Managed Care Assessments

NYCHSRO/MedReview has established a program to assist Medicaid Managed Care and MLTC providers in the assessment and authorization of Personal and Home Care Services. NYCHSRO has been assessing Personal Care Service needs for New York City’s Medicaid program (Human Resources Administration/Home Care Services Program) for over 25 years and has a staff of RNs and physicians experienced in home care assessment. NYCHSRO/MedReview is the only organization in New York with extensive experience in all facets of Medicaid Personal Care Review.

WHAT IT IS:

  • In developing its program, NYCHSRO/MedReview uses the assessment tools approved by NYS DOH for Personal Care Assessment, and has successfully transitioned the assessment process into the use of the UAS-NY. The plan can be adapted to meet the requirements of any new regulations promulgated by the New York State DOH.

HOW IT WORKS:

  • Based on its experience working with HRA, NYCHSRO/MedReview’s program utilizes full-time RNs in its assessment process. This improves the quality and consistency of the assessment process. In addition, many Per Diem RN consultants have been recruited for the provision of additional staff support, to satisfy the growing need in the managed care arena. NYCHSRO/MedReview’s RNs are experienced in Personal Care assessment, and are trained in New York regulations as they apply to personal care services.

  • RNs:

    • The RNs complete the Nursing and Social assessments, or the UAS-NY assessment required by regulations, and developed by the Department of Health (DOH). The “PERS” Personal Emergency Response System” assessment is also completed to determine if a member will benefit from the use of a PERS. The assessments are reviewed by a Supervisory RN for quality. The Supervisory RN then forwards it to the Managed Care manager for approval. NYCHSRO/MedReview’s staff can also assist with appeals as necessary.

  • MDs:

    • NYCHSRO/MedReview offers a staff of physicians trained in Medicaid Personal Care assessment which is available for consultation for difficult clinical issues or for approval of high-hour service plans. The Homecare medical Director is also available for consultation in the appeals process.

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