If you live in NY and rely on CDPAP services, then you need to know about fiscal intermediaries. Your relationship with fiscal intermediaries determines the kind of care you receive, so it is in your best interest to know what fiscal intermediaries are, what they do, how they make sure you receive the services that you need, and what kinds of rules they must follow in order to offer CDPAP services in the state of New York.
What Is CDPAP Fiscal Intermediary?
A Fiscal Intermediary is basically a middleman that serves as the mediator between consumers and government healthcare programs such as Medicaid and Medicare. In other words, fiscal intermediaries are private companies that are contracted to provide Medicaid or Medicare services.
These companies provide info to MDs, DMs, and DIOs about healthcare services offered and make decisions about cill payments and coverage. The point of a fiscal intermediary is to serve as the link between consumers and the government so the consumer can get the service they need in a fast and efficient manner.
All fiscal intermediaries in the state of New York are regulated by the Office of Insurance Regulation and have to meet certain legally mandated requirements before they are allowed to operate. For example, they must go through registration and authorization steps before they can provide services to the public.
When a fiscal intermediary becomes registered, they then start a relationship with programs like Medicaid and medicare. The point of the FI-consumer relationship is so that the consumer has more choice and freedom in how they receive their CDPAP services. These FIs allow you to choose the kind of treatment you will get including a personal home care assistant.
To sum up, FIs serve as the go-between for consumers and government-run programs. They exist so that the consumer can exert a level of control over how they consume services and the FI makes sure that resources and services are being distributed in accordance with federal rules and regulations.
Responsibilities of the Fiscal intermediary
Given that they are contracted with government agencies, fiscal intermediaries must abide by specific rules and regulations before they are allowed to provide services. In New York, CDPAP FIs must
– Establish personal assistant wages and process income taxes, withholdings, etc
– Process benefits of wages for CDPAP personal assistance
– Comply with laws surrounding worker’s comp, unemployment, and disability insurance
– Monitor the consumer or their representatives to make sure that they are fulfilling their end of responsibilities
– Maintain administrative agreements with the state Department of Health to provide CDPAP services
– Establish and evaluate personal assistants to make sure they are healthy according to state regulations
– Contact and notify consumers of any situation or details that are pertinent to them fulfilling their responsibilities or relevant to their personal care
Any CDPAP FI that is found to not be following these rules can face punishment, legal fines, and be prohibited from offering future services until any violations of regulations are fixed. You can read more about specific rules and regulations for CDPAP FIs here at the New York State Department of Health.
How to Become a Fiscal Intermediary in NY
The most recent set of rules regarding becoming a fiscal intermediary was passed in December 2019. In 2019, the state made it so that any FI that works with the CDPAP program must also be joint employers, meaning that employees work for one employer but the terms and definitions for employment are laid down by multiple entities.
The state also passed regulations specifying the types of organizations that can become CDPAP FIs
– Service centers and independent living centers (LCs)
– Institutions providing CDPAP services are grandfathered in and can continue providing CDPAP services
– Organizations that work with and can provide services in accordance with New York Social Services Law section 565-f
If an organization is eligible, then it must follow a set of steps to become registered and authorized. Individuals cannot be FI; an FI must be a business, organization, non-profit, or some other kind of entity.
First, entities need to submit an application to the New York State Department of Health to get authorized. This application ensures that the business is the right kind of organization to be an FI. Next, organizations that have their applications accepted must contact the Bureau of Long Term Care Reimbursement and open a Health Provider Network Account.
Next, if the organization is not already part of the Medicaid provider network, then it must reach out to the Bureau of Provider Enrollment at the Division of OHP Operations to get a provider ID number. This provider ID number is a unique 10-digit code that the consumer and insurance uses to identify a specific health care provider.
Once all the previous steps have been completed, the FI can get a Managed Care Organization (MCO) contract to provide CDPAP homecare. From here the FI can discuss wage and reimbursement terms as well as agreement terms. FIs will not be able to sign any MCO contracts until their application has been viewed by the Department of Health and they have been authorized to act as a FI.
List of Fiscal Intermediaries in NY
You can browse a list of CDPAP fiscal intermediaries that are authorized by the New York State Department of Health here. Every fiscal intermediary on this list has been authorized and approved by the New York State Department of health to provide Medicare and Medicaid CDPAP services. You can also download the list in .pdf format from the link for viewing when offline.
It is important to know your rights and responsibilities as a consumer when seeking CDPAP care. The Fiscal intermediary program is designed to maximize your freedom and the various licensing steps and requirements ensure that any FIs are competent and able to provide the necessary services in accordance with the law. A good fiscal intermediary will work with you to discuss your options and what kind of services you are entitled to under the law.