Transcription
Hello folks. Thank you so much for joining us. We can switch to the next slide. I would encourage people um to join by the WebEx if you can just so that we can see who you are um that's joining. Um so if you can go ahead and switch to that that would be great. But thank you for joining us very much. I'm Trisha Sha Guy. I am the director of the division of program development and management in the Medicaid program. We're the policy division and within that division is the Bureau of Medicaid long-term care policy. So, we are glad to have you here today so that we can begin to talk about um the minimum needs requirements.
Next slide. Just some ground rules um for the logistics. As I said, please try and join by WebEx or put your name in um instead of a phone number so that we know who who you are. We are going to have you on mute throughout the presentation, but you can ask questions and answers through the Q&A function. I would encourage you to um wait a little bit before putting in a question and answer. We have a a pretty robust and um lengthy slide deck. So you may get your question answered um at some point in the presentation. So you might just want to wait a little bit before putting in um too many questions. Um the slides and the recording will be shared after the webinar.
Next slide please. uh our agenda here um the first thing that we're going to talk about is the introduction to these policy changes that we've made around minimum needs. So those were shared with you in the ADM that we released on June 30th that was 25 ADM 03. We're going to talk about initial assessments and reassessments. What remains the same? What has changed? Get into some details on the Alzheimer's and dementia documentation. And there are some changes that are happening in for folks with Alzheimer's and dementia related to documentation that is going to now be required. We're going to go over legacy. What do we mean by legacy? How do you know if someone has legacy? What's happening in the UAS and why with regards to legacy? Also talk about changes that are made to the outcome notices and some of the reports that you receive. And there's also a pretty lengthy appendix attached to the slides. We are not going to go over it today. Time would not permit us to get through all of that. But we attached many um snips of the outcome notices so that you can see the changes uh in those outcome notices that are going to be released.
Now, next slide, please. So, this is uh intended just to really provide that legal basis for why we're doing what we're doing. Where did this come from? This is references with links to all of the uh laws that speak to minimum needs and the legal basis for it. These statutory changes came about in 2020 and then we made corresponding regulatory changes in 2021, but we're here now in 2025. And people might be wondering, well, why did it take us so long? Um that was because we were delayed um under the federal laws that were enacted during the COVID pandemic. It prevented states from making lots of different changes in the Medicaid world. One that I'm sure you're all familiar with was the continued eligibility where folks remained eligible and we could not disenroll folks. So like that, we were prohibited from making changes that would have involved what we needed to do to implement minimum needs. So that's why we're here now in 2025 um and and going to implement these changes now.
Next slide, please. So let's talk about what these changes are. Um starting September 1st, the changes are going to be implemented in the criteria that is used for assessments to assess folks. Um and that's for two groups of individuals. So for individuals that are initially seeking personal care services and consumer directed personal assistance services, so PCS or CDP. um also for individuals who are in initially seeking enrollment into a Medicaid advantage plan or a managed long-term care partial cap plan. So those are the two cohorts of um individuals that these minimum needs changes impact.
Next slide. And sort of what is happening now here? What are these changes that are occurring? So now these individuals need to be assessed using the community health assessment. So the assessment tool remains the same but the requirements change the now the requirements are to determine if they meet these new minimum need requirements which are as follows. So it's individuals will need to need at least limited assistance with physical maneuvering with more than two activities of daily living or for individuals that have a dementia or Alzheimer's diagnosis, they will need supervision with more than one ADL. So those are the two new criteria beginning September 1.
Next slide, please. So just to further clarify um this these minimum needs requirements apply to the initial assessments that folks are getting and then subsequent reassessments for individuals that were initially seeking or that are initially seeking PCS and CDPAP and individuals initially seeking enrollment into a MAP or MLTC plan.
