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March 18, 2020
Re: COVID-19 Guidance for the Authorization of Community Based Long-Term Services and Supports Covered by Medicaid
The New York State Department of Health (NYSDOH) is providing this guidance to Medicaid Managed Care Plans, Local Departments of Social Services (LDSS), and Consumer Directed Personal Assistance Program (CDPAP) pertaining to the current novel coronavirus (COVID-19) outbreak. The guidance applies to Medicaid covered services as described below when delivered through either Licensed Home Health Care Services Agencies or CDPAP. Topics include: (1) physician orders; (2) the initial Community Health Assessment; (3) Community Health Reassessments; (4) Annual Health Assessments for Personal Assistants; and (5) Facility-Based Assessments. Guidance provided herein should be shared by CDPAP Fiscal Intermediaries with Consumers and by Consumers with their Personal Assistants. This guidance is provided in light of the COVID-19 outbreak and the state disaster emergency declared by Executive Order No. 202 and shall remain in effect until subsequent notice from the NYSDOH which will be provided prior to or upon the expiration of such state disaster emergency.
Background
The health and safety of the State’s health care workforce and our ability to provide and support patient care remain our priorities. Recently, community-wide transmission of COVID-19 has occurred in the United States (US), and the number of both Persons Under Investigation (PUIs) and confirmed cases are increasing in NYS. The situation with COVID-19 infections identified in the US continues to evolve and is very rapidly changing. It is important for all agencies, Medicaid Managed Care Plans, LDSS and Consumer Directed Personal Assistance Program (CDPAP) consumers keep apprised of current guidance by regularly visiting the Centers for Disease Control and Prevention (CDC) and NYSDOH websites, as well as the NYSDOH Health Commerce System (HCS), for the most up-to-date information for healthcare providers.
CDC: https://www.cdc.gov/coronavirus/2019-ncov/index.html
NYSDOH: https://www.health.ny.gov/diseases/communicable/coronavirus HCS: https://commerce.health.state.ny.us
It is important to keep staff, enrollees, and Consumers updated as the situation changes and educate them about the disease, its signs and symptoms, and necessary infection control to protect themselves and the people they serve. NYSDOH distributes alerts and advisories on its website and, therefore, it is vital that all organizations maintain up-to- date contact with both the CDC and NYSDOH. Additionally, Medicaid Managed Care Plans, LDSS and CDPAP Consumers may wish to provide internal contact information for their staff, enrollees and Consumers, as applicable, to call with concerns, reports or questions.
Guidance
1. Physician Order:/Initial authorizations for Personal Care Services (PCS) and Consumer Directed Personal Assistance Services (CDPAS) will continue to require a physician order. Pursuant to applicable state regulations, the physician’s order documents the medical examination that assess an individual’s needs for PCS or CDPAS and describes the patient’s medical condition and regimes and the patient’s need for assistance with personal services tasks. Based on this information, the physician must certify as part of the order that the patient is able be cared for at home. To promote compliance with CDC and NYSDOH guidance and avoid unnecessary exposure to COVID-19, effective immediately, and until further notice is provided by NYSDOH, the ordering physician is encouraged to use the telephone or permitted telehealth modalities in connection with completion of the required physician order. Physicians should consult with applicable provisions of NYSDOH’s recently issued special guidance on the use of telehealth for a description of permitted telehealth modalities (https://www.health.ny.gov/health_care/medicaid/program/update/2019/2019- 02_speced.htm).
2. Initial Community Health Assessment/: Initial authorizations for PCS, CDPAS, and other community based long term services and supports (CBLTSS) (i.e., nursing services in the home, therapies in the home, home health aide services, adult day health care, and private duty nursing) and requests for changes in service authorizations, will continue to require a completed Community Health Assessment (CHA). To promote compliance with CDC and NYSDOH guidance and avoid unnecessary exposure to COVID-19, effective immediately, and until further notice is provided by NYSDOH, registered nurses may conduct the CHA by telephone or permitted telehealth modalities, as described in the applicable provisions of the Telehealth Guidance. During this time period, CHAs conducted by telephone or telehealth, which would otherwise require a face-to-face assessment to be fully completed, may be used to develop an initial plan of care for the recipient and to authorize necessary CBLTSS, both through fee-for-service and Medicaid managed care.
