Last week, HCA submitted comments to the state Department of Health (DOH) on its proposed rule that would establish a per member per month (PMPM) payment for administrative services provided by Fiscal Intermediaries (FIs) under the Consumer Directed Personal Assistance Program (CDPAP).
Our comments are at https://hca-nys.org/wp-content/uploads/2020/03/FI-PMPM-Proposed-Rule_FINAL-Comments_022620.pdf.
The proposed rule is at https://regs.health.ny.gov/sites/default/files/proposed-regulations/Consumer%20Directed%20Personal%20Assistance%20Program%20Reimbursement.pdf.
“While HCA is not opposed to payment for FI administrative services on a PMPM basis, the amounts must be adequate to enable FIs to carry out their administrative responsibilities,” we write. “Unfortunately, according to our members who provide FI services, the proposed levels ($64 for Tier 1; $164 for Tier 2; and $522 for Tier 3) cannot sustain FI viability and will result in the closure of many FIs who have a long history of providing services and are essential to CDPAP operation and consumer accessibility. Our FI members have informed us that these amounts will result in annual losses that range from $49,000 to $4.4 million.”
We also state that the “3-tiered” amounts do not incorporate any of the new administrative expenses that will be incurred under the state’s recent Request for Offers for existing and new FIs.
The proposed rule follows DOH’s attempt to make a similar change administratively that was challenged by a lawsuit. In the case, a judge ruled that the state must follow the State Administrative Procedure Act to implement such a policy.