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DOH Releases CDPAP Fiscal Intermediary Request for Offers and Proposed Administrative Reimbursement Regulation

The Department of Health (DOH) has released a Request for Offers (RFO) seeking offers from qualified organizations to provide fiscal intermediary (FI) services for Medicaid beneficiaries in the Consumer Directed Personal Assistance Program (CDPAP). The RFO stems from legislation enacted as part of the State Fiscal Year (SFY) 2019-2020 budget. Under the legislation, only entities that are selected to enter into FI contracts with the State will be permitted to provide FI services. All current FIs that wish to continue providing FI services must submit an offer within 60 days of the release of the RFO. Similarly, any entity that is not currently authorized to provide FI services and is interested in initiating FI services must submit an offer and be selected to enter into a contract. The deadline to submit questions about the RFO is Jan. 10th, and the deadline for submission of offers is Feb. 18th.

The following organizations are eligible to submit an offer to contract with the State to provide FI services:

  • Independent Living Centers (ILCs) under Section 1121 of the New York State Education Law;
  • Entities that were established as FIs prior to Jan. 1, 2012 and have been continuously providing services for individuals in the CDPAP; and
  • Entities capable of appropriately providing FI services, performing the responsibilities of an FI, and complying with Social Services Law § 365-f.

FIs currently in operation that fail to submit an offer in response to the RFO or that are not selected to contract with the State to provide FI services will be required to cease operations in accordance with the Department’s transition procedures. Those transition procedures will include written notice at least 45 days in advance of closure to the FI, affected consumers, consumer representatives, personal assistants, local departments of social services (LDSSs), and managed care organizations (MCOs).

The Department welcomes applications in which an eligible offeror, acting as the Lead FI, partners with other eligible entities that operate in a service area. Such collaborations may operate to optimally address the needs of consumers, provide operational efficiencies, ensure access in rural and underserved areas, and provide cultural and language competencies specific to the consumers they will serve and the workforce.

The RFO includes a variety of requirements and best practices, including requirements in the areas of employment practices, compliance, information technology, privacy and security, quality monitoring, fiscal integrity, and organizational structure. Questions about the RFO may be submitted here.

In addition to the RFO, the Department has released proposed regulations defining a tiered reimbursement structure for FI administrative payments. These regulations also arise out of the SFY 2019-2020 budget and apply only to FI services provided to beneficiaries of fee-for-service (FFS) Medicaid. They do not apply to reimbursement paid through Medicaid managed care or managed long term care (MLTC) plans. Under the proposed regulations, managed care plans may continue to reimburse FIs in accordance with their provider contracts. The proposed regulations are expected to be published in the Dec. 31st State Register and subject to public comment until March 2nd. Comments may be submitted to DOH here.

Contact: Karen Lipson, klipson@leadingageny.org, or Meg Everett, meverett@leadingageny.org, 518-867-8383