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DOH Appeals CDPAP FI Court Decision

The Department of Health (DOH) recently filed an appeal to the October Article 78 State Supreme Court decision negating changes to the Medicaid reimbursement methodology for Consumer Directed Personal Assistance Program (CDPAP) fiscal intermediaries (FIs).

Last month, State Supreme Court Judge Christina Ryba ruled that the changes to Medicaid fee-for-service (FFS) reimbursement were made improperly, prompting DOH to suspend the FFS rate changes as well as provisions in Managed Long Term Care (MLTC) Policy 19.01 outlining the Per Member Per Month (PMPM) tiered reimbursement structure. The court ruled that DOH must follow the State Administrative Procedure Act (SAPA) regulatory process before such an action may be taken. DOH did not do so prior to its issuance of the rate tiers.

The judge ordered DOH to revert to the rate methodology utilized prior to the change.

While they pursue an appeal of the decision, the Department may also seek to make the changes through the regulatory process. The cuts were expected to reduce reimbursement by $150 million in the current state fiscal year, making it likely that the State will continue to pursue the issue in some form. While the court ruling was specifically related to FFS rates, DOH has not yet implemented anticipated reductions to MLTC plan payments reflecting FI reimbursement changes.

LeadingAge NY will continue to monitor this issue. Please contact our office with questions or concerns.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871