DOH Outlines Independent Assessor Next Steps at Managed Care Meeting 

Situation Report | March 15, 2021

State Department of Health (DOH) officials last week provided an update on the new Independent Assessor (IA) — a major new program design change affecting home and community-based care.

As extensively reported, the IA will be conducting assessments for individuals who apply for personal care or consumer directed services in Managed Long Term Care (MLTC), Mainstream Medicaid Managed Care or fee-for-service Medicaid.

New information was provided at last week’s Managed Care Policy and Planning meeting (a separate article about other updates from the meeting is here).

The deadline to submit comments on DOH’s revised proposed rule for the IA ends on March 15, 2021; DOH expects to incorporate comments and republish on or about April 1, 2021. Implementation will begin sometime after April 1, 2021 (not before May or June).

Full implementation is contingent on four approvals: 1) State Plan Amendment (SPA) approval by the U.S. Centers for Medicare and Medicaid Services (CMS) for new minimum needs criteria; 2) 1115 waiver amendment approval by CMS for the new MLTC enrollment eligibility criteria; 3) promulgation of final regulations governing the IA process and responsibilities; and 4) contract approval by the state Comptroller’s office.

Implementation of the IA will be in stages:

  • It will begin with initial assessments (individuals new to services and/or MLTC plan enrollment) and non-routine reassessments including Sudden Change in Condition (SCIC), Return from Institutionalization, and consumer-requested assessments.
  • Next, the Independent Practitioner Panel (IPP) and Independent Review Panel (IRP) will begin, soon after, the implementation of the IA based on recruitment timelines.
  • Lastly, the IA will perform routine reassessments once reinstated by DOH, and DOH will work with the IA, Local Departments of Social Services (LDSS), and plans to determine how best to reinstate reassessments based on “pent-up” need.
  • The IA will schedule an initial community health assessment and a clinical review appointment during the same phone call.
  • Due to federal preemption, PACE plans will not be impacted by the IA requirements.

Anticipated Timeline

  • DOH begins drafting contract language: August 1, 2021
  • DOH sends draft contract language to the trade associations/state partner agencies for comment: November 1, 2021
  • Contract negotiation conference calls: November to December 2021
  • Contract amendment language finalized: January 2022
  • Contract amendment submitted to the health plans for signature: February 2022
  • Health plans return signed contract: March to April 2022
  • Contract approval process: April 2022 to June 2022
  • Contracts executed: July 1, 2022

Based on comments from our plan members, HCA had earlier given feedback to DOH on the then-proposed IA rule and DOH had subsequently made some changes to address some of our concerns.