Eligibility and Need for Personal Care Services
The budget makes amendments to address how the need for Personal Care Services (PCS) is determined and what level of need must be met. The budget amends Social Services Law (SSL) Section 365-a (2)(e) to provide that the need for Personal Care Services will be determined by a qualified independent physician selected or approved by the Department of Health (DOH).
In addition, SSL Section 365-a (2)(e)(v) is amended to provide that PCS will be available to those assessed as needing at least limited assistance with physical maneuvering with more than two ADLs. Dementia and Alzheimer’s care has a lower threshold for the availability of PCS. The assessment shall be defined and determined by an evidence based validated assessment instrument approved by the DOH.
Independent Panel for Clinical Orders for PCS
The DOH shall also establish a panel no later than 10/1/2022 to provide independent physician orders for PCS and the consumer directed personal assistance program (CDPAP).
Dual Eligibles enrolled in Medicare Duals Plans who do not need long term care services will be required to enroll in an affiliated plan.
Assessments and Reassessments
DOH shall establish or procure an independent assessor to take over from Local Departments of Social Services (LDSS) and Managed Care Organizations (MCO) assessments and reassessments to determine an individual’s needs for PCS and CDPAP services.
Medicaid Long Term Care Look Back Period
Amendments to SSL366 establish a 30-month look back period when determining eligibility for Medicaid Long Term Care services. It also provides for ineligibility of Medicaid when an asset transfer is made.
CDPAP Notification Availability
MLTCs no longer need to provide notice of the availability of CDPAP initially and annually thereafter. Rather, individuals receiving home care will have the opportunity to apply for CDPAP no less than annually.
Evidence Based Assessment Tool
The DOH shall develop and implement an evidence based validated uniform task based assessment tool no later than 4/1/2021 to assist MCOs and LDSS to make appropriate and individualized determinations for utilization of home care services, including the number of assistance hours of care each day and how the needs for assistance can be met such as through telehealth, and other available alternatives, including family and social supports.
Continued Enrollment Assessment
Continued enrollment in a managed long term care plan shall be based upon a comprehensive assessment of medical, social and environmental needs, which shall be performed at least annually, rather than every six months.