New York Independent Assessor for PCS and CDPAS (22 OHIP/ADM-01)

What this rule requires your agency to do

• 1On or after May 16, 2022, anyone seeking PCS and/or CDPAS for the first time (or initial MLTC eligibility) must be referred to the NYIA for a Community Health Assessment (CHA) and Clinical Appointment; the LDSS/MMCO no longer conducts a separate CHA to authorize these services.(New York Independent Assessor for PCS and CDPAS (22 OHIP/ADM-01))
• 2For proposed plans of care calling for more than 12 hours per day on average of PCS/CDPAS for newly assessed individuals, the LDSS must refer the case to the NYIA Independent Review Panel (IRP) and consider its recommendation before finalizing the plan of care.(New York Independent Assessor for PCS and CDPAS (22 OHIP/ADM-01))
• 3The LDSS must review the NYIA CHA and PO, develop the plan of care, and authorize services within seven (7) business days of receipt of the CHA and PO (unless an earlier immediate-need decision is required).(New York Independent Assessor for PCS and CDPAS (22 OHIP/ADM-01))
• 4PCS/CDPAS must be ordered by a qualified, independent practitioner (MD, DO, NP, or PA) of the Independent Practitioner Panel via a Practitioner Order (PO), replacing the prior third-party physician's order (DOH-4359/HCSP-M11Q) for adults.(New York Independent Assessor for PCS and CDPAS (22 OHIP/ADM-01))
• 5A NYIA CHA and PO are valid for 12 months for PCS/CDPAS authorization and MLTC eligibility, unless a new CHA/PO is required due to a significant change in condition or at the individual's request.(New York Independent Assessor for PCS and CDPAS (22 OHIP/ADM-01))
• 6For immediate-need requests, the individual must provide the LDSS an Attestation of Immediate Need plus a Practitioner Statement of Need (DOH-5779), and the LDSS must refer adults to NYIA immediately (CHA and clinical appointment to be completed within six calendar days).(New York Independent Assessor for PCS and CDPAS (22 OHIP/ADM-01))