Guidance on Immediate Need for Personal Care Services (PCS) or Consumer Directed Personal Assistance Service (CDPAS)

The Department of Health (DOH) posted an ADM-02 to provide guidance on the approval of Medicaid applicants/recipients who have an "Immediate Need" for either personal care services (PCS) or Consumer Directed Personal Assistance services (CDPAS). The ADM follows a 2015 law that required local departments of social services (LDSS) to expedite Medicaid determinations for Medicaid applicants/recipients who have an immediate need for PCS or CDPAS.

The ADM outlines the purpose, which includes advising the LDSS of the requirements to provide expedited Medicaid eligibility determinations and of expedited procedures, defines an applicant/recipient with an immediate need, and outlines the requirements that need to be met along with the timeframe for the assessments of PCS or CDPAS.

The procedures require submitting a new attestation form. The front of the attestation form is a fact sheet for an individual who thinks they have an “immediate need” for services, and the back of the form is their attestation. The front of the form outlines what to do if you don’t have Medicaid or what to do if you’re currently a Medicaid recipient. The actual attestation has two components: (1) attesting you are in the community and are in immediate need; or (2) if you are in a hospital or nursing home and intend to return home.

Please note the new timeframes. If an individual does not have Medicaid, LDSS offices are now required to process and approve a Medicaid application in SEVEN DAYS if all of the required forms have been submitted. If more information is needed, the LDSS must send a letter within FOUR DAYS to let the applicant know what is missing. No later than TWELVE DAYS after receiving all of the information, the LDSS must inform the Medicaid applicant whether they are eligible for Medicaid and whether they are eligible for PCS or CDPAS. If a Medicaid recipient has coverage that includes coverage for community-based long term care and a doctor’s order has been submitted along with an attestation form for “immediate need,” the LDSS, in no later than TWELVE DAYS, has to determine whether the recipient can receive PCS or CDPAS.

Please note that this was effective July 6, 2016.

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