CDPAS Fiscal Intermediary Workgroup Meets

The Department of Health (DOH) convened the first of four meetings of the Consumer Directed Personal Assistance Program (CDPAP) Fiscal Intermediary (FI) workgroup on May 15^th, providing a roadmap for the group’s work. The workgroup is comprised of clients, consumer advocates, organizations that provide CDPAP services, social services district staff, managed care plans, and associations and is charged with helping the State to develop selection and contracting criteria for FIs while also considering other issues, including quality and reporting requirements. Participants stressed the need for well-defined and understood roles for clients, FIs, and managed care plans and suggested some standards and best practices for the program, agreeing that the program is critically important and acknowledging the need to balance the consumer-directed nature of the program with an appropriate level of oversight.

DOH framed the discussion by asking whether selection criteria for FI services should address geographic differences, method of service delivery, and cultural/linguistic needs and seeking to identify best practices pertaining to the delivery of FI services under CDPAS. The slides from the meeting are available here.

Comments and suggestions from workgroup members included:

Each consumer is unique, so the parameters of the program must be flexible enough to accommodate a high level of variety.
Geographic proximity of the FI to the consumer is important to ensure familiarity with community dynamics to allow the client to be served in the most effective way.
Any guidance will always face the challenge of balancing accountability with self-directed nature of the program.
It is important that any new process not undermine the program in rural and suburban areas that rely on CDPAS and where it is working well.
Some areas of the state see increases in CDPAS due to the unavailability of home care staff.
It is important that FIs provide the support and education that the consumer needs to understand their responsibilities in the program.
Information to consumers from plans, Districts, and FIs needs to be consistent.
FIs should communicate care information to the consumer, not the assistant.
The program works best when each entity knows and fulfills their role and only their role. Plans, Districts, FIs, assistants, and consumers should know their roles and not overstep.
The consumer, not the FI, should determine which services are provided and when. Time is authorized on a weekly basis to allow the consumer to structure their own care.
Consumers should be given information about FI quality (e.g., consumer guide) and be provided the opportunity to choose or change FIs.
It is important for plans to know the value of the FI to the consumer. It would benefit plans to know who the good FIs are and what FIs are doing well.
Any instances of inappropriate attempts on the part of an FI to recruit clients and aides should be addressed.
Monitoring visits is important but can be intrusive to the client and should be standardized.
Enforcement of compliance in the program is critical to ensure it operates efficiently and that a bad actor does not tarnish the program.
There needs to be a way to identify and address situations where a client is no longer able to truly self-direct.
DOH is interested in best practices, especially on cultural and linguistic competency, orienting new clients, and on-boarding new assistants.

For the next meeting, scheduled for early June, DOH requested that workgroup members submit best practices and recommendations for standardizing FI services and for potential quality indicators. Future meetings will focus on quality measures and reporting as well as processes and consumer protections when consumers transfer from one FI to another. Although the budget legislation makes changes to the reimbursement methodology for the program, DOH made it clear that those issues were outside of the workgroup’s charge.

While the workgroup discussion was informed by clients who take active charge of their care, there may be some concern that younger, physically disabled individuals may not be fully representative of the typical Managed Long Term Care (MLTC) CDPAS consumer, who may have cognitive, as well as physical, challenges.

The new statutory provisions require DOH to enter into contracts with FIs selected through the procurement process and governed by the eligibility criteria developed through the workgroup process starting in January 2020. Once the application process is announced, responses will be due within 60 days. DOH expects to post materials around the time that the workgroup meetings end in early August.

Contact: Darius Kirstein, dkirstein@leadingageny.org, 518-867-8841