New York Independent Assessor Program (NYIAP)

Department of Health Announcements Regarding the New York Independent Assessor Program

NOVEMBER 17, 2023: NYS Department of Health POSTPONES Implementation of New York Independent Assessor Program (NYIAP) Conducted Reassessments

This notice is to alert managed care organizations (MCOs), local departments of social services (LDSS) and interested parties that, due to stakeholder and other concerns, the Department of Health (Department) is postponing the rollout of the New York Independent Assessor Program (NYIAP) conducting reassessments at this time.  NYIAP will not be conducting any reassessments (routine or non-routine) starting in January and the full rollout schedule will be redetermined at a later date.

The delay in implementation means that the LDSS and MCOs must continue to perform both routine and non-routine reassessments of the individuals under their responsibility.

The Department will provide notice of a new rollout schedule and guidance once the revised timeline has been determined.

Any further updates will also be posted on the Department's website.

Questions can be directed to independent.assessor@health.ny.gov.

OCTOBER 2, 2023 - LETTER Announcing the Implementation Date of the Rollout of Reassessments to be Conducted by the New York Independent Assessor Program (NYIAP)

The Department of Health announces the New York Independent Assessor Program (NYIAP) will begin sending notifications to individuals needing routine reassessments and conducting non-routine reassessments in January 2024, using the phased-in approach in the letter. This applies to Local Departments of Social Services (LDSS) and Medicaid Managed Care Plans (MMCP), including Mainstream Medicaid Managed Care (MMC) Plans, HIV Special Needs Plans (HIV SNPs), and Health and Recovery Plans (HARPs) and Managed Long Term Care (MLTC) Medicaid Advantage Plus (MAP) and Partial Capitation Plans (MLTCP). Please note: NYIAP reassessments for MLTC plans do not apply to enrollees in PACE plans, unless the enrollee is transitioning to a MAP or MLTCP plan.

AUGUST 30, 2022 UPDATE To Immediate Needs/Expedited Assessment Implementation Date

GIS 22 MA/07 and Mainstream MC Guidance were posted on August 30, 2022 to delay implementation of the NYIAP conducting initial assessments based on an immediate or expedited need for PCS and/or CDPAS to December 1, 2022.

JUNE 17, 2022 UPDATE To Immediate Needs/Expedited Assessment Implementation Date

GIS 22 MA/05 and Mainstream MC Guidance were posted on June 17, 2022 to delay implementation of the NYIAP conducting initial assessments based on an immediate or expedited need for PCS and/or CDPAS to October 1, 2022.

UPDATE To Implementation Date - April 15, 2022

The implementation date of the New York Independent Assessor Program is now anticipated to begin on May 16, 2022.

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.  This additional time will allow DOH to continue to engage with Medicaid managed care organizations, local departments of social services and other stakeholders to ensure the smoothest transition possible.

Questions can be sent to independent.assessor@health.ny.gov.

Program Information:

Chapter 56 of the Laws of 2020 authorized the Department of Health (Department) to contract with an entity to conduct an independent assessment process for individuals seeking Community Based Long Term Services and Supports (CBLTSS), including Personal Care Services (PCS) and Consumer Directed Personal Care Services (CDPAS or CDPC Program – CDPAP). Subsequently, New York´s PCS and CDPAS regulations at 18 NYCRR 505.14 and 18 NYCRR 505.28, respectively, were amended to require that individuals seeking these services under the Medicaid State Plan must obtain an independent assessment and be evaluated and have a Medical Review and Practitioner´s Order form completed by an independent clinician that does not have a prior relationship with the individual seeking services.

The Department has contracted with Maximus Health Services, Inc. (Maximus) to implement the New York Independent Assessor Program (NYIAP), 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.

Upon implementation the NYIAP will conduct all initial assessments and all routine and non-routine reassessments for individuals seeking Personal Care Services (PCS) 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 Program (NYIAP); and
    • for high needs cases, defined as the first time, after the date of NYIAP 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.

In addition to these changes, effective November 8, 2021, 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)

As of November 8, 2021, the regulations also increased the length of time the CHA may be valid from six (6) months to up to twelve (12) months. However, individuals will continue to be reassessed upon a change in medical condition, upon release from institutional care, or upon their request (non-routine reassessments) and before their current assessment expires (routine reassessment).