A.9023 Independent Assessor MLTC

This legislation, A.9023, seeks to repeal the independent assessor process as currently envisioned by the Department of Health and replaces it with the same process operated by a not-for-profit entity.

While we support the repeal of the independent assessor (IA) process for Medicaid members in need of personal care services (PCS) and consumer directed personal assistance services (CDPAS), we are opposed to the new process outlined in the proposed legislation.

The legislation proposes to establish a process – which is exactly the same as the independent assessor process envisioned by the State, with the exception that it would be conducted by a not-for-profit entity.  We believe that the IA process – whether operated by the State’s Medicaid eligibility determination vendor, or by one or more not-for-profit entities – is misaligned with the system’s needs, workforce crisis and service access gaps.  Any IA process adds an unnecessary layer, risks access problems for patients, will cause confusion in care and care management, lead to administrative burdens for plans and providers and ultimately duplicate functions that plans and providers have to carry out regardless of the IA’s assessment process.

It is unclear that not-for-profit entity or entities exist with the expertise to conduct these assessments in a timely manner, or how that process would then be coordinated with both the Medicaid eligibility determination process and the managed long term care (MLTC) plan’s whole-person plan of care development process.  It is also unclear as to the cost of supporting the envisioned entity or entities.

Further, one of the greatest concerns with the IA process has been the impact on nurse staffing at the MLTC plans.  As the IA contractor has staffed up to implement the IA process, they have hired most of that nursing staff from the MLTCs – because plans have the staff with the expertise to perform those assessments, and develop comprehensive care plans.  The not-for-profit based proposal in this legislation would create the same problem, while also creating another layer in the process, likely delaying access to care for the most vulnerable New Yorkers, at a time when timely care intervention makes the difference between a member being able to remain at home – or being forced into institutional care.

Plans are held to strict standards with respect to cultural and linguistic competence and expertise, along with timelines for completing assessments and plans of care and robust requirements related to consumer protection.  Any IA process in unnecessary.

For these reasons, we urge opposition to A.9023.