How CDPAP Benefits NY Residents

CDPAP stands for “Consumer Directed Personal Assistance Program.” This Medicaid-funded program allows residents in the state of New York with chronic health conditions or disabilities to select their preferred personal care provider, such as a home health attendant or nurse.

The consumer-directed model allows for greater flexibility in making informed decisions regarding one’s long-term care needs, acting as their own employer. Additionally, financial aspects of the CDPAP program, such as competitive pay and benefits, can be administered by a fiscal intermediary to ensure all payments are timely, accurate, and compliant with Medicaid requirements and state law. 

Today, we are going to cover the basics of CDPAP eligibility to help you understand the process and what to expect during assessment and reassessment. 

Requirements for CDPAP Eligibility

General Requirements

As listed by the State of New York, a person is deemed eligible for CDPAP if they meet the following requirements:

• Meets a standard for medical assistance eligibility
• Deemed eligible for long-term care services
• Is experiencing a medical condition classified as “stable”
• Able to act as a self-directing entity or has a representative to do so in their place
• Has a need for services provided by a personal care aide, home health aide, or nurse
• Willing and able to fulfill full responsibilities or has a representative who can do so
• Able to engage in the assessment or reassessment process as needed

Consumer eligibility is determined through a multi-assessment evaluation process that satisfies the criteria above. First, it begins with the Physician’s Order.

Submit an Official Physician’s Order

To initiate CDPAP services, the patient must first be evaluated by an authorized medical professional to confirm their need for long-term care. This can be completed by a doctor, physician’s assistant, nurse practitioner, or another provider that meets proper certification requirements.

Once the examination has finished, the Physician’s Order for long-term care services must be sent to the proper social services administration office within 30 days. This can be done by the medical provider or by the patient.

Social Assessment

Once the Physician’s Order has been received, a social services organization will begin the social assessment. This process involves a brief interview with the patient or their designated representative to determine the patient’s willingness to participate in care as well as the existing level of support they receive informally. For example, the social assessment may account for any care the patient currently receives from family members.

Nursing Assessment

The nursing assessment is completed by a New York-licensed and registered nurse to evaluate the patient’s long-term care needs from a medical perspective. Depending on the person’s condition and the skilled tasks that may be part of their treatment, the nurse may ask the patient or their representative to demonstrate these tasks. This aids in determining if the care recipient has the ability to accurately communicate their care needs to a provider.

Assessment Authorization

Once determined eligible for CDPAP services, the district authorizes the plan of care’s scope of services, hours, and frequency to ensure it meets the consumer’s medical needs as well as those defined in the assessments. In some cases where a patient is receiving other services simultaneously, CDPAP services may also be approved. 

Participate in Reassessment

Prior to the end of an authorized care period, the consumer or their representative must participate in the reassessment process, which addresses:

• Has the existing authorized care plan satisfied their needs so far?
• Is the consumer still medically eligible for CDPAP services?
• Has the consumer recently experienced a change in their informal support?
• Has the consumer’s medical condition changed in a way that requires a new assessment?

If a consumer’s medical condition has changed significantly, this often requires a new Physician’s Order, social assessment, and nursing assessment. For example, if the person’s condition has worsened and they can no longer make informed decisions independently, these assessments may be reconducted with a new representative acting on their behalf.

Consumer Responsibilities

The consumer is responsible for handling the administrative requirements of their care plan. These can include duties like keeping accurate timesheets, issuing payroll, and evaluating the quality of services they receive. However, the financial aspects can also be administered through a fiscal intermediary if preferred.

Can a Consumer’s Family Member Act as Their Personal Care Assistant?

Many consumers ask if their family member can act as their personal care assistant and receive financial benefits from Medicaid through CDPAP. According to New York State law, parents of adult children over 21 years of age can be deemed eligible for CDPAP aide compensation. However, spouses are not eligible and neither are parents that are already acting as their child’s representative.

Get Fiscal Intermediary Assistance Today

At CDChoices, we provide New York consumers with fiscal intermediary assistance for their Medicaid-funded CDPAP needs. By providing services such as payroll and benefits administration to care assistants, we help streamline the financial requirements for your long-term care and ensure that all obligations are met promptly and accurately. 

To learn more about working with a fiscal intermediary for your consumer-directed care plan, please contact us at any time.