LeadingAge NY Submits Comments and Recommendations on Proposed Personal Care and CDPAS Regulations
In response to proposed regulations on eligibility and assessment for personal care services (PCS), consumer directed personal assistance services (CDPAS), and managed long term care (MLTC), LeadingAge NY has called for safeguards that strengthen the validity, timeliness, and accessibility of the new independent assessment processes. In a letter to State Medicaid Director Donna Frescatore and her staff, LeadingAge NY urged the Department of Health (DOH) to abandon its aggressive timeline for implementation of the new regulations and proceed with a phased implementation. LeadingAge NY's comments also sought recognition in the regulations of the unique standards and procedures applicable to Programs of All-Inclusive Care for the Elderly (PACE).
As previously reported, the proposed regulations implement changes adopted as part of the State Fiscal Year (SFY) 2020-21 budget and the Medicaid Redesign Team II (MRT II) deliberations. They incorporate a new eligibility standard for PCS and CDPAS and set forth an independent assessment process and independent medical evaluation process for determining eligibility. Under the new eligibility standard, applicants for PCS and CDPAS must need at least limited assistance with physical maneuvering with more than two activities of daily living, and applicants with dementia or Alzheimer’s must need at least supervision with more than one ADL, in order to qualify. Applicants will undergo an independent assessment and an independent medical evaluation by a DOH contractor to determine their eligibility. The contractor will determine the individual's eligibility for services. The independent medical evaluation will result in the physician order for PCS or CDPAS. The independent assessor will also conduct change in condition assessments and annual reassessments. Individuals who are authorized by a managed care plan or local department of social services (LDSS) to receive more than 12 hours of PCS will be evaluated by a clinical review panel, which will make a recommendation as to whether the proposed plan of care is reasonable and appropriate to maintain the health and safety of the individual at home.
LeadingAge NY convened a work group of members to develop its comments on the proposed regulations. In addition to recommendations to strengthen the accuracy, timeliness, and accessibility of all phases of the new process, LeadingAge NY's comments included proposals to clarify the legal standards for each determination, to maintain the integrity of the quality measurement and risk scoring processes, and to maintain requirements to assess beneficiaries for appropriateness for hospice. LeadingAge NY's comments and recommendations are available here.
Contact: Karen Lipson, klipson@leadingageny.org, 518-867-8838