Next slide. want to switch gears and get a little bit more granular into what these new requirements are for individuals that are going to qualify by using that Alzheimer's disease or dementia diagnosis. So, we now will need to have a form and that is a form DO5821 — completed for individuals who are qualifying using that Alzheimer's disease or dementia diagnosis and assistance with more than one ADL. This form has to be completed by one of the licensed health care professionals that is identified on the form. The diagnosis has to be made by a physician. So that's an MD or a DO, but that physician does not need to be a Medicaid enrolled provider or a New York State Medicaid provider. Um the form needs to be provided for each assessment — where that condition is present unless otherwise directed by the department. And the form needs to be retained in the individual's file. Um, and the date of the diagnosis, documentation of diagnosis must be retained in the individual's case notes and it's also going to be in the UASNY sectionh disease diagnosis and we're going to get to that in a little while. So initially it's very important that these forms be maintained — because they will not yet be in the UASNY. There is not yet the ability to put the form and upload the form into the UASNY. So there's going to have to be retained in other ways. We're going to get to that, but we're not there yet. Not when we're initially — implementing.
Next slide, please. So legacy status — individuals that are so so the law required — when it was implemented that some folks have to maintain their eligibility for services or their MLTC plan enrollment. Um and and in order for us to identify who these folks are, we came up with the term legacy status. And so you'll see us referring to legacy status. It's not something that's in the statute, but the statute did direct us to make sure that people who were qualified prior to implementation remain qualified. And so we refer to that as legacy status and legacy individuals. So individuals who are assessed and authorized, right? So assessed and authorized for services, that's PCS or CDPAP before September 1st. um and individuals who are continuously enrolled in MLTC will not be subject to minimum needs requirements. And this slide's a little bit confusing and we'll we'll make corrections on it before we send it out. There's two groups of individuals here. So the individuals do not need to be both, right, assessed and authorized for PCS and CBS and enrolled in MLTC. It's either or, right? So, if you have folks who are assessed and authorized for services prior to se September 1st, they receive legacy. If you have individuals who are continuously enrolled in MLPC, they receive legacy. They are not subject to those minimum needs requirements.
Next slide, please. And so, a little bit more — granular into sort of what is legacy status. There are two different types of legacy status. And that's what I was trying to explain on that last slide. The first is service legacy. So the individuals who get service legacy are those folks who are receiving and authorized for CDP and PCS — or in let's see prior to September 1st of 2025. Right? These individuals — are going to be assessed and reassessed using their PCS and CDP pass — legacy criteria. And then there's plan legacy. — that is for individuals who are assigned — I'm sorry that is assigned to individuals who are enrolled in an MLTC plan including a PACE plan before September 1st and plan legacy individuals will be reassessed using their legacy criteria the legacy criteria if they remain continuously enrolled in an MLTC plan. So, I'm also going to note we're going to fix this slide too — as well on the criteria number one where we're talking about service legacy. Service legacy really applies to the individuals — authorized for PCS and receiving PCS and CDAP.
Next slide. And just a little bit more detail on that plan legacy status. — plan legacy members who transfer to another MLTC plan again including PACE will retain — plan legacy — and therefore they would continue to be assessed and reassessed under legacy criteria. But plan legacy can be lost when an individual disenrolls from their plan and they do not transfer to another plan because they are not continuously enrolled in an MLTC plan at that time. The plans are going to be responsible for updating plan legacy status end date when the member disenrolls from the MLTC plan and they will have to do that in the UAS.
Next slide. So now how do you how do you at the district know if an individual has legacy status? So legacy status is going to be indicated in the uniform assessment system for New York. the UASNY there will be a new node in that system and we're going to go over this in a couple of slides so you can see what that looks like to tell you whether or not there's legacy status. There are a small group of individuals — for whom legacy status will not be identified and there is going to be some work on the districts who are going to have to identify these individuals and change their status — to indicate legacy status. We're going to go over that in a minute, but for the most part, most folks will have their legacy status indicated in the UASNY and policies will outline the specific criteria that the districts and the plans are going to have to use when they have to go in and make it make a change and indicate legacy status.
