MLTC Policy 16.01

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Office of Health Insurance Programs

Division of Long Term Care

MLTC Policy 16.01: UAS-NY Assessment Requirements

Date of Issuance: March 15, 2016

The purpose of this memo is to reiterate the assessment requirements for Managed Long Term Care (MLTC) Plans as previously provided in MLTC Policy documents, the UAS-NY Training Environment and Department issued memos.

Assessment Requirements

As per MLTC Policy 13.09, a nurse assessor is required to complete all required questions in the UAS-NY Community Assessment. It is not permissible to administer only the items that determine the Nursing Facility Level of Care (NFLOC). If a Functional and/or Mental Health Supplement are triggered, they must be completed in order for the assessor to sign/finalize the assessment. Upon finalizing the assessment, the Assessment Outcomes must be conducted, signed and finalized.

Assessments must be conducted in person, face-to-face. Telephonic and video assessments (i.e. Skype, FaceTime) are not permitted.

Timeframe for Signing Assessments

As per MLTC Policy 13.09, nurses conducting a UAS-NY assessment should sign and finalize the assessment at the time the assessment is conducted. This allows the nurse to then conduct the Assessment Outcomes with input from the patient. The nurse assessor should then sign and finalize the Assessment Outcomes. When signing an assessment, the complete legal name, license number, and official title of the assessor is required and must be accurately recorded in the appropriate fields.

If the nurse assessor must collect information from a collateral who is not available at the time of the assessment in order to complete the assessment, it is expected that the nurse gather the necessary information and sign and finalize the assessment no later than 2 days of the date that the assessment was conducted. At that time, the nurse should conduct and sign/finalize the Assessment Outcomes.

Review/Consult Process

Many Plans have instituted a Review/Consult process as part of the assessment process. Some Plans have incorrectly instructed staff to leave assessments unfinalized until after the supervisor has reviewed the assessment. This is incorrect. Supervisors who have the review/consult responsibility cannot sign an assessment using the "Review/Consult" node until the assessment is finalized. Leaving assessments unfinalized impedes the review/consult process and lends itself to any number of unintended consequences including viable assessments being deleted.

Unsigning/Unfinalizing Assessments

In rare instances, a Plan may identify a need to unsign and unfinalize an assessment. A nurse supervisor (UAS-45) from that organization has that functional capability provisioned to that role. It is important to note, unfinalizing an assessment also unfinalizes the Assessment Outcomes.

Assessments that were finalized and then unfinalized should be refinalized in a timely manner. It is the Department´s expectation that assessments are signed and finalized the day the assessment is conducted or within a day or two of when they are conducted if collateral information must be collected. Prior to refinalizing the assessment, there should be an appropriate note written in the comments section of the Sign/Finalize node explaining the circumstance for unfinalizing the assessment. The Assessment Outcomes must then be resigned/refinalized.

Unsigned Assessments

On October 3, 2014, the Department issued a memo regarding signing assessments. As per that memo, unsigned/unfinalized assessments are not recognized as valid. Moreover, these assessments cannot be used in conjunction with care planning, authorization of services or billing.

There are several scenarios that present the occurrence of unfinalized assessments.

  1. Assessments initiated by administrative staff (UAS 15) that are blank because a nurse assessor never used that assessment. These blank assessments created by your organization must be deleted.
  2. There is no assessment in the individual´s record, however, there is an active enrollment in the record for your organization. If your organization has enrolled, billed and/or care planned for a member and there is no current valid assessment for that enrollment period, then your organization should dispatch a nurse immediately to conduct a valid assessment and assessment outcomes. Once the nurse assessor signs and finalizes that assessment, your organization´s nurse supervisor (UAS 45) should add a review/consult comment explaining the circumstances under which the assessment was conducted and the nurse supervisor (UAS 45) should sign the review/consult node.
  3. There is an enrollment for your Plan in the record, however, the initial assessment is missing but there are subsequent signed finalized assessments supporting reauthorization. No action is required at this time.
  4. Assessments conducted on behalf of your organization more than 30 days prior to the issuance of this policy and never finalized. These assessments cannot be finalized because it is not possible to determine if the assessment is complete and/or accurate. If your organization has used this unsigned/unfinalized assessment for enrollment, reauthorization of services, billing and/or care planning then your organization should dispatch a nurse immediately to conduct an assessment. Once the nurse assessor signs and finalizes that assessment, your organization´s nurse supervisor (UAS 45) should add a review/consult comment explaining the circumstances under which the assessment was conducted and the nurse supervisor (UAS 45) should sign the review/consult node.

    The following statement should be captured in the comment section of any unfinalized UAS that falls within this category: "We (plan name) recognize that this UAS Community Assessment, dated ______________, has not been finalized due to __________________________ and appropriate actions have been taken."

It is important to understand that the above declaration is only to be added to unfinalized assessments that were conducted more than 30 days prior to the issuance of this policy. Plans may not include this statement in any assessment created after the issuance date of this policy document.

  1. Assessments conducted less than 30 days prior to the issuance of this policy and are not finalized. The assessing nurse must provide a written explanation of the circumstance as to why the assessment was not finalized in a timely manner. This explanation must be recorded in the Nurse Assessor Signature comment box in the Sign/Finalize node. The assessor will then proceed to finalize the assessment and Assessment Outcomes. Once the nurse assessor finalizes the assessment, the nurse supervisor from your organization (UAS 45) will add a review/consult signature and indicate in the comments box an acknowledgement of the disparity in the date the assessment was conducted and the date the nurse actually signed the assessment.
  2. Assessments conducted less than 30 days prior to the issuance of this policy by a nurse who is no longer employed by your organization. In this circumstance, the assessment cannot be signed and finalized because the organization cannot ensure the assessment is complete. The organization should promptly dispatch a nurse to assess the individual. Once the nurse conducts, signs and finalizes the assessment and the assessment outcomes, a nurse supervisor from the organization (UAS 45) should add a review/consult signature including an explanation describing the circumstances under which the assessment was conducted.

This work should be completed no later than 30 days after the issuance of this policy.

If you have questions concerning the assessment policy guidelines, please email the Bureau of Managed Long Term Care at mltcworkgroup@health.ny.gov.

Please contact the UAS-NY Project Team at 518-408-1021 or via email at uasny@health.ny.gov if you need additional information concerning the UAS-NY.