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CDPAP Rules and Regulations for Consumer and Caregivers in New York State

CDPAP Rules and Regulations for consumers and caregivers

The Consumer Directed Personal Assistance Program (CDPAP) is a Medicaid program that provides services to individuals who require assistance with activities of daily living (ADLs) or skilled nursing services due to chronic illness or physical disability. CDPAP covers a wide range of services typically provided by personal care aides, home health aides, or nurses. Recipients of CDPAP enjoy unparalleled flexibility and freedom in selecting their caregivers, ensuring that their unique needs and preferences are met.

Under the CDPAP framework, the consumer or their designated representative assumes full responsibility for various aspects, including hiring, training, supervising, and if necessary, terminating the employment of caregivers. This program gives recipients the autonomy to choose their caregivers, which is a major advantage over traditional home care services. This article will provide an overview of the CDPAP program, including how to access it, applying for Medicaid, program implications and definitions, roles and responsibilities, and training requirements for the Electronic Verification Visit (EVV) system users.

Key Takeaways

  • CDPAP provides services to individuals who require assistance with ADLs or skilled nursing services due to chronic illness or physical disability.
  • Recipients of CDPAP have the freedom to choose their caregivers, ensuring that their unique needs and preferences are met.
  • The consumer or their designated representative assumes full responsibility for various aspects of the program, including hiring, training, and supervising caregivers.

Accessing CDPAP:

Accessing CDPAP involves several steps to ensure eligibility and suitability for the program. The first step is the assessment process. For individuals 18 years and older, a community health assessment and clinical appointment conducted by the New York Independent Assessor (NYIA) are required. For individuals under 18 years, a completed Physician’s Order for Services submitted by their doctor initiates a community health assessment by the local social services district.

Once the assessment process is complete, recipients must demonstrate the ability and willingness to make informed choices regarding their care or have a designated representative capable of assisting in decision-making. Additionally, the consumer or designee must be responsible for various tasks, including recruitment, training, supervision of caregivers, arranging backup coverage, coordinating services, and maintaining payroll records. These requirements ensure that participants are able to effectively manage their care and receive the support they need.

Applying for Medicaid:

Accessing the Consumer Directed Personal Assistance Program (CDPAP) typically involves applying for Medicaid, which can be done through various channels. These channels include the NY State of Health, Managed Care Organization (MCO), and Local Department of Social Services (LDSS) Office. Enrollment assistors are available for personalized assistance.

Eligibility Determination:

Determining Medicaid eligibility involves considering factors such as income, age, disability status, residency, and household size. Depending on the eligibility category, applicants may apply through NY State of Health or their LDSS office. Eligibility for Medicaid is determined by the state and federal government.

Qualifying for CDPAP:

To qualify for CDPAP, individuals must be chronically ill or physically disabled and require assistance with activities of daily living (ADLs) or skilled nursing services. Accessing CDPAP ensures personalized care tailored to individual needs and preferences. Applicants can hire almost anyone that is legally allowed to work to be their personal assistant.

In conclusion, by navigating the Medicaid application process and meeting program requirements, eligible individuals can access the support they need to lead independent and fulfilling lives through CDPAP.

The Evolution of CDPAP

The Consumer Directed Personal Assistance Program (CDPAP) has undergone significant evolution since its inception as the Patient Managed Home Care Program (PMHCP) in New York State. The program was introduced as a demonstration program, aiming to empower individuals with disabilities or chronic illnesses by allowing them to manage their home care services. Its initial focus was on providing greater flexibility and control to recipients of home care services, enabling them to choose their caregivers and tailor care to their specific needs.

Recognizing the success and benefits of the PMHCP, New York State elevated the program to official status in 1995 under Social Services Law 365-f. Renamed as the Consumer Directed Personal Assistance Program (CDPAP), it became a cornerstone of Medicaid-funded home care services, emphasizing consumer choice and empowerment.

