Another Revised Rule to Meet Immediate Need for Personal Care Services and Consumer Directed Personal Assistance

Page 18 of the Mar. 2nd NYS Register contains a notice of another proposed revised rule to amend Parts 505.14 and 505.28 of Title 18 NYCRR, Immediate Needs for Personal Care Services (PCS) and Consumer Directed Personal Assistance (CDPA).

The rule seeks to implement the 2015 State law changes regarding Medicaid applicants and recipients with immediate need for PCS and CDPA. Social service districts would be required to perform expedited Medicaid eligibility determinations for Medicaid applicants who have an immediate need for PCS or CDPA. This includes applicants who are not currently authorized for any type of Medicaid coverage as well as those who are currently authorized for Medicaid but only for community-based Medicaid coverage without long-term care services.

In the 2016 revised rule, the social services district would be required to determine whether the applicant has submitted a “complete” Medicaid application as soon as possible after receipt of the application, physician’s order, and signed attestation of immediate need, but no later than four calendar days after receipt of such documentation. The complete Medicaid application means a signed Medicaid application and all documentation necessary for the district to determine the applicant’s Medicaid eligibility. In the 2015 revised rule, it proposed to amend section 505.14(b)(5)(iv) on providing for an expedited assessment process. In this revised section, it defined “immediate temporary personal care services”; provided the criteria for a Medicaid recipient to qualify for “immediate temporary personal care services”; defined presumptive eligibility; and defined “expeditiously as possible, but no later than three business days after receipt of the physician’s order.”

This proposed rule requires the social services district to determine whether a Medicaid applicant with an immediate need for PCS or CDPA is eligible for Medicaid, including Medicaid coverage of community-based long-term care services, and notify the applicant of such determination. The district must make this determination and notify the applicant as soon as possible, but no later than seven calendar days after receipt of a complete Medicaid application.

LeadingAge New York reported on the several prior rules published in the NYS Register in Aug. 2015 and July 2014 to meet the immediate need for PCS and CDPA.

The Department of Health (DOH) will be accepting comments on this proposed rule up to 30 days from the Mar. 2nd posting. Please submit your comments to: Katherine Ceroalo, DOH, Bureau of House Counsel, Reg. Affairs Unit, Room 2438, ESP Tower Building, Albany, NY 12237, or email: regsqna@health.state.ny.us.

Contact: Cheryl Udell, cudell@leadingageny.org, 518-867-8871