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Fiscal Intermediary Administrative Payment to Shift to Non-Risk on Aug. 1st

(July 8, 2024) The Department of Health (DOH) has announced that the administrative component of Consumer Directed Personal Assistance Services (CDPAS) fiscal intermediary (FI) rates will be paid on a non-risk basis effective Aug. 1st. Under this initiative, the administrative component of the FI rates will be carved out of managed care plan capitation and paid separately through a complex billing process involving plans, DOH, and FIs. Originally slated to commence on July 1st, this initiative was delayed in order to permit managed care plans and FIs to execute contracts to reflect the new process. The carve-out applies to mainstream Medicaid Managed Care plans, partially capitated Managed Long Term Care (MLTC) plans, and Medicaid Advantage Plus (MAP) plans, but does not apply to Programs of All-Inclusive Care for the Elderly (PACE programs) and Fully Integrated Duals Advantage for Individuals with Intellectual and Developmental Disabilities (FIDA-IDD) plans.

The new process will require FIs to bill managed care plans for the administrative component of their rates according to the previously promulgated three-tiered monthly schedule, using the existing rate codes, based on the number of CDPAS hours actually delivered to each member. Managed care plans will pay the FIs the appropriate amounts based on the three-tiered schedule and the number of hours delivered, on a per member basis. Plans will bill DOH the appropriate amounts using newly established rate codes, and the State will pay the plans. Plans are expected to bill DOH no earlier than the first of the month following the month for which reimbursement is being claimed.

Plan premiums will be reduced on a regional basis, retroactive to April 1st, to reflect the carve-out.

More information is available in the May 2024 Medicaid Update here.

Contact: Darius Kirstein, dkirstein@leadingageny.org, or Karen Lipson, klipson@leadingageny.org