hour PCS remain unchanged from prior directives, except for the requirement for additional medical review by the NYIA IRP in the first instance once the NYIA is implemented. 4. The Request for Review (RFR) application provides New York City property owners an opportunity to challenge their estimated market values as of January 5, 2022, the taxable status date. The MMC plan does not need to refer cases to the IRP if the amount of service in excess of 12 hours a day, on average, is ordered pursuant to a Fair Hearing decision, external review decision, or by any other court of competent jurisdiction. 2. GIS 22 MA/09 - Implementation of Assessments Conducted by the New York Independent Assessor (NYIA) Based on an Immediate Need for PCS/CDPAS (PDF) When determining the availability of voluntary informal supports, MMC plans must contact the caregiver identified by NYIA during the assessment process, or one identified by the MMC plan through care planning activities. The regulations, as cited above, define the high needs threshold as more than 12 hours a day, on average of PCS and/or CDPAS. Current recipients will be grandfathered in. NYIA registered nurses conduct a UAS assessment of these individuals to determine whether they qualify for these services. %PDF-1.6 % Members of the Independent Practitioner Panel (IPP) conduct clinical appointments by telehealth and issue Practitioners Orders for Medicaid members who have been assessed as requiring personal care and other services. Complete the interest form and you will be contacted by one of our agency partners to discuss current opportunities. See PHL 4903(2)(a). This guidance provides notification of changes to the initial assessment process for Medicaid Managed Care (MMC) members in mainstream (MMC) plans, to include HIV Special Needs Plans (HIV SNPs), and Health and Recovery Plans (HARPs), seeking Personal Care Services (PCS), Consumer Directed Personal Assistance Services (CDPAS) or transfer to a Managed Long Term Care (MLTC) plan. The NYIA will also take over the work currently done by the Conflict Free Evaluation and Enrollment Center (CFEEC) to assess individuals for MLTC plan eligibility. The content of the site in no way creates an attorney-client relationship. City of New York. All rights reserved. Questions on this guidance can be sent to independent.assessor@health.ny.gov. For more information, please contactGuardianship, probateandestate planningattorneyRegina Kiperman: Phone:917-261-4514 Fax:929-556-2089 Email:rkiperman@rklawny.com, Or visit her at:40 Wall StreetSuite 2508New York, NY 10005Visit Regina on LinkedInVisit Regina on Facebook. xok0\I ? Property owners have the right to challenge the Department of Finances assessments and correct erroneous information associated with their properties. C3lL?q nCBfm.pD|@5 '90 IW1"cJ HL$S>+1pqPg'cO=?y$=Nd%6dRF>9 bO-]>)}z]xo-rkC"_!g,;=^H). View a form by clicking the link to the form number or use the following steps to download the form: Right-click on the link to the form number. 103 0 obj <>/Filter/FlateDecode/ID[<466FD9BA560342CE95011ED96A1EE776>]/Index[65 78]/Info 64 0 R/Length 149/Prev 63200/Root 66 0 R/Size 143/Type/XRef/W[1 2 1]>>stream Saturday and Sunday, 10 a.m. to 6 p.m., except for designated state holidays. Managed Care Plan Information SECTION 3. Practitioner Order (PO) - The Practitioner Order (PO) is the order form, which is required to authorize PCS and/or CDPAS, that must be completed by the IPP clinician after reviewing the CHA in the UAS-NY and determining if the individual is self-directing, or has an appropriate self- directing other, and can safely receive PCS and/or CDPAS at home based on their medical stability. Get the facts about the COVID-19 vaccine. {9t . NYIA will complete the Community Health Assessment (CHA) to determine service needs and, where applicable, MLTC plan eligibility. 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