Notwithstanding the ability to conduct a CHA by telephone or through telehealth, eligibility requirements and standards for services and Managed Long-Term Care (MLTC) plan enrollment are not being changed. To that end, a CHA conducted by telephonic or through telehealth, but that cannot be fully completed (e.g., the functional assessment) may not be used to determine initial eligibility for members to enroll in MLTC plans. Until such time as the CHA may be fully completed, the member’s LDSS will develop and monitor the plan of care. Additionally, this guidance does not preclude completion of a full CHA and enrollment in an MLTC if consistent with CDC and NYSDOH guidelines. For individuals already enrolled or newly enrolled in a Mainstream, HIV-SNP or HARP Medicaid Managed Care plan, the member’s plan will remain responsible for completing the CHA and monitoring the plan of care.
3. Reassessments and Home Visit:/Effective immediately, and until further notice, NYSDOH is suspending all required periodic re-assessments of CHAs through Medicaid managed care (including MLTC) or fee-for-service Medicaid. In addition, the six-month in-person care management home visit requirement is also suspended. CHAs and in-person care management home visits otherwise due, but not conducted under this suspension should be noted in the plan of care and care management records for audit purposes.
4. Personal Assistant Annual Assessments./Effective immediately, and until further notice, to ensure continuity of care for individuals receiving PCS through CDPAP, NYSDOH is suspending the annual renewal of the health assessment, immunizations and TB test required for personal assistants providing services to Consumers in CDPAP. This suspension does not apply to new personal assistants. Renewals that do not occur as a result of this suspension should be documented in the employee’s record.
5. Facility-Based Assessments./When scheduling the CHA with a skilled nursing facility or other health care facility, LDSS and Conflict-Free Evaluation and Enrollment Center (CFEEC) staff must rely on the guidance and direction of facility medical director as to whether it is medically necessary for the individual to have a CHA evaluation. This guidance is consistent with Executive Order 202.1, which states only medically necessary visits will be allowed at skilled nursing facilities.
Guidance on Home Care Services and Close or Proximate Contacts
To help protect consumers and personal assistants, attached are two NYSDOH COVID-19 guidance documents related to home care services and close or proximate contact of a confirmed or suspected case of COVID-19. The links to those guidance documents are provided below:
* Interim Guidance for Home Care Services Regarding COVID-19 https://coronavirus.health.ny.gov/system/files/documents/2020/03/03-16- 20_home_care_services.pdf
* Guidance on the Contacts of a Close or Proximate Contact of a Confirmed or Suspected Case of COVID-19 https://coronavirus.health.ny.gov/system/files/documents/2020/03/contacts_of_contact s_guidance.pdf
Instructions for provider personnel who are at risk of being a Person Under Investigation (PUI)
Staff are exposed to the general community each day and could become infected with an acute respiratory illness (e.g. COVID-19, influenza, respiratory syncytial virus (RSV)), if community transmission of that illness is occurring. Providers should ensure they have a policy in place to speak with staff prior to them conducting face-to-face visits with enrolled members in order to screen the staff for symptoms or contacts that might have put them at risk. It is important that providers strictly enforce their illness and sick leave policies. Staff showing symptoms of illness should not be permitted to remain at work or visit members and should not return to work until completely recovered.
Staff who have been potentially exposed to someone with confirmed COVID-19, or to someone who is a person under investigation (PUI) for COVID-19, might be placed under movement restrictions by public health officials/,/based on exposure risk for having contracted COVID-19 and any presenting symptoms.
If a staff person is found to be ill upon screening, the agency should send the person home and suggest that they contact their primary care physician immediately or refer them to immediate medical care, if indicated.
Where can I direct my questions about COVID-19?
Questions can be directed to the following email address: icp@health.ny.gov; or to the toll-free call center at 888-364-3065.
Your diligence in implementing appropriate measures for COVID-19 preparedness is appreciated.
Where can I direct my questions about this guidance?
Please send any questions relating to this guidance to MLTCinfo@health.ny.gov.
Your diligence in implementing appropriate measures for COVID-19 preparedness is appreciated.
Sincerely, Jonathan Bick, Director, Division of Health Plan Contracting and Oversight Office of Health Insurance Programs
Lana I. Earle, Director, Division of Long Term Care, Office of Health Insurance Programs