The establishment of CDPAP was formalized through Social Services Law 365-f, which outlined the program’s objectives, eligibility criteria, and operational guidelines. This legislative framework provided a legal basis for the provision of consumer-directed care, ensuring compliance with state regulations and Medicaid requirements.

Over the years, CDPAP has expanded to accommodate a diverse range of individuals with varying care needs, including those with physical disabilities, chronic illnesses, and age-related conditions. The program has adapted to changes in healthcare delivery, incorporating technological advancements and best practices to enhance efficiency and quality of care.

CDPAP has had a profound impact on the lives of countless individuals and families across New York State, empowering them to remain in their homes and communities while receiving necessary care. Success stories abound, illustrating how CDPAP has enabled individuals to live independently, pursue personal goals, and maintain meaningful connections with their caregivers and communities.

In conclusion, the evolution of CDPAP has been shaped by the program’s commitment to consumer choice and empowerment, as well as changes in healthcare delivery and best practices. The legislative framework provided by Social Services Law 365-f has ensured compliance with state regulations and Medicaid requirements, while the program’s expansion and adaptation have enabled it to accommodate a diverse range of individuals with varying care needs. The impact and success stories of CDPAP illustrate its profound role in empowering individuals to live independently and remain connected to their communities.

2: Program Implications and Definitions

The Consumer Directed Personal Assistance Program (CDPAP) is governed by regulations outlined in 18 NYCRR § 505.28, which dictate how social services districts in New York State must administer the program. These regulations cover various aspects of program administration, including eligibility determination, assessment processes, and authorization of services. By following standardized procedures, districts can ensure equitable access to CDPAP services across the state. Adhering to these regulations is crucial for maintaining the integrity and effectiveness of the program. It is important to note that compliance with these regulations is mandatory for social services districts in New York State.

Definition of Key Terms:

REQUIRED ACTIONS

In the Consumer Directed Personal Assistance Program (CDPAP), certain actions and criteria are necessary to ensure effective service delivery and support for eligible individuals. This section outlines the scope of the program, eligibility requirements, assessment procedures, and authorization protocols.

A. Scope of CDPAP

The CDPAP encompasses a range of assistance provided by consumer-directed personal assistants under the direction of participants or their designated representatives. This assistance may include personal care tasks, home health aide tasks, and skilled nursing tasks, tailored to meet the unique needs of each individual. Participants in the CDPAP have the flexibility to receive some or total assistance with various aspects of daily living, promoting independence and autonomy. However, if the assistance required is solely for nutritional and environmental support functions, there is a limitation on the number of hours permitted per week to ensure equitable distribution of resources.

B. Eligibility Requirements

The eligibility criteria for participation in the CDPAP are designed to target individuals in need of long-term care and support. Applicants must meet the eligibility criteria for medical assistance to qualify for participation in the program. Additionally, individuals must be eligible for long-term care services provided by certified agencies or programs authorized under relevant state laws. A stable medical condition is a prerequisite, indicating that the individual’s health status does not require frequent medical interventions.

Participants must demonstrate the ability to self-direct their care or appoint a designated representative to oversee their interests. Eligible individuals must require some or total assistance with personal care, home health aide tasks, or skilled nursing tasks, as determined through assessment processes. Applicants or their representatives must be willing and able to fulfill their responsibilities within the program framework. Active participation in assessment processes is essential to ensure accurate evaluation of care needs and service requirements.

C. Assessment & Authorization

The assessment and authorization processes play a pivotal role in determining eligibility and tailoring care plans to individual needs. A licensed medical professional conducts a thorough medical examination and completes the necessary physician’s order form, detailing the consumer’s medical condition and care requirements. Social services district staff conduct a comprehensive social assessment to evaluate various factors, including the consumer’s preferences, support network, and ability to fulfill responsibilities. Registered nurses assess the consumer’s medical condition, review diagnosis codes, and evaluate the need for assistance with specific tasks to develop personalized care plans.

