DOH ADOPTS CDPAP Fee-For Service Reimbursement Rule Effective Today
In today’s New York State Register at page 7, the Department of Health (DOH/the Department) published for adoption a new rule related to Consumer Directed Personal Assistance Program (CDPAP) Reimbursement.
The purpose of the rule is to establish a program to pay home care services and establish a methodology framework for the payment of FI administrative costs.
Under the new rule the tiers of payment for fiscal intermediary administrative costs shall be as follows:
Tier 1 - 1 – 159 hours - $145 per member per month (PMPM)
Tier 2 - 160 – 479 hours - $384 PMPM
Tier 3 - 480+ hours - $1,036 PMPM
Nothing in the pertinent subdivisions shall impact wages or wage-related requirements for consumer directed personal assistants nor impact the ability of Medicaid managed care organizations to reimburse fiscal intermediaries for fiscal intermediary administrative costs pursuant to their provider contracts.
Significant points to note:
With the adoption of this rule, DOH has clearly heard, acknowledged and accepted the message that the rates initially proposed when this rule was published for comment several months ago were far too inadequate. These adopted rates are either double or nearly double what was initially proposed, validating the advocacy that HCP has and continues to do on this issue.
Another important change advocated for by HCP deals with the retroactive application of the rule as originally proposed. The original proposal aimed at making these reimbursement changes retroactive to when the original proposal was first released. The adopted rule states that it is effective as of today, January 13, 2021. There is nothing in the regulation or commentary that suggests it is intended to have any retroactive effect, indicating that retroactive application is not likely.
HCP has been in contact with its attorney in this matter, Hermes Fernandez of Bond, Schoeneck and King as to HCP’s lawsuit which is pending appeal by DOH. This rulemaking does not appear on its face to directly impact the Department’s appeal. HCP is attempting to determine Department intentions with respect to the appeal.
It is unclear what this rule adoption means for the currently and long pending CDPAP RFO, but it may signal that the Department is readying itself to take the next step in that process. HCP is working to get clarification on this point.
CDPAP Contracts with MLTCs
By its own terms, this rule does not apply to services pursuant to a contract with a Medicaid managed care organization or managed long term care (MLTC) organization. It may, however, be of assistance to providers in negotiating the terms of contracts with MLTCs.
HCP welcomes feedback from its members on these developments. Please contact Kevin Kerwin for further discussion.