DOH Guidance Rescinds Emergency Procedures for Plan/LDSS Assessments and CDPAP Annual Health Assessment, Prompting Need for Follow-up Clarification

Situation Report | August 2, 2021

The state Department of Health (DOH) on July 26 posted guidance rescinding several COVID-emergency-era flexibilities in the requirements for various assessments conducted by Managed Long Term Care (MLTC) plans and Local Departments of Social Services (LDSSs).

Following concerns and a meeting with industry representatives (including HCA), the Department later followed up, on July 29, with an e-mailed clarification of its guidance, specifically addressing timetables for resuming in-person assessments and consumer directed personal assistant annual health assessments.

HCA and other industry representatives requested official notice of these clarifications (beyond an e-mailed communication); however, DOH indicated that a Dear Administrator Letter (DAL) revision could not be accomplished timely.

We note that the procedural changes for patient assessments apply to managed care plan and LDSS assessments, not to in-person patient assessments and aide supervision activities by Certified Home Health Agencies (CHHAs) or Licensed Home Care Services Agencies (LHCSAs) except in circumstances where a CHHA or LHCSA is conducting patient assessments on behalf of a plan. (See our separate article here addressing this issue.)

Personal Assistant Annual Health Assessments 

In its July 26 guidance, DOH withdrew the suspension of annual health assessments for CDPAP personal assistants. Personal assistants must now obtain a health assessment, if already due, no later than September 30, 2021. A subsequent health assessment will be due one year later.

DOH later clarified that personal assistants may continue working until September 30, 2021 while they have their annual health assessment scheduled and completed, but only until September 30, 2021, at which point “the personal assistant would have to discontinue working until [the annual health assessment] has been completed.”

In-Person RN Assessments, Reassessments and Care Management Visits 

According to the July 26 guidance, all RN assessments must be in-person for initial authorizations and requests for change in service authorizations. “The ability to conduct the CHA (community health assessment) via telephonic or telehealth modalities to develop an initial plan of care has been rescinded.”

Also, managed care plans and LDSSs must begin resuming required face-to-face periodic reassessments and the six-month in-person care management home visits. The DOH guidance also includes a timetable outlining when these activities should take place.

In its July 29 clarification, however, DOH offers a minimal transition period, stating that managed care plans and LDSSs may continue to use telehealth or telephonic CHAs until August 13, 2021 ”in order to accommodate a previously scheduled telehealth or telephonic CHA, or to transition assessor staff scheduling.” Use of this modality should also be documented.

Over a month ago, when DOH initially raised the topic of resuming Uniform Assessment System (UAS) assessments, HCA requested ample lead time, as well as flexibility to maintain telehealth as an option for UAS. While HCA and others sought a more reasonable lead-in period, DOH explained that factors related to its planned implementation of the Independent Assessor initiative had constrained the amount of extension that the Department could provide.

DOH’s July 29 communication also addressed the issue of patient refusals for in-person reassessments, stating that plans and LDSSs “should make reasonable efforts to complete periodic reassessments” per the schedule outlined in the July 26 guidance. “If an enrollee refuses the periodic reassessment, the refusal should be noted in the enrollee’s case file as services continue.”

Physician Order Form Required for CHAs 

For personal care and CDPAP, physicians may still use telephonic or telehealth modalities to conduct medical examinations that assess an individual’s needs for services. However, the Department in its July 26 guidance rescinded the “ability of physicians to transmit the results of the medical examination and a physician order verbally,” and a community health assessment may no longer be initiated upon receipt of a verbal order. Effective immediately, the physician order form (DOH-4359 or HCSP-M11Q) is required.

Temporary Care Plans Rescinded 

According to the July 26 guidance, DOH will no longer allow a partially completed CHA to be used in care plan development. For those members with a temporary plan of care in place, managed care plans and LDSSs “should ensure all members have a completed CHA and plan of care with notice of determination in place within 90 days of the effective date of this guidance.”

HCA has met with DOH and documented our priorities for continuation of regulatory relief measures beyond the expiration of the state’s emergency declaration (the federal emergency is still in effect). HCA will advocate for extensions of these core relief areas at a time when providers, plans and staff continue to confront COVID-related challenges and impacts.