HLT-39-10-00006-P Consumer Directed Personal Assistance Program
9/29/10 N.Y. St. Reg. HLT-39-10-00006-P
NEW YORK STATE REGISTER
VOLUME XXXII, ISSUE 39
September 29, 2010
RULE MAKING ACTIVITIES
DEPARTMENT OF HEALTH
PROPOSED RULE MAKING
NO HEARING(S) SCHEDULED
I.D No. HLT-39-10-00006-P
Consumer Directed Personal Assistance Program
PURSUANT TO THE PROVISIONS OF THE State Administrative Procedure Act, NOTICE is hereby given of the following proposed rule:
Proposed Action:
Addition of section 505.28 to Title 18 NYCRR.
Statutory authority:
Social Services Law, section 365-f
Subject:
Consumer Directed Personal Assistance Program.
Purpose:
To establish regulations for the administration and operation of the Consumer Directed Personal Assistance Program (CDPAP).
Substance of proposed rule (Full text is posted at the following State website:www.health.state.ny.us):
The Consumer Directed Personal Assistance Program (CDPAP) regulations provide local social services districts, CDPAP fiscal intermediaries, consumers, and other long term care stakeholders with a single, standardized operational framework supportive of the program’s unique design and philosophy.
The regulations include a description of the program as defined in Social Services Law section 365-f, followed by definitions of terms referenced throughout the regulations.
The regulations also contain the CDPAP eligibility requirements and the assessment/reassessment process used by local social services districts to determine an applicant's eligibility and appropriateness for participation in the program.
As a Medicaid funded home care program administered and prior authorized by the local social services districts, the regulations also include prior authorization and client notification protocols.
As a consumer directed model of home care, the regulations describe the role and responsibilities of program participants and of the fiscal intermediary that acts as the employer of record on behalf of the consumer.
The payment portion of the regulations identifies the Department of Health as being responsible for establishing CDPAP rates. The regulations also identify that a local social services district, with Department of Health approval, may establish an alternative payment methodology for determining a county's CDPAP rates.
The regulations promote state-wide program uniformity and comparability of benefits by providing stakeholders with a clear understanding of their respective roles and responsibilities, the purpose of the program, and procedures to be used in determining program eligibility.
Text of proposed rule and any required statements and analyses may be obtained from:
Katherine Ceroalo, DOH, Bureau of House Counsel, Regulatory Affairs Unit, Room 2438, ESP, Tower Building, Albany, NY 12237, (518) 473-7488, email: regsqna@health.state.ny.us
Data, views or arguments may be submitted to:
Same as above.
Public comment will be received until:
45 days after publication of this notice.
Summary of Regulatory Impact Statement
The Regulatory Impact Statement (RIS) identifies the statutory authority which allows the Department of Health to propose Consumer Directed Personal Assistance Program (CDPAP) regulations and describes the legislature's objectives in directing the Department to establish a CDPAP.
The Needs and Benefits portion of the RIS identify that the CDPAP is administered by local social services districts and that regulations are needed to establish a uniformly administered program with comparable state wide benefits. Standardized application, assessment and authorization protocols will ensure that Medicaid beneficiaries have access to appropriate benefits and that local social services districts, CDPAP fiscal intermediaries, and consumer's roles and responsibilities are governed by a single set of standards.
As an existing Medicaid entitlement, no new costs associated with establishment of the regulations to regulated parties, or to local government are anticipated. The State share of program expenses may be increased as the regulations would expand the types of family members who may provide care and be reimbursed under the CDPAP benefit. The CDPAP was previously operating under the Personal Care Services regulations which bar a consumer's spouse, parent, son, son-in-law, daughter or daughter-in-law from providing Medicaid funded services to the consumer. The proposed CDPAP regulations would no longer bar the consumer's son, son-in-law, daughter, or daughter-in-law from serving as the consumer's assistant. As the Department has no data quantifying the extent to which adult children or children-in-law of Medicaid beneficiaries provide informal non-Medicaid funded care currently, the number of unpaid caregivers converting to Medicaid funded care is unknown.
Although the regulations impose a mandate on local social services districts, local social services districts have been administering the program for nearly two decades and the regulations do not impose any new requirements.
The proposed regulations do not impose any new forms, reporting or other paperwork requirements and do not duplicate or overlap any existing State or federal requirements. Additionally, the proposed regulations do not exceed any minimum federal standards.
