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DOH Adopts New FFS Rates for Fiscal Intermediaries Serving CDPAP

The Department of Health (DOH) has finalized and adopted a regulation to amend the fee-for-service (FFS) reimbursement for Fiscal Intermediaries (FIs) under the Consumer Directed Personal Assistance Program (CDPAP), effective as of Jan. 13, 2021.

The regulation implements the three-tier, per member/per month (PM/PM) rate structure for FI administrative fees contained in the proposed regulation; however, the adopted regulation significantly increases the monthly payments for administrative expenses from the proposed rule. The reimbursement rate per month has increased for each tier: Tier 1 has increased from $64 to $145; Tier 2 has increased from $164 to $384; and Tier 3 has increased from $522 to $1,036. The Department stated that new cost report data, in combination with other data provided by commenters, enabled the Department to update many of the values used to determine the Monthly Rate. The adopted regulation also removes a provision from the proposed regulation that would have implemented the revised rate structure retroactively.

New FI Rates – FFS Only

Tier

Direct Care Hours Authorized Per Month 

Monthly Rate Per Consumer 

1

1-159

$145

2

160-479

$384

3

480+

$1036

The regulation technically does not require managed care organizations (MCOs) to adhere to the three-tier structure. MCOs are therefore free to continue to negotiate their own reimbursement with FIs irrespective of the rule. However, because MCO premiums may be revised to reflect the new FFS methodology, it is anticipated that they may need to revise their provider contracts to reflect any revised administrative payment resulting from a premium reduction.

Lastly, the adopted regulation no longer allows social service districts to request from DOH an alternative payment methodology for FIs based on allowable costs and adjustments for inflationary increases in the cost of doing business.

Contact: Meg Everett, meverett@leadingageny.org, 518-929-9342