MLTC Policy 24.04: Consumer Directed Personal Assistance Program (CDPAP) Statewide Fiscal Intermediary Transition Policy for Medicaid Managed Care Plans

Managed Long Term Care (MLTC) Policy 24.04

Consumer Directed Personal Assistance Program (CDPAP) Statewide Fiscal Intermediary Transition Policy for Medicaid Managed Care Plans

Date of Issuance: December 6, 2024

The purpose of this policy is to provide guidance for mainstream and managed long term care plans regarding the transition to a single Statewide Fiscal Intermediary (SFI) pursuant to Request for Proposals (RFP) #20524: New York State Fiscal Intermediary Services.

Background

The State Fiscal Year 2024-25 Enacted Budget amended Social Services Law Section 365-f(4- a) to require the Commissioner of Health to contract with a single statewide fiscal intermediary (SFI) to provide fiscal intermediary services to CDPAP consumers. In response to this legislative requirement, the Department of Health (the Department) issued Request for Proposals (RFP) #20524 New York State Fiscal Intermediary Services on June 17, 2024.

Public Partnerships LLC (PPL) was selected as the SFI vendor and effective April 1, 2025, will be the only entity authorized to provide fiscal intermediary services for the CDPAP per Social Services Law section 365-f. See the announcement here.

Introduction

This policy provides guidance to Medicaid managed care plans (MMCPs) to facilitate the transition of services from entities currently providing fiscal intermediary services ("Current FIs") that will be required to cease providing fiscal intermediary services as of 11:59pm on March 31, 2025. This policy is effective immediately and provides guidance to MMCPs for required consumer transitions resulting from the Department's announcement of the selection of an SFI.

Definitions

The following terms are defined to enhance the clarity and consistency of the transition processes described herein, and the materials specifically related to these transitions.

Consumeror CDPAP consumermeans a Medicaid recipient, who Medicaid managed care plan (MMCP) has determined eligible to participate in the consumer directed personal assistance program, and who is participating in the program.

Consumer Directed Personal Assistance Program (CDPAP)means the program provided under section 365-f of title 11 or article 5 of the Social Services Law. CDPAP is intended to permit chronically ill and/or physically disabled individuals receiving home care services under the medical assistance program greater flexibility and freedom of choice in obtaining such services.

Current FImeans an entity providing fiscal intermediary services to CDPAP consumers and personal assistants prior to April 1, 2025.

Facilitator or CDPAP Facilitatormeans any entity that has entered into a subcontract with the Statewide Fiscal Intermediary to provide services to CDPAP consumers and personal assistants.

Statewide Fiscal Intermediary (SFI)means the entity that has a contract with the New York State Department of Health to provide statewide wage and benefit processing for personal assistants under the CDPAP and other statewide fiscal intermediary responsibilities as specified in RFP #20524.

Medicaid Managed Care Plans

Transition Requirements for Managed Care Plans

Medicaid managed care plans (MMCPs) are expected to contract with PPL as the single SFI and support their members through the transition.

MMCPs are directed to send the CDPAP SFI Transition Policy for Current FIs to the FIs with which they have contracts and to monitor compliance with the transition requirements.

To facilitate a smooth transition, the Department will facilitate weekly meetings with MMCPs and PPL throughout the duration of the transition. These sessions will provide an opportunity for the Department and PPL to share updates about the transition, address questions, and collect feedback from MMCPs. As members transition to PPL, PPL will also use these weekly meetings to engage with MMCPs on additional outreach strategies to members. MMCPs will receive regular reports from PPL regarding the transition of their members to PPL.

MMCPs will communicate with their members regarding the transition to PPL as the SFI. On November 25, 2024, the Department sent member notification templates to MMCPs with targeted mailing dates by county. MMCPs should follow this guidance for sending member notifications regarding the SFI transition. MMCPs, PPL, and the Department will coordinate on additional communications to send to members.

Starting no sooner than January 6, 2025, MMCPs are encouraged to direct new CDPAP members to the approved CDPAP facilitators subcontracted with the SFI. The list of approved CDPAP facilitators will be posted on PPL's website. Connecting new CDPAP members to the approved CDPAP facilitators will enable a smoother transition to the SFI. Starting March 1, 2025, MMCPs will direct all newCDPAP members to PPL. MMCPs may continue to receive claims from Current FIs for transition CDPAP members for dates of service through March 31; however, effective on April 1, 2025, as the date of service, PPL will be the only entity authorized to provide fiscal intermediary services for the CDPAP.

Data Transfer and Procedures

MMCPs will facilitate the transfer of data from the Current FIs they contract with to the Department. As detailed in the CDPAP SFI Transition Policy for Current FIs, Current FIs will provide data files, in the template provided by the Department, to the MMCPs with which they have contracts no later than January 15, 2025. MMCPs will aggregate the data and send to the Department no later than January 22, 2025.

MMCPs will share member data and updated prior authorizations with the SFI per the terms of their agreements.

Care Manager Role

MMCPs will ensure each enrollee utilizing CDPAP receives outreach from their Care Manager to educate the member about the transition. The Care Manager will work to assist CDPAP members to ensure the member has contacted the SFI and ensured that the member has directed their personal assistant to contact the SFI. Health Plans are encouraged to support this transition through direct communications with members, call campaigns, and additional outreach efforts. PPL will provide MMCPs with resources to educate their call centers and Care Managers – including contact information for PPL, frequently asked questions about the transition, and talking points to use when meeting with members.

Questions regarding SFI transition should be directed to the Department of Health at StatewideFI@health.ny.gov

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Posted: December 2024