Uniform Assessment System for New York

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October 6, 2011

Uniform Assessment System – New York:
Research, Evaluation, Planning and Implementation of an automated, uniform assessment system

Carla R. Williams, Deputy Director,
Division of Long Term Care,
Office of Health Insurance Programs

UAS NY: Goal

  • Develop a comprehensive assessment instrument that:
    • Evaluates an individual´s health status, strengths, care needs, and preferences.
    • Guides the development of individualized long–term care service plans.
    • Ensures that individuals with long term care needs receive the right care, within the right setting and at the right time.

Current Environment

  • Multiple screening and assessment tools in current use complicates an already fragmented and poorly coordinated delivery system.
  • Many instruments lack standardization, have not been tested for reliability or validity, and are not automated.
  • Care plans and referrals are open to subjectivity.

Objectives of UAS – NY

  • Assess individual´s functional needs and abilities through empirically tested and validated means.
  • Provide accurate data to develop individualized plans of care that are consumer–driven, build on consumer strengths and offer consumer choice.
  • Identify level of care.
  • Assist with care planning and oversight. Reduce redundancy.


  • Improve the quality, consistency, and accuracy of assessment and care plans.
  • Enhance the state–s capacity for program development and policy decisions that are data–driven.
  • Increase access to data by multiple providers via electronic means.
  • Provide compatibility with other data sets and align with existing standards to the extent possible.


  • Extensive review of literature to identify uniform data sets and assessment instruments developed by other states and countries.
  • Secured expertise to validate preliminary findings and recommendations.

Learning from Other States and Countries

  • Conducted focused discussions about uniform assessment instruments, e.g., Washington, Michigan, Massachusetts, New Jersey, Maine, Louisiana, Canada.
    • Why particular tool was chosen/developed.
    • How was the business plan developed, from goals to implementation.
    • Functions of the tool.
    • Settings in which the tool is used. Stake holder support.
    • Screening process to determine who gets the in–home assessment. Training needs and resources.
    • Inter–rater reliability.

Tool Selection

  • Two possibilities surfaced:
    • CMS CARE.
    • interRAI Community Health Assessment
  • An interRAI Community Health Assessment was chosen (interRAI CHA).

InterRAI Capabilities

  • Evaluates an individual´s health status, care needs and preferences.
  • By design, compatible in key areas with the nursing home RAI.
  • Consistent, standardized, and validated level of care and assessment.
  • Automatable.
  • High inter–rater reliability.
  • Data set can be used across settings with customization for specific settings.
  • Reasonable length of assessment. Available for use.

InterRAI – CHA Key Domains:


  • Identification Information Intake and Oral History Cognition
  • Communication and Vision Mood and Behavior Psychosocial Well–being Functional Status Continence
  • Disease Diagnoses Health Condition
  • Oral and Nutritional Status Skin Condition Medications
  • Treatment and Procedures Responsibility
  • Social Supports
  • Environmental Assessment Discharge Potential and
  • Overall Status Discharge
  • Assessment Information

Clinical Assessment Protocols (CAPs)

Problem–focused conditions that are common risks:


  • Functional Performance
  • Sensory Performance
  • Mental Health
  • Bladder Management
  • Health Problems/Syndromes
  • Service Oversight

Development for Software and Training

  • Evaluate the interRAI CHA vis–à–vis programs and regulations.
  • Map the current assessment process in all programs. Document use of the current assessment.
  • Identify outcomes and initiate curriculum for assessor education program.
  • Computer readiness survey of users.
  • Beta testing preparation.
  • Web–based training being created.
  • Training tools incorporated into software.


  • InterRAI:
    • Community Health Assessment
    • Functional Supplement
    • Mental Health Supplement
    • Scales,Triggers, CAPs, RUG III
  • New York State Adds:
    • Skilled Nursing Facility Level of Care
    • New York State–Specific Data
  • Summary Output Will Support:
    • Service Planning
    • Care Planning
    • Case Management

System Structure

  • Department of Health
    • Health Commerce System
    • User Login and Authentication
    • System Security
  • Ability to Work "off–line"
    • Off–line Assessment
    • Other Remote Connection

Iterative Development

  • Phase 1 began May 2011:
    • Project Planning
  • Phase II to be completed end of October:
    • Initial system iteration

UAS–NY Project Schedule

  • Iterative Development Cycle
    • Iteration 1: May – July
    • Iteration 2: August – October
    • Iteration 3: November – December
    • Iteration 4: January – February
    • Iteration 5 BETA: March – May
    • Final Candidate Cycle: May – June
    • Pilot Implementation: June – September
  • State–wide Implementation
    • September 2012 onward

Questions: uasny@health.state.ny.us