Requests for PCS and/or CDPAS made on an expedited basis will continue to be made by the MMC plan until July 1, 2022. This is an excellent opportunity for clinicians to exercise their management skills in a hands-on, collaborative, and dynamic work environment. A disagreement occurs when the MMC plan disputes a finding or conclusion in the CHA that is subject to the independent assessor's clinical judgment. 4. ), saving your entries may make your personal information available to others. After assessments are conducted, anIndependent Practitioner Panel (IPP)composed of physicians, nurse practitioners, and physician assistants will conduct clinical appointments and issue practitioners orders for personal care and other services for individuals who have been assessed as being qualified for these services. Timeframes for authorizing services are not pended for high-needs cases that are forwarded to the IRP. Questions can be sent to independent.assessor@health.ny.gov. For standard requests, the MMC plan will no longer conduct a separate CHA to authorize PCS and/or CDPAS. If NYIA cannot reach a decision on whether such variance occurred due to insufficient or incomplete information, NYIA OSU staff will reach out to the MMC plan to obtain additional documentation. GIS 22 MA/05 and Mainstream MC Guidance were posted on June 17, 2022 to delay implementation of the NYIA conducting initial assessments based on an immediate or expedited need for PCS and/or CDPAS to October 1, 2022. Simply click your left mouse button in the field you want and the cursor will return. Independent Review Panel (IRP) - An independent panel of clinicians under the NYIA that will provide a secondary medical review for high needs cases and issue a recommendation to the LDSS or MLTC plan regarding whether the proposed plan of care is reasonable and appropriate to maintain the individual's health and safety at home. 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. The implementation date of the New York Independent Assessor is now anticipated to begin on May 16, 2022. It has been in continuous use in NYS since 2011 and is not changing based on the revised statute or regulation. After assessments are conducted, an Independent Practitioner Panel (IPP) composed of physicians, nurse practitioners, and physician assistants will conduct clinical appointments and issue . %PDF-1.7
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Some important dates to know are as follows: May 16th is the start date for MLTC enrollment and all new requests for Personal Care and CDPAP made to mainstream or HARP plans, and to local districts (DSS/HRA) on a standard timeframe (pushed back from May 1st, which DOH had posted on Feb. 4, 2021), July 1st is the start date for Immediate Need requests to DSS/HRA and all EXPEDITED PCS and CDPAP requests made to mainstream/HARP plans or to local districts (pushed back from May 1st). The IRP report and recommendation form for high needs cases will be uploaded to the UAS-NY and must be considered by the MMC plan prior to finalizing the POC and authorizing services. Save the form on your computer. Copyright 2023 Regina Kiperman, RK Law PC, Contested Accountings in Surrogates Court, Regina Kiperman, RK Law PC (917) 261-4513, 40 Wall Street, Suite 2508 New York, NY 10005, Contested Accountings in Surrogates Court. Your phone call is important to us. An assessment form can come in different types. 5 iFf -}Oly9-"CT2|0 Y
To obtain the latest version of the free Adobe Reader, visit theAdobe Web site. 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. %/L}Q_&wv>UF\n1 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). Be sure to make and keep a copy of your completed forms after they are signed. nyia assessment request form pdf. %PDF-1.6
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C3lL?q nCBfm.pD|@5 '90 IW1"cJ HL$S>+1pqPg'cO=?y$=Nd%6dRF>9 bO-]>)}z]xo-rkC"_!g,;=^H). 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. Managed Care Plan Information SECTION 3. To schedule your assessment, we will ask for your Medicaid or Social Security number. 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. NYIA sends LDSS representative anauto-generated email confirmation that the form has been received. hb```e``"y@