Next slide. So we're going to kind of go back a little bit and start — at the beginning of the process so we can understand from the beginning — what is changing and what is not changing. Right? So to start at the beginning — the New York Independent Assessor Program so NYAP is going to continue to do and they are responsible as they always have been for initial assessments for the adults that are seeking PCS and CD pass or MLTC enrollment and NYAP will apply minimum needs criteria beginning September 1st 2025. — NYUP is going to schedule and complete the community health assessment and the practitioner order. — and at the conclusion of both appointments as typical, they are going to issue that outcome notice — to that individual which tells that individual that they may contact — that you know if they're qualified and if they're assessed as qualified they can contact their districts or — indicates that they are not qualified. — a a change that you and members are going to see is updates to those outcome notices. And that was back on that agenda slide, and we'll get to that a little bit later. — these outcome notices are now going to incorporate minimum needs criteria. And we'll talk a little bit more — later about — some of the other changes — to these outcome notices and some of the changes to the reporting that you're going to receive to — to help to help you — to help you with some more information with regards to these minimum needs criteria.
Next slide. So most things do not change, right? And that's what this slide is really really — attempting to highlight for you. Right? As I said, NYApp's going to continue to perform that initial assessments — districts will still be responsible for assessing children ages 0 to 17. NAP is still going to issue eligibility outcomes — to all of the adults that they assess. Individuals who meet minimum needs are going to reach out to the district to request their PCS or CD pass services. — NYUAP doesn't create the plan of care. — assessment outcomes will inform the amount, duration, and frequency of the services. NAP is still going to perform variance reviews when there's a disagreement on the outcome and the independent reviews for individuals that seek more than 12 hours a day. — and NAP will still continue to send their reports which include individuals who have requested immediate need. So, all those things stay the same.
Next slide. So what's happening for districts? What are the changes for districts? What what is not staying the same — for districts? So after the individual has comp has a completed assessment and receives their outcome notice telling them to — contact the district, the district now has to check the UAS to verify service legacy. So that that is something new, right? You're going to have to go into the UAS system, locate the service legacy status, and review the assessment outcomes practitioner order and section H comment to see whether or not an Alzheimer's disease or dementia form was submitted. And we'll take a look at some screenshots so you will — you will have an understanding as to kind of what that looks like. — just a note here, most initial assessments after September 1st are going to fall under the minimum needs criteria. However, there may be a few folks, right, who are who are coming in after September 1st who do not have to go through minimum needs who would qualify for service legacy. And this that, you know, there would be a group of folks who do not have — a valid CHA — and and would potentially be eligible for legacy criteria. And we'll get to that list. There's a couple of categories of folks who might still fall into that legacy criteria. What else do the districts need to do? — as you know, you have to complete the the care plan. you to develop your person- centered service plan. Authorized services, notify the individual using your appropriate notifications. — and if if the individual's NAF assessment indicates they don't meet minimum needs, there's no action required by the LDSS at this at that stage. Okay.
Next slide, please. So, what's new? What stays the same when we talk about reassessments? — As always, reassessments continue at this point to be the responsibility of the LDSS. Those reassessments begin with receipt of the physicians order, but the districts must after September 1st determine the service legacy status of the individual to know which requirements are going to apply. Is it legacy criteria that needs to apply or is it the new minimum needs criteria?
Next slide, please. Okay. So, this slide is really about when you're doing a reassessment — because — you know, initially we're you're not going we're not going to you're not doing initial assessments where you're going to have to have to deal with this Alzheimer's or dementia documentation. — but we want to make sure that you have this information and you understand exactly what is necessary when that Alzheimer's or disease or or dementia documentation is required. And so to start, — you know, it's it's really critical that if the individual does have that Alzheimer's disease or dementia or you think they might have Alzheimer's disease or dementia, you're not going to know that right before the reassessment. You're not going to know whether or not they will need assistance with more than two ADLs. You're not going to know if they're only going to meet assistance with more than one ADL. And so, it's our recommendation that you advise individuals with an Alzheimer's or dementia diagnosis to obtain the form and have it with them at their reassessment so that there is no issue — with qualifying. — we really — you know, we want to have the most accurate outcome — in the UAS system and we want to know what you know why individuals are qualifying and so we're really — recommending that you do — reach out to those folks and and recommend that they get this form and that this form be submitted — before or during the assessment so it can be considered at the outcome of the CHA when you're doing these reassessments.
