ProLife CDPAP Program for New York State

ProLife CDPAP Program for New York State

January 04, 2023   23

What is the CDPAP

The Consumer Directed Personal Assistance Program, commonly referred to as CDPAP,  is a statewide Medicaid program that provides an alternative way of receiving home care services. The individual receiving care - known as the Consumer - has complete freedom to choose who is hired to be their caregiver and total flexibility to direct how care is provided.  Rather than assigning a home care agency to control selection, training, and scheduling of aides, the Consumer or the family member, friend or guardian directing his/her care performs all these functions.  All State counties - and now all mainstream Managed Care and Managed Long Term Care plans - are required to have a CDPAP program and notify “eligible individuals” of the option to join.  Eligible individuals include those eligible for  services provided by a certified home health agency, a long term home health care (waiver) program,  AIDS home care program, or personal care (home attendant). Click here for the list of Counties ProLife Home Care provides service to.

 

CDPAP Consumer Eligibility Requirements

To participate in the CDPAP, a consumer must meet all of the following eligibility requirements:

  1. Be eligible for medical assistance;
  2. Be eligible for long term care and services provided by a certified home health agency, long term home health care program or an AIDS home care program authorized pursuant to Article 36 of the Public Health Law; or for personal care services or private duty nursing services;
  3. Have a stable medical condition;
  4. Be self-directing or, if non self-directing, have a designated representative;
  5. Need some or total assistance with one or more personal care tasks, home health aide tasks or skilled nursing tasks;
  6. Be willing and able to fulfill the consumer's responsibilities or have a designated representative who is willing and able to fulfill such responsibilities; and
  7. Participate as needed, or have a designated representative who participates, in the required assessment and reassessment processes.

 

CDPAP Consumer or Designated Representative Responsibilities

A consumer or, if applicable, the consumer's designated representative has the following responsibilities under the CDPAP:

  1. Managing the plan of care including recruiting and hiring a sufficient number of individuals to provide authorized services that are included on the consumer's plan of care; training, supervising and scheduling each personal assistant; and assuring that each consumer directed personal assistant competently and safely performs the personal care tasks, home health aide tasks and skilled nursing tasks that are included on the consumer's plan of care; terminating the personal assistant's employment;
  2. Timely notifying the social services district of any changes in the consumer's medical condition or social circumstances including, but not limited to, any hospitalization of the consumer or change in the consumer's address, telephone number or employment;
  3. Timely notifying the fiscal intermediary of any changes in the employment status of each consumer directed personal assistant;
  4. Attesting to the accuracy of each consumer directed personal assistant's time sheets;
  5. Transmitting the consumer directed personal assistant's time sheets to the fiscal intermediary according to its procedures;
  6. Timely distributing each consumer directed personal assistant's paycheck, if needed;
  7. Arranging and scheduling substitute coverage when a consumer directed personal assistant is temporarily unavailable for any reason; and
  8. Entering into the Department approved CDPAP Agreement between the LDSS and the Consumer/Designated Representative with the social services district that describes the parties' responsibilities under the CDPAP.

 

CDPAP Personal Assistant (PA) Eligibility Requirements

Almost any relative, friend or neighbor qualifies to become a Personal Assistant - commonly referred to as the PA - for which they are paid a salary to provide care for the Consumer. Personal assistants are not eligible from being hired as CDPAP assistants if they are legally responsible for the eligible individual’s care and support. This means that an adult who is not legally responsible for the eligible individual’s care and support may be a CDPAP assistant for that eligible individual. In particular, this means that a parent of an adult child (21 years of age or older) may serve as that adult child’s CDPAP assistant. Parents of children who are younger than 21 cannot be hired as that minor child’s CDPAP assistant. Consistent with current regulations, spouses and designated representatives also cannot be hired as CDPAP assistants. 

Any other adult relative of the CDPAP eligible individual may serve as the individual’s CDPAP assistant. In all cases, the CDPAP authorization is based on the eligible individual’s assessed needs. This applies regardless of whether the CDPAP assistant is a parent or other adult relative of the individual or not related to the individual. 

