1. The UAS-NY: Abound in Questions, Challenges and Change June 18, 2013 Diane Darbyshire, LeadingAge NY Senior Policy Analyst Anne Hill, Adult Day Health Care Council Policy Analyst Linda Spokane, Director of Research & Analytics Cheryl Udell, LeadingAge NY Community Services Policy Analyst Panelists from LeadingAge NY/ADHCC member organizations

2. Today’s Agenda Introductions Provide brief overview of UAS-NY project Discuss recommended transition activities Review IT requirements Discuss offline and paper-based assessment process Review UAS-NY Readiness Survey results Discuss LeadingAge New York advocacy efforts to date Panelist discussion Questions and Answers

3. Programs Required to use UAS-NY and the Assessment Instruments Being Replaced Adult Day Health Care - RAI Assisted Living Program – PRI, DSS-4449B, DSS-4449D, DSS- 4449C Care at Home I/II Waiver – DSS-4362, DSS-3139 Consumer Directed Personal Assistance Program – DMS-1 Long Term Home Health Care Program – DMS-1, DSS- 3139 Managed Long Term Care plans - SAAM Nursing Home Transition and Diversion Waiver – PRI, Screen Personal Care Services Program - M27-R Traumatic Brain Injury Waiver - PRI, Screen

4. RegionCountiesBegin TransitionImplementation deadline PilotBroome, Chautauqua, Otsego, Warren March 2013July 1, 2013 MLTC plansStatewideJune 1, 2013Oct. 1, 2013 Region VIAllegany, Cattaraugus, Chemung, Erie, Genesee, Livingston, Monroe, Niagara, Ontario, Orleans, Schuyler, Seneca, Steuben, Wayne, Wyoming, Yates May 1, 2013Oct. 1, 2013 Region VCayuga, Chenango, Cortland, Delaware, Herkimer, Jefferson, Lewis, Madison, Oneida, Onondaga, Oswego, St. Lawrence, Tioga, Tompkins June 1, 2013Nov. 1, 2013 Region IVAlbany, Clinton, Columbia, Essex, Franklin, Fulton, Greene, Hamilton, Montgomery, Otsego, Rensselaer, Saratoga, Schenectady, Schoharie, Washington July 1, 2013Dec. 1, 2013 Region IIIDutchess, Orange, Putnam, Sullivan, Ulster, Rockland Aug. 1, 2013Jan. 1, 2014 Regions I & IINassau, New York City, Suffolk, Westchester Sept. 1, 2013Feb. 1, 2014

5. UAS-NY Overview Single record for individuals in Medicaid Long Term Care system Secure web-based software application Role-based system Housed within NYS- DOH HCS Off-line application available Ad hoc reporting capabilities Community Health Assessment (for adults over the age of 18) includes two supplements: Functional and Mental Health Program regulations not subject to change

6. How does MLTC fit into the picture? For MLTC enrollees: – MLTC plan will conduct assessment in the home, determine a plan of care, and prescribe community-based services. Downstream provider will fulfill care plan and MLTC plan will conduct reassessment every 180 days. – MLTC plan may contract with downstream provider to conduct UAS-NY and/or reassessments using a Care Management Administrative Services (CMAS) contract. For Medicaid recipients NOT in enrolled in MLTC plan: – Program is responsible for conducting assessment and reassessment by appropriate staff and within the timeframe as reflected in regulation.

7. UAS-NY Training Environment All training is web-based and self-paced Training modules contain fundamental (required), intermediate and advanced courses Training is classified as either mandatory or recommended based on assigned role(s) Staff will not be allowed to access the UAS-NY application before completing mandatory courses Training for certain roles may take at least 10 hours to complete At our urging, DOH is developing a test environment

8. Transition Activities Establish HCS User Accounts – Time consideration – Trust Level III assurance for all UAS-NY users is required Establish a UAS-NY workgroup within your organization – Appoint UAS-NY Coordinator(s) – Thoroughly review the most recent version of the UAS-NY Transition Guide (dated 5/14/2013) – Establish an internal and external communication plan – Establish UAS-NY roles - authorize access – Participate in DOH and LeadingAge NY webinars Assess staff computer literacy and provide additional training as needed

9. Organizational Considerations Leadership team – UAS-NY workgroup – UAS- NY Coordinator Point person to facilitate the change to UAS-NY within your organization Point person for internal and external communication Administrative activities Back-up

10. Internal and External Communication Plan Consider how your organization/staff responds to change and plan accordingly What is effective internal communication? – Face-to-face meetings – Emails – Teaching labs – Timing – timing – timing – I wish I knew in advance………. What is effective external communication? – Contractors – sub-contractors for assessments – Social service districts – DOH – LeadingAge New York

11. UAS-NY Roles UAS Role Name Generally Intended For: UAS-15 Administrative Staff UAS-20 Review/Consult/OT, PT, ST UAS-30 Social Assessors UAS-35 Social Assessor Supervisors UAS-40 Nurse Assessors UAS-45 Nurse Assessor Supervisors UAS-50 Managers Source: DOH Transition Guide (page 41), dated 5/14/2013

12. IT Specifications Remember that ALL users of the UAS-NY must have an HCS account – Time considerations – Includes contractors Page 38 of the Transition Guide provides the technical requirements for using the UAS-NY Online Application Page 39 provides technical requirements for the Offline Application