Next slide please. This is just a sample of what this new form, this DO5821 looks like. — It will be I don't believe it's posted on our website yet. Actually, I'm not 100% sure, but somebody can can correct me. — And I and I'll let you know if I'm wrong on that, but will be posted very very soon if it's not posted. So, it will be available for consumers. that will be available for their physicians — easily available on our website and a form also that you can print and give out if you need to.
Next slide. So now we're going to talk a little bit about how you get to understanding legacy status and and a little bit about sort of the the the UAS. — So plan and service legacy is going to be preloaded — and we've been able to update the UAS with information in our systems — provided you know through plans and and and through ourselves for folks who were authorized for services on or before 73125. However, there are some folks who should have service legacy that are not reflected and and as I said earlier, the district is going to need to manually add service legacy. And we don't expect that there's going to be large numbers of folks where this is going to happen. Like like I said, we're we're getting everybody in — who's been authorized for services as of July 31st of 2025. — but you will need to make a change for a few folks and they really fall into — three categories that you see outlined here. So — for individuals who were authorized for services in August of 2025, those individuals are not going to be preloaded. So we're going to we're going to have everybody up through July 31st. We go live on September 1st. But if you authorize folks in August of 2025, those folks will be entitled to service legacy, right? Because they were — authorized prior to the September 1st date and you are going to have to make an adjustment in the system to indicate that they have service legacy. Also, for individuals who are assessed before September 21st, right? So, they've been assessed, but they haven't yet been authorized for services. — including individuals who have valid assessments completed as far back as August 31st, 2024, but before September 1st. — So long as the district is authorizing their services within one year of that assessment, they get service legacy because they were assessed before September 1st, but they just have not yet been authorized for their services. And then there's going to be a small group, we hope a very small group of individuals that had an initial assessment that was scheduled before September 1st, but their appointment has been rescheduled through no fault of their own to a date after September 1st. So there's there could be right a very small group of individuals who that happens to. — Those individuals also are are entitled to service legacy because their initial assessment was scheduled before. Wasn't their fault that it had to get rescheduled and so now — we're going to be giving them service legacy. You are going to be getting a report — from Maximus that's going to give you this information and we're going to get into in a couple of slides what that report looks like. So three categories of folks which the district is going to have to add service legacy.
Next slide, please. Okay, continuing on talking a little bit about legacy status fields in the UAS. So, there will be legacy fields. These fields will be view viewable to all long-term care users in the assessments outcome and the LTC legacy status fields fields. There are some users that have — roles where they will be able to manually edit the fields, right? and you see the the — role numbers listed up there. And as I said, there are few folks we expect that you're going to have to do that for.
Next slide. So, we are going to be providing you training. We're doing this training now on policy, but the UASNY is going to be providing training — on using the UAS and minimum needs. — It will be available to all long-term care and long-term care independent assessor users before September 1st. — It's going to show you how to locate and understand the legacy status nodes — and — provides information on the fields and information on how you can go in and edit those fields if you have to. — Beginning in September, this training is going to become mandatory and there will be specific training — for those folks who do need to go in and make edits to — the service legacy field.
Next slide, please. Okay, now we get to just some screenshots — just so you can kind of see what we're talking about when we say that legacy status is in the legacy node. — So what you see here now is the — the legacy status node. — You will be getting a notification I think in early September when this node is is going to become available. So you can see we've got sort of two — two boxes. One is the MLTC plan legacy and the bottom one is the service legacy. And you can see you check yes or no, right? Is is there service legacy or is there not? And and there's a little — edit service legacy box — for folks who will need to go in and make those edits that we talked about.
Next slide. Okay. So this is the screen. So now as you go into the eligibility — this is the screen that really kind of gives you some details on how that individual is becoming eligible like where is the minimum needs eligibility — and it has a little bit more detail on that Alzheimer's and Alzheimer's disease or dementia diagnosis. So, if you look up at that first purple arrow up at the top, you'll see that there's four boxes, right? And you can see that the the second box down where it says more than two ADLs at limited assistance. So, that's your first category, right? Did the individual need more than two ADLs? And then you've got that second box. — Is there Alzheimer's or dementia and more than one ADL? And that's that's checked yes in this example that we're looking at here. — As you scroll down to that next arrow — they're indicating that that diagnosis is present and they're receiving treatment. You can also select diagnosis present monitored but no active treatment. — and then as you're going down to that final box, this is what I was talking about earlier. This is where that section H comments box is located and indicates that proof of diagnosis was provided. And that proof of diagnosis is that form 5821. Right? And so for folks with Alzheimer's or dementia, it's going to be important that if that is selected here, districts are making sure that that proof is is showing up in that bottom box as have as having been provided to the nurse doing that initial assessment. Okay.
