Executive Summary. On November 1, 2017, the NYS DOH issued its "Application for Fiscal Intermediary Authorization" and implementation guidelines. Significantly, DOH imposed a very short timeframe, stating: "As of November 1, 2017, all existing FIs will have thirty (30) days to submit their FI Authorization application to the Department." If no filing is made, the FI must cease operating under CDPAP. Those who wish to begin operating an FI may also want to file by this date. A copy of the application can be obtained at https://www.health.ny.gov/health_care/medicaid/redesign/mrt_10003.htm
Attend our firm's complimentary 4th Annual Home Care Symposium at the Scandinavia House, NYC next Wednesday, November 15, 2017, 9:00 AM-12:30 PM to hear more about the application and how to complete it. If you would like to attend, please RSVP to email@example.com no later than Monday, November 13, 2017.
The Application. The application is designed to obtain complete information about the entity operating under CDPAP -- its corporate documents, ownership, leadership, organizational structure, and any related organization that will have the ability to direct or cause direction of actions, management or policies of the FI. The application filing is made under penalty of perjury. DOH may request additional information.
Schedule 1 to the application requires detailed personal information from each principal stockholder or LLC member and managing member, officers and Board members of the FI and any related organizations and relatives of any person submitting, which information includes, among other things, 5 year employment histories, any criminal, civil or administrative actions against them or state enforcement actions against facilities they or their relatives were affiliated with, and personal associations for the past 10 years with any licensed or certified health care entities in or outside New York State, including documentation to show that any associated out-of-state entity was in substantial compliance with that state's applicable codes, rules and regulations.
In addition the application requires submission of numerous documents, among which are (i) a certified copy of a Board resolution authorizing submission of the application and confirming the FI's corporate authority to operate under CDPAP; (ii) the FI's policies and procedures, including any contracts or other documents used in communications with Consumers; (iii) all marketing and outreach materials; and (iv) plans to solicit and consider input from Consumers and other interested parties about the FI's services.
Observations. The application is clearly intended (i) to obtain detailed information about the bona fides of all individuals who own, serve in decision-making roles or manage an FI, or seek to do so, and any entities, parent or otherwise, that can influence any decisions, policies or practices of the FI; (ii) to allow DOH to review an FI's marketing and outreach materials and any contracts or other documents used in communications with Consumers to determine whether these materials are consistent with NYS guidance on CDPAP; and (iii) to reiterate what Fiscal intermediaries are prohibited from engaging in. Indeed, the application contains the specific admonition: "activities in which an FI should not be engaged, such as recruiting and hiring personal assistants, [are] as set forth in the Consumer-Directed regulations under Title 18 NYCRR §505.28. It has never been, nor will it ever be, appropriate for an FI to participate in such activities."