Terms of Service

The purpose of the CDPAP is to allow 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. In order to participate in the CDPAP it is important that the consumers clearly understand their roles and responsibilities.

The fiscal intermediary shall have the following responsibilities:

1. Process each CDPA’s wages and benefits including establishing the amount of each assistant’s wages and benefits; process all income tax and other required wage withholdings; and comply with workers’ compensation, disability and unemployment insurance requirements.
2. Ensure that the health status of each consumer directed personal assistant is assessed pursuant to 10 NYCRR § 766.11(c) and (d) or any successor regulation.
3. Maintain records for each CDPA which shall include, at a minimum, time records, the CDPA health assessments required pursuant to 10 NYCRR § 766.11(c) and (d) or any successor regulation, and the information needed for payroll processing and benefit administration.
4. Maintain records for each consumer, including copies of the authorizations, reauthorizations, and the contracts between the consumer and the FI.
5. Obtain a signed agreement with consumer outlining consumer’s responsibilities as contained in 18 NYCRR § 505.28. Use best efforts to notify the MCO if the FI becomes aware that the consumer has been admitted to a higher level of care such as an inpatient hospital or skilled nursing facility. Monitor enrollment in MCO on the 1st and 15th of each month; provided, however, that such monitoring on the part of the FI shall not relieve the MCO of the MCO’s responsibility to notify the FI in the event of a consumer’s disenrollment in the MCO or in the event of a determination that the consumer is no longer authorized to participate in the CDPAP program.
6. Monitor the ability of the consumer, or the ability of the consumer’s designated representative, if applicable, to fulfill the consumer’s responsibilities under the consumer directed personal assistance program and notify the MCO promptly in the event that the FI becomes aware of any circumstances that may affect the ability of the consumer, or that of the consumer’s designated representative, if applicable, to fulfill such responsibilities.
7. Comply with applicable NYSDOH regulations regarding the responsibilities of providers enrolled in the medical assistance program.
8. Enter into an Agreement with the consumer that stipulates that the consumer and, as applicable, the consumer’s designated representative shall be solely responsible to the following responsibilities:

The Consumer/Designated Representative shall have the following responsibilities:

1. Understand the purpose of the CDPAP and the responsibilities of the LDSS, fiscal intermediary and consumer/designated representative.
2. Be responsible for recruiting, hiring, training, supervising, scheduling and terminating the qualified individual of their choosing in adequate numbers to meet their needs.
3. Maintain an appropriate home environment and provide training as necessary.
4. Review the plan of care with each personal assistant (PA) outlining their responsibilities and ensure that the PA only performs the tasks identified on the plan of care during authorized hours.
5. Comply with Labor Laws, providing equal employment opportunities as specified in the Consumer's agreement with the CDPAP fiscal intermediary.
6. Inform the LDSS and the fiscal intermediary of any change in status or condition, including but not limited to; hospitalizations, address and telephone number changes.
7. Assure the accurate and timely submission of the PA’s required paperwork to the CDPAP fiscal intermediary including time sheets, annual worker health assessments, and required employment documents.
8. Develop and maintain a contingency plan to assure adequate supports are available to meet needs.
9. Ensure that each PA has submitted timecards reflective of hours worked within the weekly authorized hours by signing timesheet.
10. Distribute paychecks to each PA, if applicable.
11. Cooperate with the LDSS and comply with Medicaid Program requirements to be available for the required reassessment.
12. Consumer and, as applicable, the consumer’s designated representative shall be solely responsible to:
    1. Manage the plan of care authorized by the MCO, including recruiting and hiring a sufficient number of CDPAs to provide authorized services as set forth in the plan of care authorized by the MCO; training, supervising and scheduling each CDPA; terminating the CDPA’s employment with the consumer; and assuring that each CDPA completely and safely performs the personal care services, home health aide services and skilled nursing tasks included on the consumer’s MCO approved plan of care;
    2. Notify the MCO within 5 business days of any changes in the consumer’s medical condition or social circumstances including but not limited to, any hospitalization of the consumer or change in the consumer’s address or telephone number;
    3. Timely notify the FI of any changes in the employment status of each CDPA;
    4. Attest to the accuracy of each time record for each CDPA;
    5. Transmit the CDPA’s time records to the FI according to the FI’s policies and procedures;
    6. Timely distribute each CDPA’s paycheck, if needed;
    7. Arrange and schedule substitute coverage when a CDPA is temporarily unavailable for any reason;
    8. Acknowledge and agree that: (1) any person who receives, directly or indirectly, an overpayment from the Medicaid program is obligated to report and return the overpayment, within sixty days of the identification of the overpayment. Failure to do so may expose the person to liability under the False Claims Act, including whistleblower actions, treble damage and penalties; and (2) that the Office of the Medicaid Inspector General or MCO may suspend payments to the FI and CDPA, if applicable, pending an investigation of a credible allegation of fraud against the FI or CDPA, as applicable, unless the state determines there is good cause not to suspend such payments; and
    9. Comply with applicable labor laws and provide equal employment opportunities to CDPAs in accordance with applicable laws.
    10. Notify the FI and/or MCO of any disclosure of information that the MCO has taken reasonable measures to maintain as confidential and which derives independent economic value from not being generally known or readily ascertainable by the public (Proprietary information). Proprietary information includes the compensation arrangements between the MCO and the FI and the amount the FI pays the CDPA and any other information relating to the MCO’s business that is not public information.

BOTH PARTIES ACCEPT THE ROLES AND RESPONSIBILITIES IN THE CDPAP AS EXPLAINED ABOVE.