MLTC Policy 13.09:

Transition of Semi-Annual Assessment of Members to Uniform Assessment System for New York

  • Policy is also available in Portable Document Format (PDF)

Office of Health Insurance Programs

Division of Long Term Care

MLTC Policy 13.09: Transition of Semi-Annual Assessment of Members to Uniform Assessment System for New York

Date of Issuance: April 26, 2013

The purpose of this document is to highlight changes related to the assessment of members in Managed Long Term Care (MLTC) Plans. Effective July 1, 2013, the Uniform Assessment System for New York (UAS-NY) will replace the Semi-Annual Assessment of Members (SAAM).

  1. Enrollment of New Members
    Currently the Start of Enrollment SAAM assessment can be started 6 weeks prior to enrollment and then finalized within three days of enrollment.

    Modification - The UAS-NY will be used for all Start of Enrollment assessments of a MLTC member. This assessment must be completed, signed, and finalized within 30 days of referral. For example, an individual is referred to a MLTC Plan on May 5, 2013 for a July 1, 2013 enrollment. The Plan is required to conduct, sign and finalize the UAS-NY assessment no later than June 4, 2013. If there is a significant change in condition prior to enrollment, the Plan will conduct a new assessment.

  2. Reassessment of Members
    Currently the reassessment of a member with SAAM can be completed two weeks prior to or two weeks after the due date.

    Modification - Effective July 1, 2013, all reassessments of a MLTC member will use the UAS- NY and must be completed, signed, and finalized at any time during the month that the reassessment is due. For example, if the reassessment is due April 1, the plan can complete the assessment at any time during the month of of April.

  3. Significant Change in Condition
    Currently the significant change in condition type of assessments are not submitted by MLTC Plans New York State.

    Modification - With the implementation of the UAS-NY, MLTC Plans will conduct a significant change in condition using the UAS-NY. When a significant change in condition assessment is conducted, the six-month reassessment clock will automatically restart. For example, if a reassessment was conducted on August 2, 2013 and a significant change in condition assessment was conducted on October 15, the next reassessment is due 6 months from the October 15, 2013 date.

  4. Deferral of Reassessment
    Currently if the member is in the hospital or out of the area when a reassessment is due the reassessment can be deferred until the member is discharged from the hospital or returns home.

    Modification - The UAS-NY does not have the option to indicate that a reassessment was deferred. If a reassessment is completed in variance to MLTC policy rules (within the month the reassessment is due), the member's record should indicate the reason for the late reassessment. The nurse should record these comments in the "Sign/Finalize" section of the UAS-NY.

  5. July 2013 Submission of SAAM Data
    The July 2013 submission of SAAM data (assessment data for December 16, 2012 through June 15, 2013) will be the final submission of SAAM data.

    The UAS-NY is a web-based application and State Department of Health (SDOH) staff have direct access to the data. As such, SDOH staff will directly access data for MLTC Plans following current reporting timeframes.

  6. Availability of DELTA
    Users may continue to access DELTA through June 15, 2013. Beginning June 16, 2013, DELTA will not be available.

  7. Time Period for Finalizing a UAS-NY Assessment
    The assessments in UAS-NY are designed to capture an individual's status at a "point-in-time". Responses for items are based on nurse assessor inquires and observation based on the assessment reference date. For most items it is a three-day look back period. Other items require a 7, 30, or 90-day look back. In order to achieve maximum consistency in assessment results assessors must adhere to the designated timeframes for each item.

    In most cases, the UAS-NY assessment will be completed during one home visit. Since data is entered directly into the UAS-NY application, it is expected that the assessment will be finalized on the day of (or within a few days) of the home visit. If other disciplines are involved in the assessment, it may take a few more days to finalizing an assessment.

    If changes must be made to an assessment that is finalized, a person with a role assignment of "UAS-45" (nurse supervisor) must unfinalize the assessment. This must occur within 30 days of the assessment finalization date.

    The UAS-NY is not designed to serve as a mechanism to keep continual updates or modifications on an assessment over a period of weeks or months.