DOH Rescinds Emergency Guidance on Physician Orders, Assessments 

The state Department of Health (DOH) has posted a new guidance rescinding several COVID-emergency-era flexibilities in the requirements for physician orders and various assessments.

The new guidance replaces a March 18, 2020 one (updated on April 8, 2020) that was issued in response to the COVID-19 state disaster emergency declaration, which expired on June 25, 2021.

The now-updated guidance is applicable to managed care plans, Local Departments of Social Services (LDSS), and Medicaid services delivered through Licensed Home Care Services Agencies and the Consumer Directed Personal Assistance Program (CDPAP).

HCA has reached out to DOH on some of the below provisions which seem to be contrary to what DOH had communicated at meetings of HCA and other Associations. We are also advocating with DOH to provide additional transition time on these areas and others given the major challenges that providers and plans are still facing in the aftermath of New York’s declared public health emergency and the continuing impacts of COVID-19.

Personal Assistant Annual Health Assessments 

DOH is withdrawing the suspension of annual health assessments for CDPAP Personal Assistants. Personal Assistants must now obtain a health assessment, if already due, no later than September 30, 2021. A subsequent health assessment will be due one year later.

Physician Order Form Required for Community Health Assessments (CHAs) 

For personal care and CDPAP, physicians may still use telephonic or telehealth modalities to conduct medical examinations that assess an individual’s needs for services. However, the Department is rescinding the “ability of physicians to transmit the results of the medical examination and a physician order verbally,” and a community health assessment may no longer be initiated upon receipt of a verbal order. Effective immediately, the physician order form (DOH-4359 or HCSP-M11Q) is required.

In-Person RN Assessments 

Effective immediately, all RN assessments must be in-person for initial authorizations and requests for change in service authorizations. “The ability to conduct the CHA via telephonic or telehealth modalities to develop an initial plan of care has been rescinded.”

Temporary Care Plans Rescinded 

DOH will no longer allow a partially completed community health assessment to be used in care plan development. For those members with a temporary plan of care in place, managed care plans and LDSSs “should ensure all members have a completed CHA and plan of care with notice of determination in place within 90 days of the effective date of this guidance.”

Face-to-face Reassessments and Care Management Visits 

Effective immediately, managed care plans and LDSSs must begin resuming required face-to-face periodic reassessments and the six-month in-person care management home visits.

Please see DOH’s guidance for a timetable outlining when these activities should take place for members who have not otherwise had a completed in-person, telehealth, or telephonic CHA conducted during the public health emergency.

The document also emphasizes screening, testing and other related policies for conducting face-to-face visits, stressing that providers strictly enforce their illness and sick leave policies.

HCA has met with DOH and documented our priorities for continuation of regulatory relief measures beyond the expiration of the state’s emergency declaration (the federal emergency is still in effect).

These include timeframes for initial visits; supervision of home health, personal care and hospice aides; home health aide (HHA) training program supervised practical training; extensions of approved personal care aide and HHA Training Programs; aide in-service training requirements; use of out-of-state and/or non-registered health professionals; and more.

HCA will advocate for extensions of these core relief areas as providers and staff continue to confront COVID-related challenges and impacts.

As a reminder, HCA yesterday sent out an alert about new DOH guidance on completion of in-service training for aides. You can read that alert here.

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