New York Independent Assessor Program (NYIAP)

LDSS/MMCO

Roles and Responsibilities of the Local Department of Social Services (LDSS) and the Medicaid Managed Care Organization (MMCO)

The NYIAP conducts the assessment for CBLTSS, including personal care and/or CDPAS. Before developing a plan of care, or authorizing services, the LDSS/MMCO must:

  • review the NYIAP Community Health Assessment and Practitioner´s Order; and
  • determine:
    • that PCS/CDPAS can be provided according to the Plan of Care;
    • that these services are medically necessary; and
    • that such services can reasonably maintain the individual´s health and safety in their home.

Prior to authorizing CBLTSS including personal care and/or CDPAS, LDSS/MMCOs are responsible for:

  • reviewing other available services and supports to determine cost effectiveness;
  • determining frequency of nursing supervision;
  • determining the individual´s preferences and social and cultural considerations for the receipt of care;
  • heightened documentation requirements for 24-hour cases; and
  • the development of the plan of care, including the amount, duration and frequency of services.

In evaluating the cost effectiveness of services, the LDSS/MMCOs must consider:

  • the availability of informal supports voluntarily offered to and received by the individual;
  • the availability of other services and programs, equipment or adaptive or assistive technologies that may meet the individual´s needs; and
  • individual preference.