CDPAP Rules and Regulations

The Consumer-Directed Personal Assistance Program (CDPAP) in New York allows a qualified Medicaid consumer to hire, manage, and fire the caretaker of their choice, including a member of their family who is eligible under the program’s rules to provide this care. 

cdpap rules and regulationsAs long as this family member is not the consumer’s designated representative, even a parent of an adult child who requires high levels of care is eligible to serve as the patient’s personal assistant. 

Certain restrictions do apply to the utilization of this Program, however, particularly concerning caregivers’ specific eligibility and restrictions. 

The patient, first and foremost, must qualify for Medicaid, which can be applied for through local health or social service departments.  Qualification for Medicaid is based on financial information, employment, assets, and financial history. 

If at first declined for entrance into Medicaid, a restructuring of your finances or appeal with the help of an elder care lawyer could prove necessary.  Once qualified for Medicaid, a patient must demonstrate their physical eligibility for this Program as well as the suitability of their personal assistant, designated representative, and social environment to the proper utilization thereof.

 

CDPAP Qualifications

For an individual to demonstrate that they are physically eligible to receive care under the CDPAP due to their physical disability or elderly status, they must demonstrate that they require the level of personal assistance associated with the Program, particularly through showing a distinct need for daily assistance. 

The patient must qualify for some level of personal care, at-home care, or the skilled care of a trained nursing service. 

In addition to demonstrating eligibility, the patient must submit a physician’s order from a qualified physician, physician’s assistant or specialist assistant, or a qualified nurse to confirm that the consumer is both qualified and stable enough for entry into CDPAP.

This examination will be further assessed by a qualified nurse to determine the accuracy and finalize the analysis of the consumer’s physical state. 

Once qualified both physically and financially, the patient is eligible to apply for CDPAP through the Managed Medicaid Long Term Care Program and begin the process of gaining approval and funding for an unrivaled level of personalized care.

 

The CDPAP Application and Regulation Process

A key step in the application and regulation process is the ‘social assessment’, which looks at the patient, personal assistant, and the patient’s ‘informal supports’ which include family members and friends who may or may not be willing to aid in care. 

Whereas parents and spouses were previously barred from serving as CDPAP caregivers, only the latter remain prohibited, with parents allowed to care for their adult child given the right circumstances. 

cdpap regulation process

There are a few specific guidelines with regard to who the caregiver can be, and in what context, that should be kept in mind, however.  Notably, someone who is ‘legally responsible’ for the patient in need of care cannot serve as that individual’s personal assistant or caregiver. 

This can preclude both parents and spouses given their typical legal responsibility in such instances.  Parents may serve the role of caregiver, but only if the parent does not reside with the consumer or resides with the consumer because the amount of care the consumer requires makes such relative’s presence necessary.

Immigrants who wish to serve as a caregiver must have already obtained a valid work visa or other authorization for employment within the country.

 

Designated Representatives

A designated representative who represents a patient incapable of or unwilling to serve as his/her own representative cannot simultaneously serve as the patient’s caregiver; ‘The designated representative’, which typically refers to a surrogate such as parent or legal guardian, ‘may not be the consumer directed personal assistance or a fiscal intermediary employee, representative or affiliated person.

The designated representative assumes many or all of the consumer’s responsibilities under CDPAP’s rules and regulations. 

Specifically, the responsibility of managing the plan of care, which includes hiring and firing caregivers and scheduling, is the first and possibly most important role required of either the consumer or designated representative. 

Furthermore, notifying social services of any changes in medical or social conditions, notifying the fiscal intermediary of any changes in the consumer directed personal assistant’s employment status, and verifying the assistant’s time sheets all contribute greatly to the success of this Program’s care and are thus explicitly required of the consumer or designated representative. 

Payments, scheduling, and ultimately approving any other alterations to the patient’s care are all covered either by the patient or by the designated representative and further demonstrate the strict requirements placed on any consumer under the CDPAP.

 

CDPAP Responsibilities

There is, ultimately, a distinct set of responsibilities placed on the shoulders of every individual involved in the care delivered by CDPAP.  

There are specific qualifications to be met by the patient, the personal assistant, and the designated representative, if applicable.  Added to this is an analysis of others who will be around the care to determine the suitability of the patient’s social environment to adequate care. 

By endeavoring to understand every aspect of a patient’s day-to-day care, the specific design, and applicability, of CDPAP can be determined and implemented. 

CDPAP is designed to put the control of the patient’s care back in the patient’s hands; these few rules and regulations are designed to ensure that the patient is able to control his/her care while simultaneously receiving the optimum level of care available. 

As long as the few conditions mentioned above are met, CDPAP can truly be a life-changing Program by giving the consumer control over their care, allowing a sense of independence and renewal of normalcy.