As the proposed regulations seek to standardize the administrative and operational environment of the CDPAP and to provide all stakeholders with clearly defined roles and responsibilities of affected parties, social services districts and fiscal intermediaries should be able to comply with the proposed regulations when they become effective.
Regulatory Flexibility Analysis
Effect of Rule:
The proposed rule was developed to standardize administrative and operational requirements for a Medicaid Program that has been in existence for nearly two decades. Small businesses and local governments will not be affected by the proposed rule.
Compliance Requirements:
The proposed rule seeks to standardize the administrative and operational requirements of a Medicaid Program which has been in existence for nearly two decades. The proposed rule does not impact existing reporting, recordkeeping or affirmative action requirements that a small business or local government would have to undertake to comply with the proposed rule. A small business regulation guide is not necessary and has not been prepared.
Professional Services:
There are no professional services that small businesses will need in order to comply with the proposed rule. Local departments of social services currently administer the program that is to be governed by the proposed rule. Local departments of social services currently employ or contract with caseworkers and nurses for several administrative functions related to this program and other home care programs. The proposed rule will not require local departments of social services to increase or alter current staffing of professional services.
Compliance Costs:
As the regulation governs an already existing program, there are no initial capital costs to a regulated business or industry or local government associated with compliance with the proposed rule. Although the regulations govern a publicly funded program, local government costs have been capped and any increase in program expenditures is borne by the State and Federal governments, thus negating any future compliance costs.
Economic and Technological Feasibility:
The regulations govern a publicly funded home health program which has existed for nearly two decades and which has consistently demonstrated economic and technological feasibility.
Minimizing Adverse Impact:
The proposed rule has no adverse economic on small businesses or local governments as it does not establish any new requirements or obligations on businesses or local governments. The proposed rule instead seeks to establish a uniform set of state-wide standards for an existing Medicaid home care program which in the past relied on the use of intermittent issuance of ad hoc policy documents to govern the program.
Small Business and Local Government Participation:
During development of the proposed regulations, the Department of Health's Office of Long Term Care met with a broad range of State Associations and stakeholders representing public and private long term care interests. Draft regulations were shared with stakeholders for comment. Appropriate concerns were incorporated into the regulations being submitted for release for public comment.
Rural Area Flexibility Analysis
Types and Estimated Numbers of Rural Areas:
The proposed rule governs a Medicaid State Plan service which is required to be provided state-wide in all counties.
Reporting, Recordkeeping and other Compliance Requirements; and Professional Services:
The proposed rule establishes regulations for a Medicaid Program which has been in existence for nearly two decades. The proposed rule does not impact existing reporting or recordkeeping requirements, nor does it impact the kinds of professional services needed to comply with the proposed rule.
Costs:
As a pre-existing program, there is no initial capital compliance costs associated with the proposed rule; because the local (county) share of Medicaid long term care costs are capped, there is no annual cost increase associated with on-going compliance of the proposed rule.
Minimizing Adverse Impact:
The proposed rule has no adverse impact on rural areas as it does not establish any new requirements or obligations on localities but instead seeks to establish uniform state-wide standards for an existing Medicaid program.
Rural Area Participation:
During development of the proposed regulations the Department of Health's Office of Long Term Care met with a broad range of State Associations and stakeholders representing public and private long term care interests. Draft regulations were shared with stakeholders, including rural county departments of social services, aging and health. Appropriate concerns were incorporated into the regulations being released for public comment.
Job Impact Statement
Nature of Impact:
The proposed regulations are meant to provide a uniform operational framework for a Title XIX home care program that has been in existence for nearly two decades. The proposed regulations reflect the current policies and procedures used in administration of the program with one exception. The proposed regulation expands the types of family members eligible to be reimbursed for provision of Consumer Directed Personal Assistance Program (CDPAP) services to include sons, sons-in-law, daughters, and daughters-in-law. As this change does not increase the number of CDPAP personal assistant jobs, but instead expands the available workforce pool, no job impact is anticipated.
Categories and Numbers Affected:
As indicated above, there are no job categories or numbers of individuals impacted by the proposed regulation.
Regions of Adverse Impact:
There are no regions in the state that will be adversely impacted by the proposed regulation.
Minimizing Adverse Impact:
The proposed regulations will not have any adverse impact on existing jobs. The regulation's expansion of family members eligible to serve as CDPAP personal assistants may help increase the pool of workers available to meet the future service demands.
