New York Independent Assessor (NYIA)

Department of Health Announcements Regarding the New York Independent Assessor

JUNE 17, 2022 UPDATE To Immediate Needs/Expedited Assessment Implementation Date

GIS 22 MA/05 and Mainstream MC Guidance were posted on June 17, 2022 to delay implementation of the NYIA conducting initial assessments based on an immediate or expedited need for PCS and/or CDPAS to October 1, 2022.


UPDATE To Implementation Date - April 15, 2022

The implementation date of the New York Independent Assessor is now anticipated to begin on May 16, 2022.

The Department of Health is delaying the implementation of this change in how Medicaid recipients are assessed for personal care and consumer directed personal assistance services, and enrollment into Managed Long Term Care, in recognition of the ongoing issues related to the COVID-19 pandemic, including additional pressures from the current Omicron surge.  This additional time will allow DOH to continue to engage with Medicaid managed care organizations, local departments of social services and other stakeholders to ensure the smoothest transition possible.

Questions can be sent to independent.assessor@health.ny.gov.

Program Information:

Chapter 56 of the Laws of 2020 authorized the Department of Health (Department) to contract with an entity to conduct an independent assessment process for individuals seeking Community Based Long Term Services and Supports (CBLTSS), including Personal Care Services (PCS) and Consumer Directed Personal Care Services (CDPAS or CDPC Program – CDPAP). Subsequently, New York´s PCS and CDPAS regulations at 18 NYCRR 505.14 and 18 NYCRR 505.28, respectively, were amended to require that individuals seeking these services under the Medicaid State Plan must obtain an independent assessment and be evaluated and have a Medical Review and Practitioner´s Order form completed by an independent clinician that does not have a prior relationship with the individual seeking services.

The Department has contracted with Maximus Health Services, Inc. (Maximus) to implement the New York Independent Assessor (NYIA), which includes the independent assessment, independent practitioner panel and independent review panel processes, leveraging their existing Conflict Free Evaluation and Enrollment Center (CFEEC) infrastructure and experience.

Upon implementation the NYIA will conduct all initial assessments and all routine and non-routine reassessments for individuals seeking personal care and/or Consumer Directed Personal Assistance Services (CDPAS).

  • The assessment process includes:
    • the Community Health Assessment (CHA) in the UAS-NY, New York´s comprehensive assessment for State Plan CBLTSS, conducted by a Registered Nurse; and
    • a clinical exam, conducted by a clinician on an Independent Practitioner Panel (IPP) under the New York Independent Assessor (NYIA); and
    • for high needs cases, defined as the first time, after the date of NYIA implementation, the proposed plan of care includes services for more than 12 hours per day, on average, an Independent Review Panel (IRP) evaluation to ensure that the proposed Plan of Care developed by the Local Department of Social Services (LDSS) or the Medicaid Managed Care Organization (MMCO) is appropriate and reasonable to maintain the individual´s safety in their home.

In addition to these changes, effective November 8, 2021, the regulations expanded the type of clinicians that may sign a Practitioner´s Order for PCS/CDPAS and conduct a high-needs case review to include:

  • Medical Doctors (MD);
  • Doctors of Osteopathy (DO);
  • Nurse Practitioners; and
  • Physician or Specialist Assistants (PA)

As of November 8, 2021, the regulations also increased the length of time the CHA may be valid from six (6) months to up to twelve (12) months. However, individuals will continue to be reassessed upon a change in medical condition, upon release from institutional care, or upon their request (non-routine reassessments) and before their current assessment expires (routine reassessment).