Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State

WHO MAY BE HIRED AS THE PERSONAL ASSISTANT?   Changes effective APRIL 1, 2016

An adult who is not "legally responsible" for a Medicaid consumer's care and support may be a CDPAP assistant for that consumer. In particular, this means that a parent of an adult child (21 years of age or older) may serve as that adult child’s CDPAP assistant. 

What is CDPAP?

The Consumer Directed Personal Assistance Program (CDPAP)  is a statewide Medicaid program that provides an alternative way of receiving home care services, where the consumer has more control over who provides their care and how it is provided.   Rather than assigning a home care vendor or agency that controls selection, training, and scheduling of aides, the "consumer" or the family member, friend or guardian directing his/her care performs all these functions usually done by a vendor.  All counties - and now all mainstream Managed Care and Managed Long Term Care plans - are required to have a CDPAP program and notify “eligible individuals” of the option to join.  Eligible individuals include those eligible for  services provided by a certified home health agency, a long term home health care (waiver) program,  AIDS home care program, or personal care (home attendant). 

NEWS EFFECTIVE April 1, 2016!  -- WHO CAN BE HIRED AS THE CDPAP AIDE

The consumer can hire almost anyone, including any family members except his or spouse.  Starting April 2016, parents of disabled adult children will be to serve as CDPAP aide if they are not also the recipient's designated representative, and with restrictions on whether they may live with the consumer.

Before, spouses and parents could not be hired as the CDPAP aide, but  a son or daughter or any other family member could be the aides, provided the family member  does "...not reside with the consumer or ... who resides with the consumer because the amount of care the consumer requires makes such relative's presence necessary...."  18 NYCRR 505.28(b)(3).   Now, only spouses are prohibited from being hired as the aides. 

CDPAP Aides may Perform "SKILLED" TASKS - unlike regular personal care aides  

Another special benefit of CDPAP is that CDPAP aides may perform "skilled" care that otherwise may only be performed by a nurse - suctioning tracheostomies, insulin injections, administration of oxygen or medications where the consumer cannot self-administer. See N.Y. Educ. Law § 6908(1)(a) .  Tasks that could not otherwise be performed by home health aides or personal care aides are indicated in the scope of tasks for personal care and home health aides.  

Different Employment Model - Fiscal Intermediary vs. Home Care Agency

How to get CDPAP - Obtain from their Managed Care/MLTC Plan or thru "Immediate Need"

Effective Nov. 1, 2012, Consumer-Directed Personal Assistance Program (CDPAP) is included in the "benefit package"  for both Mainstream Medicaid Managed Care and Managed Long Term Care.   Here is how people with Medicaid only and those with Medicare and Medicaid access CDPAP. 

See NYC HRA MICSA Medicaid Alert dated Oct. 26, 2012 on CDPAP and Managed Care.

  1. People with Medicaid Only (but do not have Medicare) -  Most are already required to enroll in a Mainstream Medicaid Managed Care (MMC) plan. Since November 2012, these mainstream Medicaid managed care plans took over the authorization and management of  CDPAP services statewide, as well as personal care services.  

    1. Transition Rights -  When a consumer is required to transition to an MMC or MLTC plan, after receiving CDPAP services through their local DSS, the MMC plan is required to continue the services previously authorized by the local district (HRA or DSS) for 90 days, at which time  the MMC plan re-assesses need.  

    2. New applicants for CDPAP who have Medicaid but do not have Medicare --

      1. If they are already enrolled in a mainstream MMC plan, then they apply to their MMC plan for CDPAP (They submit a Physician's Order (Form M11q in NYC) and any plan application for CDPAP).   The plan must assess their needs and if the plan finds them eligible for home care services, must give them the option of choosing CDPAP.

      2.  If they are not yet enrolled in a mainstream MMC plan,  then they apply for CDPAP at their local CASA/DSS.  

  2. Managed Long Term Care (MLTC)-- Most adults  who have both Medicaid AND Medicare are required to enroll in MLTC in order to obtain CDPAP,

    1.   There are some exceptions - excluded populations who may apply at local DSS (in OPWDD, hospice, etc.. see list at above link).

    2.   The new "Immediate Need" procedure can be used for people not yet enrolled in an MLTC, who have an Immediate Need for personal care or CDPAP.  The procedure may include both applying for Medicaid and requesting home care approval from DSS. See more about Immediate Need here.  Once approved, the local DSS authorizes CDPAP.  After 120 days of receipt, the individual will be transitioned to MLTC. 

  3. The State posted these documents that govern how MLTC plans must provide CDPAP services to find online, go to  Medicaid Redesign Team page, scroll down to MRT 90 - MLTC and then to CDPAS Final MLTC Documents (posted around 10/1/12)

Responsibilities of the Health Plan and Consumer (acknowledgement that MLTC member must sign)

Policy for the Transition of Consumer Directed Personal Assistance Services into Managed Care

Administrative Agreement for the Provision of Fiscal Intermediary Services for the Consumer Directed Personal Assistance Program

 

  1. Transition Rights - The MLTC plans must continue the same hours authorized by CASA/DSS for at least 90 days. This includes enrollment after receiving Immediate Need  services. After that they may change the hours -- but  plans must give advance notice of a change with the right to request a hearing and AID CONTINUING, and may reduce services only for permitted reasons - pursuant to   MLTC Policy 16.06 (a change in medical condition or other circumstances).

ELIGIBILITY FOR CDPAP

Help with Understanding and Using CDPAP -

The Consumer-Directed Personal Assistance Association of NYS (CDPAANYS) has lots of resources on its website.

Concepts of Independence - the largest and oldest fiscal intermediary, has tutorials and other info. on its website

CaringKInd NYC  -- TogetherWeCare Program -  Consumers or their families can find aides who have completed the CaringKind Dementia Care Training for Professional Caregivers  (CaringKind was formerly the NYC Chapter of the Alzheimer's Association)

BACKGROUND ON CDPAP, Laws & Regulations 

This article explains the CDPAP program in NYS, with cites to state statutes  (some have been amended since). Note that this article pre-dates mandatory MLTC.

Laws.

The statutes establishing the CDPAP program include Section 365-f of the Social Services Law and N.Y. Educ. Law § 6908(1)(a) (also known as the Nurse Practice Act, which creates an exception that allows CDPAP aides, along with family and other unpaid informal caregivers, to perform tasks that otherwise may only be performed by licensed nurses.  

Regulations.

The State published final regulations, effective April 20, 2011, creating a new section 28 to 18 NYCRR Part 505.   See New York State Register April 20, 2011/Volume XXXIII, Issue 16  (pp. 7-8)

See December 2015  NYS Dept. of Health GIS 15 MA/024 - Changes to the Regulations for the Personal Care Services Program (PCS) and the Consumer Directed Personal Assistance Program (CDPAP) (PDFNOTICE OF ADOPTION 


State Directives

The following directives have been issued since the above article was written in 2003:

State Managed Long Term Care Contracts, Guidelines re CDPAP (Posted Oct. 1, 2012, eff. 11/1/2012)

NYC Directives

HISTORY

For a history of the development of the consumer-directed program in New York City, which was a national leader in launching this form of service 33 years ago, see this article., along with:


This article was authored by the Evelyn Frank Legal Resources Program of New York Legal Assistance Group.

NYLAG



Article ID: 40
Last updated: 30 Jan, 2018
Revision: 43
Medicaid -> Home Care -> Medicaid Consumer Directed Personal Assistance Program (CDPAP) in New York State
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