DOH Posts Rule on Changes to PCS/CDPAS, MLTC Assessments and More

Situation Report | September 7, 2021 

On August 31, 2021, the state Department of Health (DOH) posted a final regulation that covers changes to personal care services (PCS) and consumer directed services that were part of the final 2020-21 state budget. 

The regulation, effective November 8, is available here. 

The final regulation includes the following: 

  • Changes to the minimum need for assistance with activities of daily living;  
  • Requires services to be ordered by a qualified and independent practitioner and not the individual’s attending physician;  
  • Requires an independent assessment; 
  • Describes the Local Department of Social Services (LDSS) and  Managed Care Organizations’ (MCO) responsibilities in the assessment process; 
  • Requires an “independent medical review” when the LDSS or the MCO proposes to authorize more than 12 hours of services per day;  
  • Prohibits the authorization of services provided by more than one fiscal intermediary per consumer;  
  • Requires consumer designated representatives to make themselves available to ensure that they can carry out the consumer responsibilities, and must be present at scheduled assessments or visits for non-self-directing consumers; and more. 

The regulation allows nurse practitioners (NPs) and physician assistants (PAs) to sign orders for home care under PCS and consumer directed services but does not apply to home health services which is being covered under a separate process.

HCA continues to press the Department to confirm state authority for Nurse Practitioners and Physician Assistants to authorize and issue orders for home health services.

HCA has also advocated for some of the other changes in this final regulation, particularly the Independent Assessor. HCA has called for the implementation to be tabled due to the adverse effects it will have on the existing dire home care workforce shortage and larger home care delivery system during and after the COVID-19 pandemic. 

HCA is still reviewing the final 267 page regulation and will provide further analysis later this week.