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Covid-19 Resources and Considerations for Fiscal Intermediaries & Healthcare Providers

Updated 4/29/2020:

On April 26 2020, the Department of Health issued updated Interim Guidance re: Protocol for COVID-19 Testing Applicable to All Health Care Providers and Local Health Departments.

This guidance document seeks to clarify the order of priority in which COVID-19 testing will be made available. Notably, per this policy, Personal Assistants in CDPA belong to priority category 3.

A summary of each category, by priority:

1. People who are experiencing symptoms of COVID-19, particularly if they belong to an at-risk population;

2. People who have been exposed (within 6 feet) of someone who is a confirmed positive case;

3. Individuals who are employed as health care workers, first responders, etc.

On April 14, 2020, the Department of Health issued interim guidance on the Executive Order requiring employers to provide face coverings to employees. 

It is unclear from this guidance whether the fiscal intermediary or consumer is responsible for procurement and distribution of masks to personal assistants. Individual fiscal intermediaries will need to make their own decisions about how to comply with this guidance.

This requirement is for face coverings, not masks, and the guidance defines face coverings as including, but not limited to: cloth (e.g. homemade sewn, quick cut, bandana), surgical masks, N-95 respirators, and face shields.

CDPAANYS has sought clarification from the Department of Health regarding several matters, including this most recent interim guidance on face coverings. If additional clarification or guidance from the Department becomes available, it will be posted here.

Consumers & Designated Representatives may not be required to purchase face coverings using their own money.

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Updated 4/8/2020: NYSDOH has updated their guidance on Authorization of Community-Based Long Term Services & Supports Covered by Medicaid. New Personal Assistants in CDPA are still required to have a health assessment, immunization record & tuberculosis test, even though many clinics are closed. 

Updated 4/8/2020: You may be required to offer paid COVID-19 leave to employees who have been ordered to be quarantined or isolated.

Updated 3/25/2020: Department of Homeland Security has announced temporary flexibility on requirements for I-9 Compliance.

Updated 4/8/2020: The Governor’s PAUSE Act, which shuts down non-essential businesses through April 29, does not apply to CDPA. Fiscal intermediaries and personal assistants are essential healthcare workers. 

CDPAANYS is committed to helping you understand Best Practices and how to proceed in a way that protects and safeguards your employees, your consumers, and your consumers’ personal assistants. 

COVID-19 will place enormous stress on FIs at a time when agencies are already struggling. FIs will need to make a host of decisions. We will never be able to adequately plan all scenarios that will arise during an unprecedented global pandemic of this sort; however, to the extent we plan in advance, we can help to mitigate those unplanned instances that will inevitably arise.

Considerations for FI Planning:

Factors that FIs should think through before they arise include (this list is inherently not complete):

  • In the event that all of a consumer’s PAs except one become ill; how will you handle overtime requirements? What, if any, systems will you put in place to protect both the consumer and the worker from injuries and deterioration due to excessive work (for instance, nobody can work 24/7).
  • What resources can you make available to consumers:
    • Masks (if they become ill with the virus)
    • Latex gloves
    • Alcohol swabs
    • Proper handwashing techniques
    • Information on COVID-19 symptoms and what to do if symptomatic?
    • Information on handling respiratory conditions that may be new to a consumer as a result of becoming infected with COVID-19, and how to talk to their health care provider about it in advance
    • Medical supplies, such as:
    • Educational resources
  • How will you help consumers build a plan for the next few weeks (or longer). See below where we offer resources and planning questions for consumers.
  • Is your office and your operations set up to work remotely? What steps need to happen to allow you to do so? How quickly can you implement them?
  • Estimates indicate that the infection rate could be as high as 70%. In the event that 70% of your office staff is missing, how will you effectively maintain operations?
  • How will you manage assessments for PAs and consumers during this period?
  • How will you handle consumers who call to inform you that their workers have all fallen ill with COVID-19 and that they need additional staff?
  • Do you have contingency plans in place in the event that travel bans are imposed on cities, towns, neighborhoods, or even buildings?
  • Have you communicated to staff that under no condition should they come to work if they feel remotely ill? Do you have paid sick leave to encourage this?

Have your reviewed all PA and consumer authorizations and health assessments for the next 30 days, notifying consumers and their PAs if they will be needed? If DOH does not suspend these rules, advance notice will be mandatory.

Articles from Bond Schoeneck & King – Updated Daily

NYSDOH COVID-19 Guidance For Authorization

THIS DOCUMENT HAS BEEN UPDATED 4/8/2020.

On March 18, 2020, the Division of Long Term Care issued COVID-19 Guidance for the Authorization of Community-Based, Long-Term Services and Supports Covered by Medicaid.

This guidance covers four areas relevant to CDPA:

1. Physician’s orders: Initial medical assessments for CDPA and personal care are still required but may be done via telehealth.

2. Initial Community Health Assessments: Still required but may be done via telehealth. MLTC enrollment eligibility criteria remains unchanged.

3. Community Health Reassessments: 6-month recertification assessments are suspended.

4. Annual Health Assessments for Personal Assistants: Initial health assessment, including TB test and vaccines, are required, but annual requirement for current PAs is waived.

5. Facility Assessments: Grants facility directors of nursing homes/other facilities discretion to permit only “medically necessary” visits, per Executive Order 202.1.

The guidance will be posted on the Department’s webpage, established to share novel coronavirus information with providers: https://coronavirus.health.ny.gov/information-providers

New York State Department of Health COVID-19 Website

Link: https://www.health.ny.gov/diseases/communicable/coronavirus/ 

Updated at least once daily. Includes updates on number of cases, key policy and emergency guidance for health care providers, and prevention and disease resources for the public.

NYSDOH Interim Guidance for Home Care Services (Updated March 22, 2020)

Link: https://coronavirus.health.ny.gov/system/files/documents/2020/03/doh_covid19_homehealthcarehospiceguidance_032220.pdf
Updated March 10, 2020.

NYSDOH Interim Guidance for Home Care Services (Updated March 16, 2020)

Link: https://www.health.ny.gov/diseases/communicable/coronavirus/docs/03-16-20_home_care_services.pdf
Updated March 16, 2020.

NYSDOH Medicaid Update: New York State Medicaid Coverage & Reimbursement Policy

Link: https://www.health.ny.gov/health_care/medicaid/program/update/2020/docs/2020-03-10_covid-19.pdf
Updated March 10, 2020.

Printable Flyers: Protect Yourself from COVID-19 (NYSDOH)

Centers for Disease Control Interim Guidance for Health Care Providers

Link: https://www.cdc.gov/coronavirus/2019-nCoV/hcp/index.html

If you have issues, or are experiencing systemic issues related to COVID-19 and CDPA, please send them to covid19@cdpaanys.org. 

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