Personal Care/CDPAS Regulations Adopted
State regulations regarding Personal Care (PCS) and Consumer Directed Personal Assistance Services (CDPAS) have been adopted and will be effective Nov. 8th. The regulations implement changes adopted as part of the State Fiscal Year (SFY) 2020-21 budget and Medicaid Redesign Team II (MRT II) deliberations. They set forth an independent assessment process and independent medical evaluation process for determining eligibility and include a clinical review process for cases involving more than 12 hours daily of PCS or CDPAS. The regulations are posted here, with more background available here and here.
According to the Department, changes from the proposed regulations were largely technical or clarifying. They noted the following:
- The final regulations extend the use of supervision and cueing to assistance with nutritional and environmental support functions. They also note in commentary that this provision does not prohibit authorization of services in between unpredictable tasks, such as night-time toileting. The State does not want plans to deny authorization of services for time spent when needs are intermittent.
- The final regulations clarify that managed care plans and local departments of social services (LDSSs) must notify the independent assessor when they find a material mistake in an assessment, and they define materiality.
- When a plan or LDSS disagrees with an assessment finding that requires clinical judgment, and a new assessment is required, the new assessment must be performed in the same manner as new assessments performed as a result of a material disagreement.
The Department also noted that the authorization for non-physicians to order home health services, outside of PCS and the CDPAS program, is being considered as part of a separate regulatory package. It also announced that the new minimum needs clinical eligibility standard will be delayed as a result of federal maintenance of effort requirements under the American Rescue Plan’s Enhanced Federal Medical Assistance Percentage (eFMAP) funding. Therefore, the independent assessor process will be carried out according to existing eligibility rules.
In addition, the independent assessor process initially will be limited to adults. Assessments for those under age 18 will be rolled in later. Although there is no set date for commencement of independent assessments, they will begin no sooner than Nov. 8th. DOH is working on more guidance before the independent assessor process starts.
Please contact LeadingAge NY if you have questions or concerns.