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Senate & Assembly Urge NYSDOH to Delay Implementation of PMPM

June 24, 2019

Howard A. Zucker, MD JD, Commissioner
New York State Department of Health
Corning Tower, ESP
Albany, New York 12237

Donna Frescatore, Medicaid Director
New York State Department of Health
Office of Health Insurance Programs
Corning Tower, ESP
Albany, New York 12237

Dear Commissioner Zucker and Medicaid Director Frescatore:

We are writing regarding the Consumer Directed Personal Assistance Program (CDPAP) rate reimbursement structure. We understand the Department is still preparing its reimbursement rate change from an hourly basis to a per member, per month (PMPM) basis with the change to be implemented July 1, 2019 – only a few days from now. To date there has been no concrete information about the financing methodology provided to the impacted stakeholders by the Department.

This program provides critical home care services to approximately 75,000 persons with disabilities and the elderly. It is difficult to overstate the negative impact this change will have on fiscal intermediaries, managed long term care programs and, most importantly, the consumers, who depend on critical home care services from this program on a daily basis.

In order to prevent significant negative impacts to all the stakeholders and provide time for a smooth transition, it is critical that the state delay implementation of the financial reforms to the program. Understanding the fiscal underpinnings of the program are critical to its continued success and neither insurers nor fiscal intermediaries can be expected to implement a new financing methodology or significant reduction in payments with knowing the detailed parameters of such a change.

We ask you to delay the implementation of the PMPM changes until at least January 1, 2020 to provide adequate time for a well-considered, open and seamless process that will ensure the safe, orderly and successful transition to the new CDPAP reimbursement model. Delaying the changes is critical to ensure we avoid unintended and potentially harmful consequences and, instead, have a safe and successful implementation.


Gustavo Rivera, Chair Senate Health Committee
Richard N. Gottfried, Chair Assembly Health Committee
CC: Paul Francis, Megan Baldwin

Click here to view the letter as a PDF file.