According to the NYS Department of Health, the Community Medicaid New York Independent Assessor (NYIA) will be implemented on May 16, 2022.
In our last webinar, we spoke of the imminent changes in the process of determining medical eligibility for Medicaid. The changes were expected to begin on May 1, but have been delayed to May 16. This process will begin on July 1, 2022 for those seeking Immediate Needs assessments. The NYIA does not seemingly include required reporting from clinicians that provide regular care (i.e. regular doctor/provider or primary care physician) to the Medicaid applicant. Upon implementation, the new process for Medicaid medical approval will be:
The NYIA will conduct all initial assessments and all routine and non-routine reassessments for individuals seeking personal care and/or Consumer Directed Personal Assistance Services (CDPAS).
- The assessment process includes:
- The Community Health Assessment (CHA) in the UAS-NY, New York´s 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
- For high needs cases, defined as the first time, after the date of NYIA implementation, the proposed plan of care includes services for more than 12 hours per day, on average, an Independent Review Panel (IRP) evaluation to ensure that the proposed Plan of Care developed by the Local Department of Social Services (LDSS) or the Medicaid Managed Care Organization (MMCO) is appropriate and reasonable to maintain the individual´s safety in their home.
The regulations expanded the type of clinicians that may sign a Practitioner´s Order for PCS/CDPAS and conduct a high-needs case review to include:
- Medical Doctors (MD);, Doctors of Osteopathy (DO); Nurse Practitioners; and Physician or Specialist Assistants (PA)
To learn more, visit the New York State Department of Health.