Next slide, please. Okay, so just a reminder — of a couple of things, things that really aren't changing. You're going to follow that process that you always did. You'll issue the appropriate notices of decisions or intent where where applicable. — If an individual is eligible for services, you meet with them. You develop their plan of care and person- centered service plan. — If the if you disagree right with the outcomes — when you get that initial outcome notice you've got that variance process that you should be following — and if that individual is initially authorized for more than 12 hours that IRP process should also be followed. So none of that changes as a result of minimum needs.
Next slide. Okay. — shifting focus now to just give you a little bit of update into — some of the changes and updates that were made to the NYAP outcome notices. So updates were made reflecting the minimum needs requirements. — These include — language that describes the eligibility for PCSC pass and MLTC — when available in the individual's area. — There's more detail now regarding criteria for folks who have been deemed ineligible to tell them why they are ineligible, what criteria they did not meet. — There's additional guidance now that describes what actions an individual needs to take based on their outcome. Do they need to contact the district? Do they need to contact the plan? — A little bit more information on where they should go, what they should do. And the notices also contain frequently asked questions section and those — FAQs are actually individually tailored to the specific criteria that's happening in the notice. There's also visual aids really just to help — improve understanding around MLTC eligibility.
Next slide. — Outcome reports. Outcome reports are also changing — changing for the better. — So the district's CHAW and clinical outcome report is now being updated and in that report now you will see columns that reflect minimum need requirements and legacy status. There's also an indicator on whether an individual needs more than 120 days of community- based long-term services and supports and the nursing facility level of care or the Enflux score. There's also a column indicating that Enflux score as well. You will also be receiving a new temporary CHA and clinical appointment outcomes report. — Hopefully hopefully temporary and only for a period of time. But this is going to be included to show individuals who re this is this is what I talked about earlier. Individuals who got their initial assessment after September 1st but are still able to meet the legacy criteria because that appointment was rescheduled — through no fault of their own. We should be phasing this report out after reschedule appointments are complete. So that's where you'll get that information. So you will know you have to go in and correct legacy status for those individuals.
Next slide please. So this is just a screenshot of the two reports. So, the CHAN clinical outcomes report is on the top — with those new fields in there as you see — the new fields that include the service legacy and the Enflox score and the CB — community based long-term service and supports columns kind of in the middle and on the bottom that new temporary report — indicating — for those folks who had that appointment type that was rescheduled. — One thing to note on here, and you'll see there's a little asterisk, and if you look up in that first box, and you look at the column towards the middle, met with Alzheimer's and dementia. If you scroll down, you'll see that we put a yes, right? So, this is for an individual who met the minimum needs criteria with the Alzheimer's or dementia and more than one ADL. It says yes. So, it says yes, that individual has met that criteria. That little star is there because while the system says yes, they've met the criteria, the system cannot tell whether or not that form DO5821 is present. Which is why when we were looking at the screenshots earlier of the UAS, I said to you there's that section H where you need to check and see whether or not that form is present. So that's that's kind of how that ties together here. And the next slide.
So, I'm not going to go over this slide, but this is really just for your benefit. And it tells you which columns are updated and provides some details and information about what information is in those columns on that report that was just added. And next slide. And and the districts received the reports. All the districts except for HA. You get your reports through secure email. — and — except HR, you get yours through Move It. — So you should be getting those reports. If you need to request it, there's information here on where to send that to Maximus and the information needed — in order to make a request for those reports, those outcome reports that we just went over. Okay. And I think we have cleared all the slides. Yeah. So, we are going to — stop the recording at this point and move on to some questions and answers.