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:

Rates Doubled

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.

Retroactivity Eliminated

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. 

CDPAP Litigation

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.  

CDPAP RFO

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.

DOH Releases New Vaccine Guidance

The New York State Health Department (DOH/The Department) released guidance late yesterday (1/12/21) for COVID-19 vaccine providers. The following are helpful items of interest from that guidance and from HCP’s Public Policy team. Information changes frequently, so check back with our COVID page often and read all News Alerts to stay informed.

Healthcare workers continue to be prioritized for vaccination, and now New Yorkers aged 65 years and older are also eligible for COVID-19 vaccines. There is an extensive list of eligible essential workers as well, including education and transit workers, along with front-end grocery store workers and many others. This expansion was based on the Centers for Disease Control announcement yesterday that Operation Warp Speed is continuing, and vaccine distribution will increase. The Federal advisors expect states to expand eligibility and ramp up vaccine administration.

Each eligible segment will be served by specific venues, many of which are getting off the ground this week and expect vaccine supply any day. Pharmacies will serve the 65+ population and local health departments will vaccinate the eligible essential workers. Healthcare workers, including home care workers, will continue to be immunized at hospitals, and now have additional opportunities at Federally Qualified Health Centers and Urgent Care centers. Providers are reminded that all eligibility guidelines must be strictly followed. 

According to the DOH guidance document, the State eligibility tool, while used by many providers, is not mandatory for appointment scheduling. HCP urges you and your staff to take advantage of any appointment opportunities, many of which may be accessed on HCP’s COVID Vaccine resources page. Please remember that appointments fill up quickly, and HCP publishes resources as frequently as possible.

If you are able to partner with a local health center or other vaccine provider in order to have your staff immunized, you are encouraged to do so. You may provide the partner with your list of eligible persons, as each person will have to attest for themselves when signing the NYS COVID-19 Vaccine Form.

Also verified by DOH, a letter from an employer is, indeed, valid proof of eligibility. (Access HCP’s eligibility template here.) An ID badge or card, as well as a paystub may also be presented at the vaccine site. 

HCP Continues Effort to Ensure Home Care Workers Get Vaccination

The COVID-19 vaccine roll-out has many moving parts and requirements, and HCP’s Pubic Policy staff have been meeting regularly with not only regulators, but regional vaccine hubs, other stakeholders, and work groups designed to brainstorm to create distribution channels for vaccines. We continue to advocate for ease of vaccination of our home care workers, and are frequent contributors to these conversations. Our vaccine resource page is updated regularly, so visit often. When we learn of new vaccination sites and opportunities for appointments, we post them there as quickly as possible. Keep in mind that availability of supply is still very limited, so these appointments are often filled before we can even let you know. 

HCP Releases Third Installment in Take 5 to Fight Covid Educational Video Series

Education is an important part of getting home care workers immunized, so HCP is continuing its series, Take 5 to Fight COVID. This week’s installment will be posted soon, and covers vaccine side effect concerns in simple language. By letting your workers know what to expect, HCP hopes to put things in perspective and increase their desire to be vaccinated. Please share the videos freely on social media, or by using the convenient YouTube link, where viewers can have closed captioning in their preferred language. 

Department of Health’s COVID-19 Update to Providers this Thursday

On Thursday, January 14 from 1-2 PM, DOH will be providing a COVID-19 update for healthcare providers. The webinar will stream via YouTube Live on the NYSDOH COVID website for providers: https://coronavirus.health.ny.gov/weekly-healthcare-provider-update. All Provider Updates are available immediately following the close of the webinar.