Upon determination of eligibility, the social services district authorizes consumer-directed personal assistance based on the consumer’s care plan, ensuring that services meet health and safety standards. Consumers receive written notification of service authorization or denial, along with information on fair hearings and appeals. Periodic reassessment ensures continued eligibility and appropriate adjustments to care plans based on changes in the consumer’s circumstances or needs. Reevaluation of care needs and service requirements supports the ongoing effectiveness of the program.

These structured procedures aim to uphold the integrity and effectiveness of the CDPAP, providing eligible individuals with personalized care and support to enhance their quality of life.

Sources: New York State Department of Health. “Consumer Directed Personal Assistance Program (CDPAP).” Social Services Law § 365-f. New York Codes, Rules and Regulations (NYCRR) § 505.28.

Roles & Responsibilities

The success of the Consumer Directed Personal Assistance Program (CDPAP) depends on the clear delineation of roles and responsibilities among consumers, caregivers, local social services districts, and fiscal intermediaries. Each entity plays a crucial role in ensuring the delivery of high-quality, personalized care to eligible individuals.

1. Consumer

Consumers or their designated representatives have significant responsibilities within the CDPAP framework, including:

  • Management of Plan of Care: Consumers are responsible for overseeing their care plans, including recruiting, hiring, training, and scheduling personal assistants to provide authorized services.
  • Notification of Changes: Consumers must notify the social services district of any changes in their medical condition or social circumstances in a timely manner to ensure effective care coordination.
  • Attestation of Time Sheets: Consumers must verify the accuracy of personal assistants’ time sheets and ensure timely submission to the fiscal intermediary.
  • Substitute Coverage Arrangements: Consumers must arrange substitute coverage when personal assistants are temporarily unavailable to ensure continuity of care.
  • Agreement with LDSS: Consumers must enter into a Department-approved CDPAP Agreement with the local social services district, outlining respective responsibilities.

2. Caregiver

Caregivers must meet specific requirements to ensure safe and reliable service provision within the CDPAP:

  • Age & Eligibility: Caregivers must be at least 18 years old and eligible to work in the United States.
  • Relationship Limitation: Close relatives such as spouses or custodial parents cannot serve as paid caregivers to avoid conflicts of interest.
  • Exclusion Check: Caregivers must not have been excluded from government-funded healthcare programs like Medicaid or Medicare.
  • Health Assessment: Initial and annual health assessments by the New York Department of Health are mandatory to confirm eligibility.
  • Electronic Visit Verification (EVV): Caregivers should utilize EVV systems to accurately track service delivery.

3. Local Social Services District

The local social services district is responsible for:

  • Assessing consumer eligibility for CDPAP services
  • Approving the consumer’s Plan of Care
  • Entering into a Department-approved CDPAP Agreement with the consumer
  • Monitoring the consumer’s compliance with the Agreement
  • Conducting periodic reassessments to ensure the continued need for CDPAP services
  • Authorizing payment for CDPAP services

Source: New York Department of Health

CDPAP Rules and Regulations for Consumer and Caregivers

CDPAP Forms for Care Recipients and Caregivers in New York State

In order to ensure the smooth and effective operation of the Consumer Directed Personal Assistance Program (CDPAP), a series of essential forms are required for both care recipients and caregivers. These forms play critical roles, encompassing tasks from enrollment and eligibility verification to the meticulous documentation of hours worked and services rendered. Presented below is an exhaustive compilation of mandatory forms tailored for care recipients and caregivers actively engaged in the CDPAP program within New York State.

Mandatory Forms for Care Consumers

Designation of Representative Form:

 If the care recipient is unable to manage their CDPAP affairs independently, they can designate a representative to act on their behalf. This form outlines the responsibilities and authority granted to the representative.

Physician’s Order/Plan of Care: 

A physician’s order or plan of care is required to verify the medical necessity of the services requested by the care recipient. This document outlines the specific care needs and services prescribed by the physician.

Authorization for Release of Health Information:

 This form authorizes the release of the care recipient’s health information to the CDPAP program administrators for eligibility determination and care coordination purposes.

