Relates to licensure requirements for fiscal intermediaries; repealer

• Democratic66
• Republican27

◆ The sponsor's argument

Why Gustavo Rivera says this is needed

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 who 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 who currently do or will benefits 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 licens- ing process for fiscal intermediaries that can demonstrate their charac- ter 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 that govern the Medicaid program. To assist in achieving this oversight, the bill also restores the Comp- troller's 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 the 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.

This is the sponsor's own case for the bill, quoted from their memorandum. It is not Agora's description of what the bill does.