BILL NUMBER: S9901
SPONSOR: RIVERA
 
TITLE OF BILL:
An act to amend the social services law, in relation to the licensure of
fiscal intermediaries, and to repeal certain provisions of such law
relating thereto
 
PURPOSE OR GENERAL IDEA OF BILL:
To establish a licensure process and requirements for fiscal interme-
diaries (FIs) to continue to operate in the Consumer Directed Personal
Assistance Program (CDPAP) under Medicaid, and to repeal the transition
to a single fiscal intermediary for the state. This legislation is
intended to address ongoing concerns that have been raised with the
operation of CDPAP while minimizing potential disrupt ion to Medicaid
enrollees receiving services and to workers providing services under the
program.
 
SUMMARY OF SPECIFIC PROVISIONS:
The bill would:
- Repeal all language associated with the transition to a single Fl
under the CDPA program.
- Require all fiscal intermediaries, including those that provide
services through Medicaid Managed Care (MMC), to report on addition al
metrics including: the number of members served; the F1's service area;
the number of personal assistants employed by consumers and the hours
and dates they worked, as well as any relationship the personal assist-
ant has with the consumer; the number of total hours consumers are
authorized to receive services and the amount of hours billed for; the
self-directing status of the consumer; and any additional information as
determined by the Commissioner of Health (COH).
- Require that on and after April 1, 2026, all FIs must be licensed in
order to provide fiscal intermediary services. The language allows the
COH to have the flexibility to grant FIs the ability to operate tempo-
rarily if their licensure application is still under review, or if the
unlicensed Fl is winding down operations and consumers and/or workers
are transitioning to another licensed Fl.
- Direct the COH to make regulations and issue guidance to ensure an
orderly transition of consumers and personal care assistants from Fls
that are ceasing operations.
- Establish a process for Fls to become licensed, including a require-
ment for the COH to review the character and competency of the Fl and
make a determination that they and their services are fit and adequate.
Factors to be considered in the review include: compliance with cost
reports; cultural and language competencies; ability to comply with
electronic visit verification (EVV) requirements; and compliance with
applicable federal and state laws and regulations.
- Require as a condition of licensure and participation in Medicaid that
fiscal intermediaries are prohibited from advertising their services to
Medicaid enrollees.
- Establish that the Commissioner may take corrective actions against
fiscal intermediaries that fail to comply with the statute or any regu-
lations or rules made thereunder. These actions include potential penal-
ties, rate reductions, or actions related to the F1's licensure.
- Require that Fls pay a one-time $10,000 licensure fee
- Establish a registry for personal assistants maintained by the Depart-
ment of Health (DOH). Fls would be responsible for providing DO H with
the information. The registry would be kept private.
- Establish a process for the revocation, suspension, limitation or
annulment of an F1's license by the COH. The process would require a
hearing. A temporary suspension without a hearing would be allowed if
public health or safety was at risk.
- Modify the current workgroup of Fl services to expand the scope of
activities they review and require an annual report on such information
beginning on December 1, 2025.
- Authorize the COH to establish minimum training requirements for
personal assistants to effectively and safely provide care to consumers.
The training requirements are allowed to be varied based on the level of
care the consumer needs and the services the personal assistant will
provide, as well as any certifications or licenses the personal assist-
ant currently holds. This training requirement is intended to be stream-
lined and not overly burdensome to provide personal assistants with some
baseline core competencies, including recognizing and responding to a
medical crisis. These requirements are not intended to be duplicative
should a personal assistant already have training or experience.
- Authorize the Comptroller to review any contract entered into by an
Fl. The Comptroller, in consultation with the Medicaid Fraud Control
Unit (MFCU), may develop an audit process. Should the Comptroller
discover unlawful activity, they would be charged with referring the
activities to DOH and MFCU. -Take effect immediately.
 
JUSTIFICATION:
Shifting demographics have led to higher rates of utilization of long
term care services in New York and nationally. Because New York 's Medi-
caid benefit includes long term care services, this has created finan-
cial pressures for the State as it seeks to continue providing Medicaid
benefits. As a result New York has taken many different actions in
recent years in an attempt to directly reduce overall spending under the
Medicaid program. The Consumer Directed Personal Assistance Program
(CDPAP) has repeatedly been a focus of scrutiny during these efforts.
CDPAP allows Medicaid enrollees to play a larger role in selecting who
is directly providing their care rather than having an agency assign a
worker. CDPAP also allows certain family members to provide this care,
often serving as an important resource for these family members that
provide significant levels of care, which impacts their ability to seek
other employment opportunities. This program allows people to select
workers they are comfortable with, allowing them to live in their commu-
nities and avoid unnecessary hospitalizations and stays in institutional
settings. It is critical that we continue to protect access to this
program for all New Yorkers that currently do or will benefit from it.
This legislation is designed to address concerns that have been raised
by the Executive as it relates to program integrity by establishing a
licensure process for fiscal intermediaries to operate. State licensure
of entities providing services in New York has a long history that
extends beyond healthcare and has withstood repeated legal challenges.
The bill addresses the State's desire for access to information as it
relates day to day operations of fiscal intermediaries and those who
receive services under the program. It would establish a uniform
licensing process for fiscal intermediaries that can demonstrate their
character and competence, as well as their compliance with applicable
state and federal laws and regulations.
The bill would allow fiscal intermediaries that are in good standing to
continue their operations while eliminating those that have failed to
comply with basic requirements and have operated in violation of basic
provisions of the law and regulations which govern the Medicaid program.
To assist in achieving this oversight, the bill also restores Comp-
troller oversight of fiscal intermediaries activities.
Since 2019, the statute governing who is allowed to operate as a fiscal
intermediary has been changed on four separate occasions. New York has
not been able to operationalize any of these changes at any point since
the initial restructuring in 2019. The timeframe for the most recent
change requires a new statewide fiscal intermediary to be selected and
for all consumers and personal care assistants to be transferred from
hundreds of different fiscal intermediaries by April 1, 2025. Though the
quick implementation of policy is laudable, it is highly likely that
this timeframe will either not be achievable or will lead to significant
disruption for critical services needed by New Yorkers. This bill estab-
lishes a timeframe that will grant the Commissioner of Health and the
Department of Health the flexibility needed to minimize service
disruptions.
This bill represents a compromise of positions by balancing program
integrity, access to services, consistency in fiscal intermediary oper-
ations, and economic opportunity. Its goal is to return stability to an
essential program that has been filled with uncertainty and left
patients and workers reeling for years. It will achieve this through a
return to basic operational controls that have been tested and proven.
 
PRIOR LEGISLATIVE HISTORY:
New Bill.
 
FISCAL IMPLICATIONS:
Undetermined.
 
EFFECTIVE DATE:
This act shall take effect immediately.

Statutes affected:
S9901: 365-f social services law, 365-f(4-a) social services law, 365-f(4-a-1) social services law, 365-f(4-b) social services law, 365-f(4-c) social services law, 365-f social service law, 365-f(5) social service law