Service Plan Agreement: 

Once enrolled in the CDPAP program, the care recipient must sign a service plan agreement outlining the type and frequency of services to be provided, as well as any special instructions or preferences.

NYIA and DOH Form: 

This form, issued by the New York Insurance Agency (NYIA) and the Department of Health (DOH), outlines regulatory requirements and eligibility criteria for participation in the CDPAP. It ensures compliance with state regulations governing personal assistance services.

MOU Form (Memorandum of Understanding): 

The MOU form establishes the agreement between the care recipient and designated caregiver(s) participating in the CDPAP. It outlines roles, responsibilities, compensation, and other terms of the caregiving arrangement to ensure mutual understanding and compliance.

Mandatory Forms for Caregivers:

  • Personal Assistant Application:
    Completed by individuals interested in becoming caregivers under the CDPAP, collecting personal and employment information.
  • Driver’s License/NY State ID/Passport:
    Documentation for verifying the caregiver’s identity and compliance with legal requirements.
  • Social Security Card: 
    Required for processing payroll and tax-related matters.
  • MMR (Measles, Mumps, Rubella) Vaccination Record:
    Proof of vaccination against contagious diseases.
  • Quantiferon (TB Gold) Test Results: 
    Documentation for tuberculosis testing to ensure the safety of care recipients.
  • Pre-employment Physical Form:
    Records the caregiver’s health status and fitness to perform caregiving duties safely.
  • Background Check Authorization:
    Caregivers are required to undergo a background check to ensure the safety and well-being of the care recipient. This form authorizes the release of the caregiver’s criminal history record for review.
  • Employee Acknowledgment Form:
    Upon being hired as a caregiver in the CDPAP program, individuals must sign an acknowledgment form confirming their understanding of their role, responsibilities, and the program’s policies.
  • Timekeeping Records:
    Caregivers are responsible for accurately documenting the hours worked and services provided to the care recipient. Timekeeping records serve as crucial documentation of caregiver activities and are subject to review by program administrators.
  • Annual Training Certification:
    Caregivers are required to undergo annual training to maintain their eligibility to participate in the CDPAP program. This certification verifies that the caregiver has completed the necessary training requirements.

By adhering to these mandatory forms and procedures, both care recipients and caregivers can ensure compliance with the regulations governing the Consumer Directed Personal Assistance Program in New York State. These forms facilitate the smooth operation of the program while safeguarding the rights and well-being of all parties involved.

Electronic Verification Visit (EVV) in New York: Ensuring Quality Care Delivery

How EVV Works:

EVV is a system that electronically verifies home- and community-based service visits to ensure that individuals authorized to receive these services indeed receive the expected care. EVV uses technological devices and systems to verify when and where a caregiver provides care to an individual in need. This system streamlines record-keeping and offers a real-time view of the care being delivered.

EVV utilizes various tools to collect and transmit data securely. From mobile applications to specialized devices, EVV collects essential data such as the date of the visit, location of service delivery, type of service provided, and more. For example, a personal assistant uses an EVV system to report information about each visit. They clock in upon arrival at the recipient’s home, document the service provided, and clock out upon leaving.

Importance of EVV:

EVV plays a crucial role in ensuring accurate records and confirming that individuals receive the right care for their specific needs. It combats fraud, waste, and abuse in Medicaid-funded in-home care by ensuring accurate documentation of service types, recipients, dates, locations, and service providers. It provides real-time insights into care delivery, allowing for timely interventions if necessary.

Key Components and Considerations:

EVV systems collect data including service type, individual receiving service, date of service, location of service delivery, individuals providing services, and service duration. New York encourages Fiscal Intermediaries (FIs) to offer multiple technology options to meet consumers’ needs, such as telephone, mobile apps, and fixed object/keyfob. Providers are responsible for safeguarding electronic and physical data, ensuring backups are in place. EVV data submission is not required for live-in caregivers, although managed care organizations and provider agencies may opt for collection based on business needs.

