What is CDPAP?

New York's Consumer Directed Personal Assistance Program, also known as CDPAP, lets people with disabilities and seniors receiving home care take charge of their services. Instead of relying on an agency, CDPAP members hire, schedule, train, and manage caregivers, called personal assistants, themselves.

New York's Medicaid CDPAP program began in 1996 as a pilot under a federal disability rights mandate to provide community-based long-term care options. The program grew statewide by 2002.

Today over 40,000 New Yorkers enroll in CDPAP through Medicaid managed care plans or fee-for-service Medicaid.

As a self-directed program, CDPAP aims to give members control over their care. But myths about paperwork and being an "employer" causes confusion and intimidates some from enrolling out of misunderstandings about how the program actually works.

Myth 1: Members Must Handle Complex Employment Paperwork

A major CDPAP myth holds that members become full legal employers who must carry out payroll, taxes, insurance, and other employer obligations. This intimidates many, but the reality is quite different.

In CDPAP, the member or a designated direct representative does handle recruiting, hiring, training, and scheduling duties. However, they are not a legal employer.

Fiscal intermediaries contracted by managed care plans handle all payroll and employer taxes for members. Fiscal intermediaries also provide membership support services.

So while CDPAP does require members or representatives to onboard staff, the fiscal intermediary executes all documentation like:

• Employment eligibility verification (I-9 form)
• Payroll setup
• Background checks
• Workers’ compensation
• Payroll and expense reporting

Fiscal intermediaries also help guide members through required paperwork. With knowledgeable support, administrative aspects appear far less daunting to potential CDPAP enrollees.

Myth 2: CDPAP Services are "Uninsured"

Since CDPAP personal assistants don't work for home care agencies, myths suggest services are then "uninsured." This generates unease about things like workers' compensation if an aide became injured on the job. Or liability if something incidental happened on a member's property.

In reality, the opposite is true. As the legally contracted employer, fiscal intermediaries provide standard worker protections like:

• Workers’ compensation
• Disability benefits
• Unemployment benefits
• Occupational accident insurance

Fiscal intermediaries also take on general liability for personal assistants' actions while on duty. Multiple systems safeguard both worker protections and member coverage through CDPAP.

Myth 3: Self-Direction Means No Oversight on Care

A common myth implies self-directed care means zero accountability or oversight over service quality. However, numerous checks and balances exist.

The authorizing physician ultimately holds responsibility for assessing ongoing care needs. After authorizing a care plan they must sign service logs to verify appropriate delivery of approved hours.

CDPAP nurses also conduct in-home visits every 90 days to evaluate:

• Safety of the care environment
• Personal assistant performance
• Plan appropriateness
• Progress on care goals
• Member/representative capabilities

Additionally, members or representatives choosing inappropriate assistants or demonstrating inability to self-direct discharge or other actions may follow to ensure member welfare.

While CDPAP necessitates member independence managing care tasks, professional medical oversight and intermediary oversight uphold essential accountability.

Myth 4: Self-Hired Assistants May Lack Training or Professionalism

Since CDPAP members hire assistants outside of agencies, myths paint assistants as less professional or qualified. Reality shows most members seek and hire highly committed workers.

CDPAP allows members to select candidates with Shared backgrounds, personalities, and care values fitting their needs. Many assistants bring substantial experience from past home health roles seeking better pay and working conditions in CDPAP. Retention averages three times higher than agency-hired home care.

Members or representatives conduct robust hiring interviews and reference checks before bringing an assistant onboard. Though not licensed like home health aides (HHAs), CDPAP assistants complete mandatory orientation training in critical areas like:

• Ethics
• Safety
• Infection control
• Respectful care
• Reporting responsibilities

HHAs in reality undergo minimal training (75 hrs) given intricate care needs. CDPAP allows members to train assistants directly on individualized needs and preferences. Mutual investment in these relationships cultivates professionalism and care quality beyond agency limitations.

FAQs

How does oversight on care work in CDPAP if members direct everything?

While members manage direct care tasks, the authorizing doctor and nurses from plans conduct oversight to uphold care standards and appropriateness of assigned hours. Issues can trigger early intervention.

What options do members have if a personal assistant doesn’t work out?

Members maintain full discretion to terminate assistants not meeting duties or other standards. Support staff also guide transitions to qualified replacements.

Who ensures CDPAP personal assistants have proper training?

Members conduct robust hiring vetting and reference checks then train assistants directly on specialized care needs. Assistants still complete fundamental training on safety, ethics and reporting duties through fiscal intermediaries.

How are assistants protected against workplace injuries if members oversee them?

Fiscal intermediaries assume all payroll employer functions like providing workers compensation, disability benefits and occupational accident insurance for on-duty injuries.

What prevents CDPAP members from misusing program funds?

Fiscal intermediaries authorize payments, monitor appropriate spending levels and would report suspected abuse or fraud to the managed care organization.

How does CDPAP guard against members hiring irresponsible or dangerous assistants?

Members carry liability for negligent hiring or inadequate oversight leading to misconduct. Like agencies, they must vet assistants, monitor performance, and terminate dangerous workers.

What options exist if a member can’t handle self-direction responsibilities due to cognitive issues?

Designated representatives, often family members, can fully manage program responsibilities while safeguarding the member’s best interests.

Who ensures care standards are upheld if members directly manage assistants?

Along with member diligence, physicians and health plan nurses monitor care quality through service logs, periodic appraisals, and modifying care plans if issues emerge. Immediate needs also trigger agency care.

When might a CDPAP member get discharged from the program by health plans?

In rare cases of documented willful program violations, hospitalization periods beyond 45 days requiring agency care, changes in condition making self-direction unfeasible, or demonstrating inability to self-direct.

Conclusion

For New Yorkers needing home care, CDPAP provides a proven path to  maximize choice, control, and self-determination with the right supports in place. Purpose-built administrative assistance from intermediaries allows members to focus fully on care while experts handle employment functions.

Additional medical and oversight accountability from both physicians and health plans also guide program integrity.By dispelling misconceptions about CDPAP through better education, more people with disabilities and aging New Yorkers can expand home care freedom and quality of life

SOURCES

1.https://www.ultimatecareny.com/myths-about-cdpap

2.https://www.homechoicenys.com/myths-about-cdpap

3.https://www.citadelhomecare.com/myths-about-home-care