Attention! In May, NY State Medicaid will start important rule changes affecting all community Medicaid home care programs. These updated laws and procedures will make planning for long term care more important than ever before. The Grimaldi Yeung Law Group has trained attorneys and staff ready to assist clients navigate these barriers to accessing Medicaid community based long term care services.

New Home Care Assessment Procedures

Effective today, May 16, 2022 there are new home care assessment procedures for Medicaid eligible individuals seeking at home care either through Personal Care Services (PCS) or the Consumer Directed Personal Assistance Program (CDPAP).

Applicants are now required to undergo a new Independent Assessment Process to determine how many home care hours they are entitled to receive once they are enrolled in a Managed Long Term Care Plan (MLTC).

This new Independent Assessment Process is comprised of a Community Health Assessment by a Registered Nurse and a Clinical Appointment by a clinician who is part of an Independent Practitioner Panel. The regulations require that these assessors have no prior relationship with the applicant.

A Practitioner Order prepared by the clinician will be required to authorize the home care services. If an applicant requires more than 12 hours per day of home care services, the case will be referred back to an Independent Review Panel for another independent medical review as a “high needs“ case. This “high needs” review is conducted by a separate panel of at least two clinicians, including a lead physician to ensure the proposed plan of care is adequate and reasonable to meet the applicant’s health and safety needs at home.

Since these procedures are brand new and untested, we will be providing special services to our clients who are seeking home care by assisting with scheduling and preparing for these appointments. Our Medicaid trained attorneys and staff will continue to advocate for our client’s needs by instructing and guiding the Medicaid applicant and their family caregivers each step of the way.

New 30 Month Lookback and Transfer Penalties or Community Based Home Care and Long Term Care Services are scheduled to be implemented in fall 2022

Effective October 1, 2022 it is projected that NYS Medicaid will review Medicaid applications seeking community based long term care services and subject these applications to a lookback period and review. In other words, the Department of Social Services will review applicant’s financial activity back to October 1, 2020. This audit will focus on transfers made by the applicant for which they did not receive fair market value or benefit. Upon finding a gift or uncompensated transfers, the agency will impose a waiting period before Medicaid benefits would begin.

This new audit period will be phased in to eventually cover 30 months prior to the application date. Initially the lookback will be 24 months back to October 1, 2020 and every month the lookback period will increase by one month until is it reaches the full 30 months.

Once this new audit review is implemented, assets transferred since October 1, 2020 will be subject to transfer penalties. However, applications filed before October 1, 2022 will have no lookback. Accordingly, applications filed before October 1, 2022 where assets have been transferred after October 1, 2020, will not be subject to a lookback period and those asset transfers will not cause any transfer penalties or waiting periods before benefits will begin.

As with the lookback for Institutional Medicaid (nursing home benefits) there are certain asset transfers that are exempt from transfer penalties, such as transfers to spouses, transfers to a disabled child and transfers by an individual under the age of 65 to a compliant supplemental needs trust, as well as transfers of a home to certain exempt beneficiaries.

Unfortunately, the New York State Department of Health has not issued any guidance on how they plan to implement this new lookback period, including how penalties will be assessed. However, it is clear that if a person is currently in need of assistance at home or may soon be, time is of the essence to begin this process.

At the Grimaldi Yeung Law Group, we have trained attorneys and staff who can assist with the long term care planning necessary to determine best options for obtaining the necessary care.

Please contact us today to review these new rules and begin Medicaid and long term care planning for you and those you are caring for.

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