DOH Proposed Rule on Medicaid Coverage for Applicants with Immediate Needs

On page 3 of the Oct. 28th NYS Register the Department of Health (DOH) released a notice of a proposed rule to amend Parts 505.14 and 505.28 of Title 18 NYCRR, allowing for the mandated coverage for the immediate needs of Medicaid applicants and recipients for 1.) Personal Care Services (PCS) and 2.) Consumer Directed Personal Assistance Services (CDPAS).

The rule provides definitions of:

Medicaid applicant with an immediate need for PCS: “includes two groups of individuals who seek Medicaid coverage: those who are not currently authorized for any type of Medicaid coverage; and those who are currently authorized for Medicaid coverage but only for community-based coverage not including coverage for long-term care services such as PCS. In addition, these individuals must present a physician’s order documenting the need for assistance with certain personal care services functions and attest to the social services district, on a required form, that they have no informal caregivers, are not receiving PCS from a home care services agency, have no adaptive or specialized equipment or supplies to meet their needs, and have no third party insurance or Medicare benefits available to pay for needed assistance.”

Medicaid applicant with an immediate need for CDPAS:  The rule includes procedures that must be followed, including assessments and relevant time periods.

The rule clarifies that these procedures would apply to Medicaid recipients seeking PCS who are exempt or excluded from enrollment in a managed care along with Medicaid recipients who are not exempt or excluded.

DOH will be accepting comments on this proposed rule until 45 days from the Oct. 28th posting. Please submit your comments to: Katherine Ceroalo, DOH, Bureau of House Counsel, Reg. Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237, or email: regsqna@health.state.ny.us.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871