 

Examples of CDPAP Personal Assistant Responsibilities

  • bathing
  • dressing
  • grooming
  • eating
  • transferring
  • ambulating
  • toileting
  • housekeeping
  • laundry
  • meal planning and preparation
  • managing finances
  • shopping and errands

 

What is a Fiscal Intermediary (FI)?

An entity that has a contract with a social services district or managed care organization to provide wage and benefit processing for consumer directed personal assistants and to perform the fiscal intermediary responsibilities specified 

As Fiscal Intermediary, ProLife Home Care has the following responsibilities with respect to the CDPAP:

  1. Processing each consumer directed personal assistant's wages and benefits including establishing the amount of each assistant's wages; processing all income tax and other required wage withholdings; and complying with worker's compensation, disability and unemployment insurance requirements;
  2. Ensuring that the health status of each consumer directed personal assistant is assessed prior to service delivery pursuant to 10 NYCRR § 766.11(c) and (d) or any successor regulation;
  3. Maintaining personnel records for each consumer directed personal assistant, including time sheets and other documentation needed for wages and benefit processing and a copy of the medical documentation required pursuant to 10 NYCRR § 766.11(c) and (d) or any successor regulation;
  4. Maintaining records for each consumer including copies of the social services district's authorization or reauthorization;
  5. Monitoring the consumer's or, if applicable, the consumer's designated representative's continuing ability to fulfill the consumer's responsibilities under the program and promptly notifying the social services district of any circumstance that may affect the consumer's or, if applicable, the consumer's designated representative's ability to fulfill such responsibilities;
  6. Complying with the Department 's regulations at 18 NYCRR §504.3, or any successor regulation, that specify the responsibilities of providers enrolled in the medical assistance program;
  7. Entering into a contract with the social services district for the provision of fiscal intermediary services; and
  8. Sharing information with the consumer or, if applicable, the consumer's designated representative, regarding their respective responsibilities and requirements under the CDPAP.

 

How Much Do I Get Paid As A CDPAP PA?

The Department will pay fiscal intermediaries that are enrolled as Medicaid providers and have contracts with social services districts for the provision of CDPAP services at rates that the Department establishes and that the Director of the Division of the Budget approves, except as provided in the following paragraph.

A social services district may submit a written request to the Department to use an alternative payment methodology. The request must describe the alternative payment methodology that the district will use to determine payments to fiscal intermediaries for consumer directed personal assistance services and include such other information as the Department may require. The Department may grant a district's exemption request when it determines that the alternative payment methodology is based on the fiscal intermediary's allowable costs of providing consumer directed personal assistance services and includes an adjustment for inflationary increases in the fiscal intermediary's costs of doing business.

No payment to the fiscal intermediary will be made for authorized services unless the fiscal intermediary's claim is supported by documentation of the time spent in provision of services for each consumer.

Email team@prolifehc.com to inquire what the maximum pay rate for your county is.

 

Important Changes Every Consumer & PA Must Know

Effective November 11th, 2021, (or later) New York will end operations for a majority of the Fiscal Intermediaries servicing CDPAP. Only 68 Vendors awarded by the New York State Dept. of Health will be able to continue as Lead Fiscal Intermediaries for the program. ProLife has been awarded a contract to continue servicing CDPAP! To see the full list of awardees click here.

All existing CDPAP Consumers must transfer to a Fiscal Intermediaries awarded by the State.  Likewise, new Consumers must enroll with one of the awardees. 

Call ProLife Home Care today tel:(718) 232-2777 or email team@prolifehc.com to speak with one of our CDPAP specialists and answer any questions regarding CDPAP enrollment, CDPAP eligibility (Consumer or Personal Assistant), CDPAP Consumer requirements, or the CDPAP application. We will help you with every step of the process whether transitioning from your current provider or enrolling for the first time.

ProLife

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ProLife Home Care