EVV System Considerations:

The EVV system must not infringe on the consumer’s right to schedule Personal Assistants. New York encourages Fiscal Intermediaries (FIs) to offer multiple technology options to meet consumer needs, such as telephone, mobile apps, and fixed object/keyfob. Providers are responsible for safeguarding electronic and physical data, ensuring backups are in place.

In conclusion, EVV serves as a critical tool in maintaining the integrity of Medicaid-funded in-home care by ensuring accurate documentation, real-time monitoring, and safeguarding against fraud and abuse. Its implementation underscores New York’s commitment to providing high-quality, personalized care to individuals in need.

Training Requirements for EVV System Users

Providers and Fiscal Intermediaries (FIs) must ensure that all caregivers, agency staff, and Electronic Visit Verification (EVV) system users receive comprehensive training to promote proficiency and compliance with regulatory mandates. The following subsections outline the training requirements for EVV system users.

Annual Refreshers:

Providers and FIs must administer annual training refreshers to all EVV system users to ensure ongoing education. In the event of significant changes to the EVV program, such as policy revisions or system enhancements, corresponding training on these updates must be seamlessly integrated into the next annual training cycle or provided sooner if necessary. Training materials should be readily accessible to accommodate the onboarding of new users or individuals assuming roles requiring EVV usage.

Compliance and Effectiveness:

Providers and FIs should maintain detailed records of training sessions conducted, including attendance logs and content covered, to ensure compliance with regulatory standards. Establishing feedback mechanisms allows for continuous improvement of training programs based on user input and evolving needs. Regular monitoring and evaluation of training effectiveness enable providers and FIs to identify areas for improvement and address any gaps in knowledge or skill proficiency.

By prioritizing comprehensive training initiatives for caregivers, agency staff, and EVV system users, providers and FIs contribute to the seamless integration and effective utilization of EVV in the delivery of home- and community-based services. Adhering to training requirements ensures compliance with regulatory mandates and fosters a culture of continuous learning and improvement within the EVV ecosystem.

Overall, the training requirements for EVV system users aim to promote proficiency and compliance with regulatory mandates. Providers and FIs must administer annual training refreshers, maintain detailed records of training sessions, and establish feedback mechanisms to ensure continuous improvement of training programs. Regular monitoring and evaluation of training effectiveness enables providers and FIs to identify areas for improvement and address any gaps in knowledge or skill proficiency.

Frequently Asked Questions

Eligibility Criteria for a Caregiver under CDPAP

To be eligible for CDPAP, the individual receiving care must be enrolled in Medicaid and require home care. The individual receiving care must be self-directing or have a representative that can direct their care.

Minimum Number of Hours for Personal Assistants in CDPAP

The minimum number of hours a personal assistant must work to participate in CDPAP varies by state. In New York, for example, personal assistants must work a minimum of 10 hours per week.

Recent Changes to CDPAP Regulations

As of November 8, 2021, there have been regulatory changes to the Personal Care Services (PCS) and Consumer Directed Personal Assistance Program (CDPAP) in New York State. The Department of Health will provide additional guidance by way of an Administrative Directive Memorandum (ADM) and Managed Long-Term Care (MLTC) policy. For more information, please refer to the PDF overview of the PCS and CDPAP regulatory changes.

Compensation for CDPAP Caregivers

Compensation for CDPAP caregivers is determined by the fiscal intermediary, which is responsible for processing payroll and other administrative tasks. In some cases, compensation for CDPAP caregivers may be higher than that of traditional home care aides.

Responsibilities of a Personal Assistant within the CDPAP Framework

Personal assistants within the CDPAP framework are responsible for providing assistance with activities of daily living (ADLs) to individuals who are chronically ill or physically disabled. Personal assistants must follow a care plan that is developed by the individual receiving care and/or their representative.

Hiring Family Members as Personal Assistants through CDPAP

Family members can be hired as personal assistants through CDPAP, but they must meet the same eligibility criteria as non-family members. In addition, family members cannot be the designated representative for the individual receiving care.