13. IT Considerations Be sure to review IT specifications in Transition Guide carefully before investing in new equipment DOH does NOT recommend the use of tablets The system does not run on MAC-based products Ensure that hardware settings, operating systems, supported browsers, settings and software requirements are per specification to ensure proper functioning LeadingAge New York can help

14. Offline Use When using the offline application, there are steps the assessor must take, while still connected to the internet (i.e. in the office prior to going into the field): – Start the UAS-NY Offline Application and log into the HCS – Select individuals you will be assessing and synchronize the data (placing case files on assessor’s laptop) – After conducting the offline assessment and returning to a site that is internet accessible, the assessor must start the Offline Application and again synchronize, updating the system with the new assessment data – Signature of assessment can only occur when online

15. Offline Use Considerations Offline use may be necessary if there is no internet access at time/place of assessment Assessor will be storing HIPAA and HITECH protected data on their computer (e.g. laptop). Your organization is responsible for data stored on your organization’s computers; you must take additional steps to protect it The UAS-NY Offline Application requires the installation of the software application on the computer (e.g. laptop). Installation instructions are available with the installation program

16. Conducting Paper-based Assessments Under certain circumstances, you may need to complete the assessment on paper. However, paper use is NOT recommended. If a paper-based assessment is conducted, additional supplements (i.e. Mental Health assessment, Functional assessment) will not be triggered automatically. Assessors must be aware of this and conduct the additional assessments, if required Assessment data must ultimately be entered into the online system You are responsible for the protection of health information

17. UAS-NY Readiness Survey In late-April, a survey was sent to all LeadingAge NY members with ADHC, ACF/AL, LTHHCP, MTLC, and TBI programs Purpose was to evaluate readiness of members to implement UAS-NY, determine barriers to implementation, and gauge interest in additional education 83 respondents – Pilot: 2 – Region VI: 15 – Region V: 23 – Region IV: 8 – Region III: 2 – Regions 1&2: 33

18. Survey Results Identifying HCS and UAS Coordinators – 78% of respondents had identified their HCS Coordinator 12% have begun the training modules – 61% of respondents had identified their UAS Coordinator 24% have begun the training modules IT Proficiency – Proficiency was rated based on a 1-10 scale, with 1 being not proficient at all and 10 being highly proficient – On average, HCS and UAS Coordinators are moderately proficient (7.3 and 6.5, respectively) – Lower levels of proficiency reported for staff responsible for conducting and reviewing assessments (<6 out of 10)

19. IT Infrastructure 78% of respondents have a dedicated IT staff – Not necessarily located on site – Some organizations contract out IT – Several noted the limited number of IT staff available compared to size of organization (e.g. 1 IT staff for 500 employees) 82% of respondents have an adequate number of computers to conduct onsite assessments but only 33% indicated they have an adequate number for offsite assessments

20. Additional Education/Training Primary challenges/concerns – Understanding the “getting started” process (i.e. appointing coordinators, assigning roles, completing training modules) – Preparing and training staff – Having enough IT resources – TIME! Overwhelming majority (87%) indicated interest in a half-day in-person UAS Readiness Workshop led by LeadingAge IT staff Stay tuned for more information about the workshops

21. DOH and LeadingAge NY webinars Participate Ask your questions – send to UAS-NY staff & copy LeadingAge NY uasny@health.state.ny.us Keep us informed of your experience-good and bad! Advocacy

22. April Meeting with DOH regarding ALP Medicaid rate crosswalk and general concerns May 28, 2013 Webinar Program specific webinars LeadingAge New York Letter to DOH requesting delay with implementation LeadingAge New York Letter to DOH 90 day delay implementing the UAS-NY for Managed Long Term Care (MLTC) plans 90 day delay implementing the UAS-NY for Managed Long Term Care (MLTC) plans Meeting again with DOH in July

23. Resources DOH UAS-NY WebsiteDOH UAS-NY Website: http://www.health.ny.gov/health_care/medicaid/redesign/unifo rm_assessment_system/index.htm LeadingAge New York site: http://www.leadingageny.org/providers/home-and-community- based-services/best-practices-and-resources/uniform- assessment-system/

24. Panelists Kathy Norsen, Clinical director, Schofield Adult Day Health Care, Buffalo Kathy Swezey, Executive Director of Good Shepherd-Fairview Home, Binghamton Phyllis Dailey, Office Manager and UAS Coordinator, UHS Home Care/Senior Living at Ideal, Binghamton Danielle Tierno, ACF/ALP Case Manager, Good Shepherd-Fairview Home, Binghamton Cindy Steele, Director of Clinical Services Hultquist Place, Jamestown Sharon H Phipps RN, BSN, Senior Director, UHS Home Care at Ideal - LTHHCP and LHCSA DPSm, UHS Senior Living At Ideal - ACF and ALP Administrator Barb Travis, Broome County CASA, Broome County Local Department of Social Services

25. Questions? Contact LeadingAge NY: Diane Darbyshire, ddarbyshire@leadingageny.org, 518.867.8828ddarbyshire@leadingageny.org Anne Hill, ahill@leadingageny.org, 518.867.8836ahill@leadingageny.org Linda Spokane, lspokane@leadingageny.org, 518.867.8857lspokane@leadingageny.org Cheryl Udell, cudell@leadingageny.org, 518.867.8871cudell@leadingageny.org Questions may also be emailed to: uasny@health.state.ny.us