A new policy being implemented by the New York State Department of Health (DOH) could end up neutering the Consumer Directed Personal Assistance (CDPA) program – and New York lawmakers are begging them to reconsider.
The CDPA was established to help disabled persons hire their own aides to provide them with day-to-day assistance. Back-office minutiae like payroll and paperwork are handled by nonprofit agencies who act as “fiscal intermediaries” (FIs). As of now, the FIs are paid by the state at a per-hour rate.
However, that may change, as the DOH has announced that they want to start paying each agency at a Per Member Per Month (PMPM) rate, meaning they’d be given a set amount of money for each of their clients. The change would save the state up to $150 million, but would also result in smaller FIs being severely underpaid – to the point where most of them would have to close shop or relocate.
Assemblymember Richard Gottfried (D-Chelsea, Midtown) and State Senator Gustavo Rivera (D- Kingsbridge Heights) have written a letter to the DOH to try and dissuade them from making the change.
“This program provides critical home care services to approximately 75,000 persons with disabilities and the elderly,” reads the letter. “It is difficult to overstate the negative impact this change will have on fiscal intermediaries, managed long term care programs and, most importantly, the consumers, who depend on critical home care services from this program on a daily basis.”
The change was originally brought to the table at the head of the year, with the announcement of the 2019 State Budget. When questioned about it, the DOH explained that there were over 600 FIs in operation across the state with little to no oversight, and the percentages they were taking from the per hour rate varied wildly.
The DOH claimed that the proposed change would both save money and, by cutting down the number of FIs in operation, allow for more stringent regulation.
After months of meetings, the Assembly managed to convince the DOH to include “guard rails”, or provisions for disabled clients in the event that their FI closes down. FIs would have to notify their client 45 business days in advance before ceasing operations, and, upon request, transfer all of their records to whichever FI the client chooses to replace them. Furthermore, the DOH agreed to delay implementation until September.
But while those clauses may make the transition easier, critics argue that they don’t address the root of the problem: namely, the fact that the new policy is designed to take $150 million out of the system.
“Delaying implementation to September does not address the concerns Senator Rivera and I raised in our letter,” said Richard Gottfried. “The proposal also applies the rate tiers to fee-for-service only, leaving managed care plans to set rates for everyone else. Counties have a history in fee-for-service of driving down hours of care, so fiscal intermediaries will have most of their cases in the lowest-paid tiers. And managed care plans are likely to drive payments even below the fee-for-service rates. In budget negotiations we managed to protect consumers’ rights to services if those services are available, but if the payment rates are too low, they won’t be available. This is especially concerning for consumers who reply on cultural- or language-specific fiscal intermediaries. The DOH plan really undermines the consumer-directed program.”
The letter ends with Richard Gottfried and Gustavo Rivera beckoning the DOH to, at the very least, let negotiations continue until they can conceive a way to reform the system without putting disabled consumers’ livelihoods at risk.
“We ask you to delay the implementation of the PMPM changes until at least January 1, 2020 to provide adequate time for a well-considered, open and seamless process that will ensure the safe, orderly and successful transition to the new CDPAP reimbursement model,” reads the letter. “Delaying the changes is critical to ensure we avoid unintended and potentially harmful consequences and, instead, have a safe and successful implementation.”
