Relates to fiscal intermediary services in the consumer directed personal assistance program

BILL NUMBER:S5565B

Title of bill

An act to amend the social services law, in relation to fiscal intermediaries in the consumer directed personal assistance program

Purpose

This bill defines fiscal intermediary services, within the consumer directed personal assistance program, and requires that fiscal intermediaries providing such services be licensed by the Commissioner of Health.

Summary of provisions

Section 1 of the bill defines the terms "fiscal intermediary" and "fiscal intermediary services" and specifies that no entity provide fiscal intermediary services without a license issued by the Commissioner of Health. It then details the process for becoming a licensed fiscal intermediary and establishes a fee of $2,000.

Section 2 provides an effective date.

Existing law

Section 365-f, the consumer directed personal assistance program, currently provides No specific guidelines as to who can be a fiscal intermediary.

Justification

The consumer directed personal assistance program 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. In 1997, when the program became law, it was left to the local departments' of social services to decide with whom they would contract to provide the fiscal intermediary services. At the time, the program was small and aimed at a specific group of individuals. There was not much demand and, generally, providers were not looking to offer the service. With the shift to managed care and managed long term care, the program has been growing tremendously, experiencing approximately 50% growth rate from 2012 to the end of 2014.

As agencies see this growth, they have looked to enter the CDPA marketplace, often with little to no understanding of the program. Indeed, the Consumer Directed Personal Assistance Program remains one of the only industries in health care that is not regulated or licensed in any manner. In an effort to ensure that public Medicaid dollars are spent effectively and efficiently, and fiscal intermediaries are operating the program in a manner consistent with state laws and regulations while taking adequate steps to ensure quality services and prevent fraud, it is necessary to license these entities and provide a level of oversight while still protecting the unique nature of the program.

Legislative history

New bill.

Fiscal implications

No cost to the state, as the fees associated with licensure are meant to offset any costs.

Effective date

The first day of July after it shall have become law; provided effective immediately the commissioner shall make regulations and take action to implement the law on that date.