DOH Suspends CDPAP Reimbursement Changes
Last week, the Department of Health (DOH) sent formal notification to Managed Long Term Care (MLTC) Plans of the suspension of several documents related to the change in how Consumer Directed Personal Assistance Program (CDPAP) Fiscal Intermediaries (FIs) are reimbursed for administrative costs. Specifically, the CDPAP Claims and Encounters guidance issued to plans on Oct. 9th as well as the portion of Managed Care Policy 19.01 that implements the Per Member Per Month (PMPM) rate structure are suspended "unless and until further notice." The frequently asked questions related to the change are suspended as well. Note that the provisions in Policy 19.01 related to protections for a CDPAP consumer transitioning to a different FI remain in effect. The notice is available here.
The action comes in the wake of a court ruling that held that the State acted inappropriately when it made the change to the FI reimbursement methodology without following all of the requirements of the State Administrative Procedure Act (SAPA). The provision that changes the methodology is part of the 2019-20 State Budget and is to be implemented under DOH administrative authority while providing $150 million in Medicaid savings. Reductions to MLTC rates to reflect the change were originally expected to be reflected in July 2019 rates, but at this time, it is unclear how and when DOH might adjust MLTC rates for CDPAP-related changes.
LeadingAge NY Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841