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Telehealth - synchronous live interactive video teleconference. 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. The NYIA process will take the place of CHAs currently conducted by the Local Departments of Social Services (LDSS) and Managed Care Organizations (MCO). Current recipients will be grandfathered in. The Request for Review (RFR) application provides New York City property owners an opportunity to challenge their estimated market values as of January 5, 2023, the taxable status date. JUNE 17, 2022 UPDATE To Immediate Needs/Expedited Assessment Implementation Date. During the Clinical Appointment, an IPP clinician will: The PO represents the clinical judgment of the practitioner. The implementation of a 30 month look back period for home care has been looming over our heads through most of the pandemic. Saturday and Sunday, 10 a.m. to 6 p.m., except for designated state holidays. These documents are used by the MMC plan to develop a Plan of Care (POC) to address the members identified needs and authorize services. 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. Theobald Theodor Friedrich Alfred von Bethmann Hollweg (29 November 1856 - 1 January 1921) was a German politician who was Chancellor of the German Empire from 1909 to 1917. the development of the POC, including the amount, duration, and frequency of services. The earliest implementation date is Oct. 1, 2022. You can move around the form without using the Tab key by clicking in any field in which you want to position your cursor. Assessment Request Form and submits via secure URL. 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. This is Attorney Advertising. 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 (CDPAS) and/or Managed Long Term Care (MLTC) Plan enrollment. The implementation date of the New York Independent Assessor is now anticipated to begin on May 16, 2022. %%EOF
A sample of the form is attached to this guidance document. MMC Guidance for the Implementation of the New York Independent Assessor for Initial Assessments, Health & Safety in the Home, Workplace & Outdoors, Clinical Guidelines, Standards & Quality of Care, All Health Care Professionals & Patient Safety, Medicaid Managed Care Advisory Review Panel (MMCARP), 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. :hX1x|29:c@C-X.5n^,=~K0D{G>4n_Fuqn7.T&~NWY,/wMH^Hl#j'.wS0&PUpRCpj;&f0)+0]0&tG . DOH will monitor MMC plan participation in coordinating assessments through the NYIA and assess violations in light of its own performance and against its peers, its history, the impact of any violations and evidence of good faith effort and past responsiveness in determining whether to levy such sanctions. The assessment helps us understand how a person's care needs affect their daily life. MMC plans will be notified of completed IRP reviews by a phone call from the OSU. 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. The Independent Practitioner Panel (IPP) is composed of physicians, nurse practitioners, and physician assistants who conduct clinical appointments by telehealth and issue Practitioners Orders personal care and other services for Medicaid members who have been assessed as being qualified for these services. The PO replaces the currently used Physician's Order forms (DOH-4359 and HCSP- M11Q) which are obtained prior to an assessment. a6fd{v[qgk.m!|;#jyFR] GnZR3`5LC5eAo>Py3:@bft0iS7H= MMC members voluntarily seeking a transfer into a MLTC plan will need a NYIA assessment to determine eligibility.
For members seeking services within the MMC plan, upon completion of both the CHA and the PO, the individual will receive a notice form NYIA indicating whether their health condition is stable to receive PCS and/or CDPAS in their home. hYko+"! I4mA$:WR~gHdv#C3IL! 65 0 obj
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Press the Tab key to accept your entry and to move to the next field. Managed Care Plans: Click herefor information on how to assist members to receive an Expedited Assessment with the New York Independent Assessor. See 18 NYCRR 505.14(b)(2)(iv)(d) and 505.28(d)(4)(iv). Sign up online or download and mail in your application. Don't forget to hand sign any forms that require a signature and to keep a copy of your signed return for your records; see the return instructions for guidance on how long you need to keep these copies. 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 Department has defined processes to address any discrepancies the MMC plan finds in the NYIA CHA or PO. endstream
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Complete the interest form and you will be contacted by one of our recruiters to discuss current opportunities. The MMC plan may seek an extension for an additional 14 calendar days to these timeframes. Prior to authorizing more than 12 hours of services per day on average, for a new recipient of PCS and/or CDPAS on or after May 16, 2022, the MMC plan must refer the case to the NYIA's Independent Review Panel (IRP) for an additional independent medical review and must consider the recommendation of the IRP when finalizing the POC. Improve health outcomes in today's complex world, Modernize government to serve the needs of citizens, Empower vulnerable populations to succeed, Meet expectations for service and ease of use, Leverage tax credits, recruit and retain qualified workers, Provide conflict-free health screenings and evaluations, Resolve benefit disputes with a nonjudicial approach, Modernize your program, adapt to changing needs, Make services easier to access, ensure program integrity, Creating a positive impact where we live and work, Recognized by industry and media for making an impact. For information about your request for an assessment or general inquiries, please call:
If 12 hours or more are indicated or required, there will be another independent medical review required by an Independent Review Panel (IRP), another group consisting of at least two clinicians. ||}a|SSyKUMaBoyX~t_x^XzrExNO /WcR/^0M-{]Xz|[~{\lZ&;zc_g}Go_}aO!rtk=6y|*a;2H~My2_g]qwaeqywo`'.xLS):'2+xM6~-`!s]. However, PCS and/or CDPAS authorized for Waiver participants by an MMC plan, will require a NYIA CHA pursuant to the revised regulations. Serving all of New York City including, but not limited to, the following localities: NYC including New York County (Manhattan); Bronx County; Kings County (Brooklyn); Queens County including Astoria, Bayside, Flushing, Forest Hills, Fresh Meadows, Kew Gardens, Long Island City, Middle Village, Queens Village, Rego Park, Ridgewood, Whitestone, Woodhaven, and Woodside; Richmond County (Staten Island); as well as Nassau County including Garden City, Great Neck, Levittown, New Hyde Park, Syosset, and Westbury; Suffolk County; and Westchester County including New Rochelle and Yonkers. SeeCompleting fill-in formsabove for more information on how to complete the fill-in form before saving. What Do I Need to Know About Assessments and Clinical Appointments? Beginning May 16, 2022, the NYIA will conduct all initial assessments for individuals seeking PCS and/or CDPAS, including Fee for Service (FFS) Medicaid members, MMC members and MLTC applicants. hbbd``b`$TqM@\aR b^cXHD y :H @&
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The IRP recommendation may suggest alternative services and supports or other changes to the POC but cannot specify the number or hours or the specific changes that must be made. 3 0 obj
If the MMC plan identifies a material mistake in the CHA or PO that can be confirmed by the submission of evidence, the MMC plan must submit the NYIA CHA Variance Form to the NYIA OSU through a secure URL along with the evidence that a mistake was identified, and it is material. The NYIA includes an Independent Practitioner Panel (IPP) to conduct the exam that is now required to obtain PCS and/or CDPAS. See 18 NYCRR 505.14(b)(4)(viii) and 505.28(f)(3). 3. If you file your Request to Update form between August 31 and mid-April of the following calendar year, and your changes are approved, you can expect to see the changes reflected in the final roll, published in June. Accordingly, the requirements for providing notice and fair hearing rights have not changed materially. . When submitting a CHA Variance request to the NYIA OSU, the MMC plan must also inform the member that a new CHA may be conducted because of this request. The MMC plan must review the NYIA CHA and the PO in the UAS-NY, which contains the relevant information to inform the development of a POC. If you are having problems downloading or printing forms,see Adobe Reader - Requirements and Download Information. 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. When the MMC plan submits a material error via the CHA Variance Form, NYIA will promptly issue a corrected assessment or schedule a new assessment. NYIA nurses meet with Medicaid members by telehealth and in-person to assess how their care needs affect their daily lives. This is a terrific opportunity for experienced home care nurses seeking meaningful interaction with people in the community and an exceptional professional experience. %
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The Department of Health is delaying the implementation of this change in how Medicaid recipients are assessed for personal care and consumer directed personal assistance services, and enrollment into Managed Long Term Care, in recognition of the ongoing issues related to the COVID-19 pandemic, including additional pressures from the current Omicron surge. The CHA conducted by the NYIA is valid for 12 months unless another CHA is required due to a significant change in condition or at the member's request. The date for those is still to be determined. Questions on this guidance can be sent to independent.assessor@health.ny.gov. P)yvg>Fi Local Departments of Social Services: Click here for information on how to assist clients to receive an Immediate Need Assessment with the New York Independent Assessor. 2 0 obj
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