About the Program
What is CDPA/CDPAP?
The Consumer Directed Personal Assistance Program (CDPA or CDPAP) program is a Medicaid home care service available to people who meet the following requirements:
- Medicaid eligible
- Eligible for home-care services, personal care services or private nursing
- Requires long-term assistance with daily living activities (including home and personal care)
- Wants to direct their own services (or has a designated representative who is willing and able to handle the responsibilities of the program)
What are the benefits of CDPA over traditional home care?
CDPA provides many benefits over the traditional home care model. By giving people direct control over who comes into their home, the program helps avoid problems such as language barriers and high assistant turnover rate. The lower levels of bureaucracy in the program (as compared to ??????) also substantially lowers the cost of care.
Who can be a personal assistant?
Almost anyone! Personal assistants can be any adult willing and able to provide consumer directed personal assistance services, with a few exceptions. The following individuals cannot be a personal assistant for their loved one:
- A participant’s legal spouse
- A participant’s designated representative
- The parent(s) of a participant under 21 years old
Is a physician’s order necessary to enroll?
Yes, a physician or other medical professional must complete Physician Orders: DSS-4359 by accurately describing the individual’s medical condition and regimens, including any medication regimens; the consumer’s need for assistance with personal care tasks, home health aide tasks and skilled nursing tasks; and provide only such other information as the physician’s order form requires.
The physician’s order form must be submitted to the social services district (or MCO) within 30 calendar days after the medical examination. The form may be submitted by the physician, other medical professional or by the consumer or the consumer’s representative.
What does “self-directing” mean?
A self-directing individual is capable of making safe choices about his/her activities of daily living, understanding the impact of those choices and assuming responsibility for the results of the choices. A self-directing individual must meet the following characteristics:
- The individual is alert, demonstrates unimpaired judgement, makes decisions that don’t put themselves or others at risk and is able to manage their own affairs.
- The individual understands what to do in an emergency that threatens their health or safety and can summon appropriate assistance (verbally or with the help of a device).
- The individual knows how to obtain assistance during times when the CDPAS is not being provided, including when services are unexpectedly interrupted due to inclement weather or personal assistant illness.
What is a “designated representative”?
A designated representative is an individual to whom a self-directing individual has delegated the authority to instruct, supervise and direct the PA and to perform other participant responsibilities.
With respect to a non self-directing individual, a designated representative means the individual’s parent, legal guardian or (subject to the social services district’s approval) a responsible adult surrogate.
The designated representative may not be the PA or a fiscal intermediary employee, representative or affiliated person.
What is a “fiscal intermediary” (FI)?
A fiscal intermediary is an entity that has a contract with a social services district (or MCO) to process each consumer directed personal assistant’s wages and benefits including establishing the amount of each assistant’s wages; processing all income tax and other required wage withholdings; and complying with worker’s compensation, disability and unemployment insurance requirements.
Parties Involved in CDPA
The Consumer Directed Personal Assistance process requires cooperation between three parties: LDSS/MCO/MLTC (SPELL OUT), CDPA participants/designated representatives and fiscal intermediaries. See the below chart for a breakdown of responsibilities.
The plan’s RN and Case Manager is responsible for:
- Assessing needs
- Approving CDPA
- Determining the amount/level of care
- Referral to a fiscal intermediary agency
The participant or their designated representative is responsible for:
- Recruiting, screening, hiring, training, disciplining and terminating their employees
- Directing, managing and monitoring their care plan
The fiscal intermediary is responsible for:
- Administering wages and benefits for the personal assistants
- Billing and processing Medicaid claims for service
- Fraud monitoring