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DOH Issues Dear Administrator Letter on FFS Rate Structure for Fiscal Intermediaries

The Department of Health (DOH) has issued a Dear Administrator Letter (DAL) regarding changes to administrative reimbursement for Fiscal Intermediaries (FIs) providing services as set forth in State law under the Consumer Directed Personal Assistance Program (CDPAP). Prior to Sept. 1, 2019, the administrative component was included in the hourly final rate for CDPAP. Effective Sept. 1, 2019, the Department will implement a three-tier Per Member Per Month (PMPM) rate structure for reimbursement of the administrative services component for CDPAP. The Fee-for-Service (FFS) guidelines for billing and reimbursement of administrative services, including the billing codes, are set forth in Attachment A of the DAL. The provider-specific direct care medical services component of the rate will be modified to remove the FI administrative costs consistent with the rate tiers. These codes will be released this week in eMedNY.

FFS CDPAP administrative claims must be approved by the Local Department of Social Services (LDSS) for each member based on hours as they fall into the three rate tiers. FIs will bill the rate once per month and can adjust the administrative claim if the LDSS changes the amount of authorized hours.

A recently updated Frequently Asked Questions (FAQ) document clarifies issues relating to the CDPAP program, new policy regarding FI closures, and consumer transitions to new FIs. For other background on the new rate structure for FIs and developments per the FI workgroup, please click here and here. Updates on the upcoming authorization process for FIs will likely be posted here.

If you have any questions regarding the above information and DAL, please send an email to PersonalCare-Rates@health.ny.gov (questions on the rates) or ConsumerDirected@health.ny.gov (questions on the policy), and the Department will respond to your inquiries.

LeadingAge NY will keep members abreast of further developments on this issue.

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