Situation Report | February 1, 2021
The state Department of Health (DOH) has issued a revised proposed rule implementing recent changes for personal care and the Consumer Directed Personal Assistance Program (CDPAP).
As highlighted in a member alert last week, the proposed rule is also poised to address a long-sought HCA priority: allowing non-physician practitioners (NPP) to broadly order home care services in New York State. Please see related in-depth story here.
In addition to the NPP change and others, the overall package would:
- Require that individuals must need assistance with more than two activities of daily living/ADLs (supervision with more than one ADL for individuals with dementia).
- Institute an “independent assessment” process.
- Change coverage whereby supervision and cueing are not covered unless an individual is also receiving assistance with nutritional and environmental support or personal care functions.
- Require that that those seeking personal care services be examined by and obtain a practitioner order from a medical professional designated by DOH who does not have an established relationship with the individual.
- Change from semi-annual assessments to annual.
- Institute an additional “independent medical review” of cases where more than twelve hours of services per day are authorized.
- Allow use of telehealth during independent assessment, medical exam and independent review panel, and require the local department of social services/managed care organization to consider whether the individual’s needs can be met through the use of telehealth services.
- Prohibit consumers from working with more than one Fiscal Intermediary.
In response to HCA and other Associations’ concerns, DOH added a process whereby a managed care organization and/or local department of social services can challenge the independent assessor’s findings on grounds of clinical disagreements instead of only on “factual inaccuracies” as in the original proposed rule. However, the proposed rule also adds a new section on “sanctions for failure to cooperate and abuse of the resolution process” that affects the assessment process.
HCA is further analyzing the lengthy proposed rule to detail these items and others of importance to HCA members and will report back. The proposed rule is subject to a 45-day comment period.