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Understanding the New York Independent Assessor Process

On May 16, 2022, New York changed the way assessments are done for people who are new to personal care or CDPA. The system used now is called the New York Independent Assessor (NYIA). 

NYIA Website: https://nyia.com/en

NYIA Contact Phone Number: 1-855-222-8350

Hours: Monday to Friday, 8:30 a.m. to 8 p.m. Saturday and Sunday, 10 a.m. to 6 p.m., except for designated state holidays.

The New York Independent Assessor’s assessment process includes the following steps:

  1. A Community Health Assessment by a nurse. These may be done in person or via telehealth, and should be scheduled within 14 days of calling for an appointment. Call 855-222-8350.

  2. A Clinical Assessment (the medical assessment) by a health care provider through the Independent Practitioner Panel (IPP), in person or via video call. During this step of the process, you must be evaluated by the IPP, not your own doctor.

  3. NYIA will send an outcome notice saying if you are approved or denied. If approved, you will be sent information to choose a Managed Long-Term Care plan (MLTC) or be referred to their local department of social services (LDSS) or a Mainstream Managed Care Plan (MMC). If not approved, you will receive information on how to file a Fair Hearing.

    4. The managed care plan or LDSS will develop the plan of care based on information from the two NYIA assessments, then authorize specific hours for the consumer and issue final notice. If the consumer doesn’t need 12 or more hours a day, this is the final step. If they are found to need 12 or more hours, see steps 5 & 6.

    5. Consumers found to need 12 or more hours a day must see the Independent Review Panel (IRP). This is an extra step that only applies to new consumers – those with 12+ hours now don’t need to see the IRP. The IRP recommends whether a proposed plan of care is “reasonable and appropriate” to maintain health & safety in the home. The IRP may recommend changes in plan of care but NOT specific amount of hours.

    6. The MLTC plan, county, or MMC plan may or may not change authorized hours based on the IRP’s recommendations. After reviewing the IRP’s recommendations, they will issue the final plan of care, hours and notice to the consumer. 

Appealing a NYIA Evaluation

  • If NYIA determines that you are not eligible to receive CDPA services you may request a fair hearing to appeal the decision.

  • A Fair Hearing is a proceeding before a judge to review the decision on your case. During the Fair Hearing you will have the opportunity to tell a judge why you disagree with the decision. You have 60 days from the date you got the letter to fill out and mail the Fair Hearing Notice that comes with your letter. You can also call the number on the Fair Hearing Notice to schedule a Fair Hearing. 

  • If you have questions about asking for a Fair Hearing, call the New York Independent Assessor Program at 1-855-222-8350 (TTY: 1-888-329-1541). A New York Independent Assessor Program counselor will explain how to request a Fair Hearing.

  • Fair Hearing request forms in multiple languages are available at: https://otda.ny.gov/hearings/request/#online 

  • You are allowed to represent yourself or have someone else represent you in a fair hearing. Legal representation while allowed is not paid for by the state. There are however a number of legal aid groups operating in the state that can represent you.