New York Codes, Rules and Regulations › Title 18 - DEPARTMENT OF SOCIAL SERVICES › Chapter II - Regulations of the Department of Social Services › Subchapter E - Medical Care › Article 3 - Policies and Standards Governing Provision of Medical and Dental Care › Part 505 - Charges For Professional Health Services › Section 505.28 - Consumer directed personal assistance program

Current through Register Vol. 46, No. 28, July 10, 2024
(a)
Purpose.
The consumer directed personal assistance program is
			   intended to permit chronically ill or physically disabled individuals receiving
			   home care services under the medical assistance program greater flexibility and
			   freedom of choice in obtaining such services.
(b)
Definitions.
The following
			 definitions apply to this section:
(1)
			 Activity of daily living means those activities recognized as activities of
			 daily living by the evidence based validated assessment tool in accordance with
			 section 2-a of part MM of chapter 56 of the laws of 2020.
(2)
consumer
means a medical
			 assistance recipient who a social services district or MMCO has determined
			 eligible to participate in the consumer directed personal assistance
			 program.
(3)
consumer
			 directed personal assistance
means the provision of assistance with
			 personal care services, home health aide services and skilled nursing tasks by
			 a consumer directed personal assistant under the instruction, supervision and
			 direction of a consumer or the consumer's designated representative.
(4)
consumer directed personal
			 assistant
means an adult who provides consumer directed personal
			 assistance to a consumer under the consumer's instruction, supervision and
			 direction or under the instruction, supervision and direction of the consumer's
			 designated representative. A person legally responsible for the consumer's care
			 and support, a consumer's spouse, or the consumer's designated representative
			 may not be the consumer directed personal assistant for that consumer; however,
			 a consumer directed personal assistant may include any other adult relative of
			 the consumer provided that the district or MMCO determines that the services
			 provided by such relative are consistent with the consumer's plan of care and
			 that the aggregate cost for such services does not exceed the aggregate costs
			 for equivalent services provided by a non-relative personal assistant.
(5) consumer directed personal
			 assistance program or consumer directed program or the program means the
			 program provided for under section 356-f of title 11 of article 5 of the Social
			 Services Law.
(6)
continuous consumer directed personal assistance
means the
			 provision of uninterrupted care, by more than one consumer directed personal
			 assistant, for more than 16 hours in a calendar day for a consumer who, because
			 of the consumer's medical condition, needs assistance during such calendar day
			 with toileting, walking, transferring, turning and positioning, feeding, home
			 health aide services, or skilled nursing tasks, and needs assistance with such
			 frequency that a live-in 24-hour consumer directed personal assistant would be
			 unlikely to obtain, on a regular basis, five hours daily of uninterrupted sleep
			 during the aide's eight hour period of sleep.
(7)
designated
			 representative
means an adult to whom a self-directing consumer has
			 delegated authority to instruct, supervise and direct the consumer directed
			 personal assistant and to perform the consumer's responsibilities specified in
			 subdivision (h) of this section and who is willing and able to perform these
			 responsibilities. With respect to a non self-directing consumer, a
designated representative
means the consumer's parent, legal
			 guardian or, subject to the social services district's approval, a responsible
			 adult surrogate who is willing and able to perform such responsibilities on the
			 consumer's behalf. The designated representative may not be the consumer
			 directed personal assistant or a fiscal intermediary employee, representative
			 or affiliated person.
(8)
fiscal intermediary
means an entity that has a contract with
			 the New York State Department of Health to provide wage and benefit processing
			 for consumer directed personal assistants and other fiscal intermediary
			 responsibilities specified in subdivision (j) of this section.
(9)
fiscal intermediary
			 administrative costs
means the allowable costs incurred by a fiscal
			 intermediary for performance of fiscal intermediary services under section 365-f (4-a)  of the Social
			 Services Law and fiscal intermediary responsibilities under subdivision (i) of
			 this section.
(10)
home
			 health aide services
means services within the scope of practice of a
			 home health aide pursuant to article 36 of the Public Health Law including
			 simple health care tasks, personal hygiene services, housekeeping tasks
			 essential to the consumer's health and other related supportive services. Such
			 services may include, but are not necessarily limited to, the following:
			 preparation of meals in accordance with modified diets or complex modified
			 diets; administration of medications; provision of special skin care; use of
			 medical equipment, supplies and devices; change of dressing to stable surface
			 wounds; performance of simple measurements and tests to routinely monitor the
			 consumer's medical condition; performance of a maintenance exercise program;
			 and care of an ostomy after the ostomy has achieved its normal
			 function.
(11) live-in 24-hour
			 consumer directed personal assistance means the provision of care by one
			 consumer directed personal assistant for a consumer who, because of the
			 consumer's medical condition, needs assistance during a calendar day with
			 toileting, walking, transferring, turning and positioning, feeding, home health
			 aide services, or skilled nursing tasks and whose need for assistance is
			 sufficiently infrequent that a live-in 24-hour consumer directed personal
			 assistant would be likely to obtain, on a regular basis, five hours daily of
			 uninterrupted sleep during the aide's eight hour period of sleep.
(12) Medicaid Managed Care Organization or
			 MMCO means an entity, other than an entity approved to operate a Program of
			 All-inclusive Care for the Elderly (PACE) plan, that is approved to provide
			 medical assistance services, pursuant to a contract between the entity and the
			 Department of Health, and that is:
(i)
			 certified under article forty-four of the Public Health Law, or
(ii) licensed under article forty-three of
			 the Insurance Law.
(13)
			 Medical assistance or Medicaid means the program to provide services and
			 benefits under title 11 or article 5 of the Social Services Law.
(14) minimum needs requirements means, for
			 individuals with a diagnosis by a physician of dementia or Alzheimer's, being
			 assessed in accordance with subdivision (d) of this section as needing at least
			 supervision with more than one activity of daily living, and for all other
			 individuals, being assessed in accordance with subdivision (d) of this section
			 as needing at least limited assistance with physical maneuvering with more than
			 two activities of daily living.
(15)
personal care services
means the nutritional and environmental support functions, personal care
			 functions, or both such functions, that are specified in section
			 505.14(a)(5) 
			 of this Part except that, for individuals whose needs are limited to
			 nutritional and environmental support functions, personal care services shall
			 not exceed eight hours per week.
(16) a
self-directing
			 consumer
means a consumer who is capable of making choices regarding
			 the consumer's activities of daily living and the type, quality and management
			 of his or her consumer directed personal assistance; understands the impact of
			 these choices; assumes responsibility for the results of these choices ; and is
			 capable of instructing, supervising, managing and directing consumer directed
			 personal assistants and performing all other consumer responsibilities
			 identified in this section.
(17)
skilled nursing tasks
means those skilled nursing tasks that
			 are within the scope of practice of a registered professional nurse or a
			 licensed practical nurse and that a consumer directed personal assistant may
			 perform pursuant to section 6908  of
			 the Education Law.
(18)
stable medical condition
means a condition that is not
			 expected to exhibit sudden deterioration or improvement and does not require
			 frequent medical or nursing evaluation or judgment to determine changes in the
			 consumer's plan of care.