CDPAS – The Ultimate Guide to the Consumer Directed Personal Assistance Service
For those looking for detailed information and background on the CDPAS, please read below! Note, however, that although much of this sounds complicated, FreedomCare is an expert at navigating the bureaucracy and paperwork. We hold your hand throughout the process to make it as easy and simple as possible.
What is CDPAS?
CDPAS stands for Consumer Directed Personal Assistance Services. It is a service through which Medicaid, through an insurance company, will pay the person of your choice to help you with their own personal care or with daily household tasks if these are difficult or impossible for you to do on your own. It can be family, a friend or anyone you, the patient, chooses, with very few exceptions. The only people who cannot be a CDPAP aide is a spouse, parent of a disabled child under 21 years old, and the consumer’s designated representative (the person who makes home care decisions on the consumer’s behalf).
Generally, this service is administered through the Personal Care Assistant (PCA) Services division of an insurance company.
PCA services generally means services that fill the need when someone requires a personal assistant to help them with Activities of Daily Living (ADL).
ADL is the term used to describe basic activities that we all perform on a normal day, but some people have trouble with these because of a disability, old age, or a medical condition. These can include but are not limited to, bathing, cooking, cleaning, laundry, shopping, and a host of other activities many of us do without thinking. When someone needs help with these activities, they become eligible for PCA services. One form of PCA services is CDPAS.
CDPAS and CDPAP
The predecessor to CDPAP was formed in December 1979. CDPAP exists in contrast with traditional home care, in which a home care agency employs aids, supervises them, and controls how a patient is cared for. CDPAP was created to provide an alternative for patients or their designated representatives to have more control over how were cared for. By creating the CDPAP program, the State created a consumer (patient) directed program in which people could act as employer to their caregivers. This means that in CDPAP, the consumer or the consumer’s designated representative chooses and hires or fires the personal assistant, trains them in the way they wish to be cared-for,
supervises their work, and schedules what days and hours the personal assistant will work. This allows consumers to take greater control over their own care. Ultimately, the program evolved into CDPAP as we know it today, in which Medicaid pays insurance companies, who then use Fiscal Intermediaries like Freedom Care to assist the consumer with the payroll and compliance aspects of the program.
You might hear the terms CDPAP, which refers to the “program,” or the term CDPAS, which refers to the “services” provided through the CDPAP program. While there are some nuanced differences between the two terms, they are essentially used interchangeably.
To receive the Consumer Directed Personal Assistance Services, the consumer will need a form signed by their doctor stating that they need to receive PCA services and that they, or their designated representative, are fit to direct their own care – i.e., that they do not need a traditional home care agency to direct their care for them.
There are two standard forms in existence, one called the M-11Q another called the DOH-4359 (“DOH” for short). These form are sometimes referred to as “medical orders” or “physician orders” by the insurance companies.
Each consumer’s insurance company may use somewhat different terminology, so it is difficult to be more specific than to say that a consumer might need one of these forms, both, or neither. It is ultimately up to the insurance company.
There is another form called the M-13D or “CDPAP Application,” and yet another form called the MOU (Memorandum of Understanding). The M-13D contains a series of questions which essentially gather information
about the different people involved in the patient’s services. Who is the personal assistant? Is there a backup? Who is it? Is the patient making their own decisions? if not, who is?
In the context of CDPAS, the MOU is an agreement in which the consumer agrees to certain responsibilities, like training the aides and complying with the rules of the program.
Some companies combine the two forms and call the combined form the “CDPAP application,” the same name other companies use for just the M-13D. Some companies require their own letterhead. The purpose of this section, however, is to make you aware of the forms that most insurance plans require in order for you to enroll in the CDPAS program. The important thing to remember, however, is that the FreedomCare staff have become experts in each insurance company’s bureaucracy and are happy to hold your hand throughout the entire process and assist you in completing the required forms.
CDPAS Regulations and the policies and procedures laid out by the individual insurance companies) can vary significantly. For example, there was a time when the law stated that the personal assistant could not live in the same house with the consumer. Then, in April 2016, the law changed and now the consumer and his or her personal assistant may live in the same home. Some insurance companies require a backup personal assistant, some require that the backup be an eligible CDPAP aide (i.e., not a spouse), and some require the patient to have a proxy in case they are unable to make decisions at some
later time. However, the most sweeping and standard insurance company policy that all companies adhere to is that one cannot combine traditional home care and CDPAS. You cannot have a Home Health Aide in the morning and a CDPAS aide in the evening.
No insurance company (even if someone tells you otherwise) ) will allow someone to receive two services that solve the same problem at the same time – i.e., no double-dipping. This means that no one can receive traditional PCA, i.e. a Home Health Aide and a CDPAS aide at the same time.
FreedomCare Sirve Con Orgullo
ALL 62 COUNTIES
of New York State.
We are the only CDPAP to have in person coverage in EVERY NY COUNTY.