ICYMI: Final Rule Posted on Reimbursement for FI Administrative Expenses 

Situation Report | January 18, 2021 

In case you missed it (ICYMI) in our alert last week, the state Department of Health (DOH) has posted a final rule on reimbursement for administrative expenses of Fiscal Intermediaries (FIs) under the Consumer Directed Personal Assistance Program (CDPAP).  

The final rule is in the New York State Register (page 7) and is posted on DOH’s website 

In a related matter, DOH has yet to finalize the highly anticipated FI Request for Offers (RFO) award process. Over the summer, the Department had indicated that award announcements were expected imminently, but DOH kept pushing back the announcement date several times, noting in August that awards were pending “Approval of the Office of the State Comptroller.” That “pending” notice remains in place and HCA will immediately inform members of any updates.       

The final rule on FI administrative services reimbursement includes three tiers of payments on a per member per month (PMPM) basis. 

Notably, the final tiered amounts were increased from the proposed amounts:   

  • Tier 1: 1 to 159 hours per month; monthly rate per consumer of $145 (up from $64). 
  • Tier 2: 160 to 479 hours per month; monthly rate per consumer of $384 (up from $164).
  • Tier 3: 480+ hours per month; monthly rate per consumer of $1,036 (up from $522). 

The rule includes what costs and expenses incurred by FIs were used to calculate the above amounts.  

The final rule also notes that:  

“nothing […] shall impact wages or wage related requirements for consumer directed personal assistants nor impact the ability of Medicaid managed care organizations to reimburse fiscal intermediaries for fiscal intermediary administrative costs pursuant to their provider contracts.”  

As extensively reported to members, DOH’s prior attempt to implement the PMPM change was invalidated by a court on procedural grounds. This action was followed by DOH’s proposed rule in December 2019. DOH had received almost 10,000 comments on the-then proposed rule, including from HCA. We had also participated in a DOH-established FI Workgroup that reviewed and made recommendations on the responsibilities for FIs.  

HCA has already sent a series of questions raised by members to DOH and will immediately inform the membership of any additional updates or clarification.