Does CDPAP Require a Background Check?

CDPAP (Consumer Directed Personal Assistance Program) is a Medicaid program that allows individuals with disabilities to hire their own caregivers, known as Personal Assistants (PAs).

The official answer is no. But there are some important factors to consider:

• Many PAs are hired by a fiscal intermediary (FI), which is responsible for managing payroll and other administrative tasks on behalf of the consumer. FIs may require background checks as part of their hiring process to ensure that PAs have no criminal history or other disqualifying factors.
• Consumers may also choose to request background checks for their PAs as an added precaution. This can be done through the FI or through a third-party background check provider.
• If the consumer is enrolled in a PACE (Program of All-Inclusive Care for the Elderly) program, then federal regulations require that PAs undergo criminal background checks before they can begin working.

Overall, while CDPAP itself does not require background checks, there are various situations where they may be required or recommended for the safety and well-being of both the consumer and the PA.

What are PACE Plans?

PACE (Program of All-Inclusive Care for the Elderly) is a Medicare and Medicaid program that provides comprehensive medical and social services to certain frail, elderly individuals who are able to live in their communities but otherwise need a nursing home level of care. PACE plans are designed to keep seniors living independently in their homes and communities as long as possible, by providing them with coordinated medical care, transportation, and other supportive services.

Under the PACE model of care, interdisciplinary teams of healthcare professionals work together to address each participant’s individual needs. This can include primary care physicians, nurses, social workers, physical therapists, occupational therapists, dietitians, and others. Here are some examples of the types of services that may be provided through a PACE plan:

• Medical care: Participants receive primary and specialty medical care from physicians and nurses who are familiar with their unique needs.
• Transportation: PACE plans offer transportation to and from medical appointments as well as other errands and activities.
• Personal care: Participants receive assistance with activities of daily living (ADLs) such as bathing, dressing, and grooming.
• Rehabilitation services: Physical therapy, occupational therapy, and speech therapy may be provided to help participants regain or maintain their physical abilities.
• Social services: Social workers help participants connect with community resources and provide support for emotional and psychological needs.
• Adult day care: PACE plans may offer adult day care services where participants can socialize and participate in activities while receiving necessary medical care.
• Meals: Participants may receive meals either in a group setting or at home.

To be eligible for a PACE plan, individuals must meet certain criteria such as being over the age of 55 years old; living within the service area of a PACE organization; needing assistance with activities of daily living (ADLs); and being certified by the state as needing a nursing home level of care. If eligible, participants can enroll in a PACE plan at no cost if they are enrolled in both Medicare and Medicaid or pay privately if they do not qualify for Medicaid.

Utilization of CDPAS by Participants Enrolled in PACE Plans

Consistent with the Medicaid Redesign Initiative #90, the Department implemented the transition of consumers receiving fee-for-service CDPAS into partially capitated MLTC plans, Medicaid Advantage Plus (MAP) plans, and PACE plans. In addition to receiving enrollments for transitioning CDPAS users, all operational MLTC plans were directed to offer CDPAS as an option to all new and current enrollees.

PACE (Program of All-Inclusive Care for the Elderly) plans are required to comply with PACE regulations at 42 CFR Part 460. At the direction of the Centers for Medicare and Medicaid Services (CMS), we are providing some clarification regarding the utilization of CDPAS by participants enrolled in a PACE plan.

Firstly, PACE plans must offer the option of CDPAS along with an explanation of the steps that a consumer must agree to follow in order to participate in the CDPAS as a PACE participant.

Additionally, there are two important requirements that must be met before a personal assistance caregiver can work with a participant enrolled in a PACE plan:

1. The PACE plan must conduct a Criminal History Background Check on any proposed personal assistance caregiver. This is required by PACE regulations at 42 CFR 460.68.
2. The personal assistance caregiver will be subject to PACE orientation, member-specific plan of care competencies, and ongoing supervision, conducted by the PACE plan. Competencies should be revised at each assessment or with a change in participant's condition/plan of care. The PACE plan is responsible, consistent with federal PACE regulations, for ensuring the competency of any individual rendering care to the participant.

Overall, while participants enrolled in a PACE plan have the option to utilize CDPAS, there are specific requirements that must be met for a personal assistance caregiver to work with a participant. PACE plans are responsible for conducting background checks and ensuring the competency of individuals providing care to participants.

How to Request Background Checks for PAs

While CDPAP itself does not require background checks for PAs, consumers have the option to request them as an added precaution. This can be done through the Fiscal Intermediary (FI) or through a third-party background check provider.

To request a background check through the FI, consumers should contact their FI and ask about their specific process for requesting background checks. Some FIs may require additional paperwork or fees to be paid by the consumer.

Alternatively, consumers may choose to use a third-party background check provider. These providers can often conduct more comprehensive checks than those offered by FIs. However, they may also come with additional costs that would need to be covered by the consumer.

It is important to note that while background checks can provide valuable information about a PA's history, they are not foolproof and should not be relied upon as the sole method of screening potential PAs. Consumers should also consider conducting interviews and checking references before hiring a PA.

How to Find a Fiscal Intermediary (FI) for CDPAP

Finding a reliable and trustworthy fiscal intermediary (FI) is an important step in the CDPAP process. FIs are responsible for managing payroll, taxes, and other administrative tasks on behalf of the consumer and their Personal Assistants (PAs). Here are some tips on how to find an FI for CDPAP:

Contact your local Medicaid office

Your local Medicaid office can provide you with a list of approved FIs in your area.

Ask for recommendations

Reach out to disability advocacy organizations, support groups, or other individuals who have used CDPAP before. They may be able to recommend an FI that they have had a positive experience with.

Do your research

Before choosing an FI, do some research online to learn more about their reputation and history. Check online reviews and ratings from other consumers who have used their services.

Interview potential FIs

Once you have a list of potential FIs, schedule interviews with them to ask questions about their services, fees, and experience working with CDPAP consumers.

Compare prices

While price shouldn't be the only factor when choosing an FI, it's important to compare prices between different providers to ensure you're getting a fair deal.

By following these steps, you can find an FI that meets your needs and ensures smooth management of your CDPAP program.

The Benefits of Conducting Background Checks on PAs

While background checks are not required under CDPAP, they can provide valuable information about a PA's history and help ensure the safety and well-being of both the consumer and the PA. Here are some specific benefits to consider:

1. Identifying criminal history: Background checks can reveal whether a potential PA has a criminal history that could pose a risk to the consumer or their property. This information can help consumers make informed decisions about who they hire as their PA.
2. Ensuring qualifications: Depending on the type of background check conducted, consumers can verify whether a potential PA has the necessary qualifications and experience for the job. This can include verifying education, work history, and any relevant certifications or licenses.
3. Reducing liability: By conducting background checks, consumers can demonstrate that they took reasonable steps to screen potential PAs and reduce their own liability in case of any incidents or accidents involving the PA.
4. Providing peace of mind: Knowing that a potential PA has undergone a thorough background check can provide peace of mind for both the consumer and the PA. It shows that safety is a top priority and helps build trust between both parties.

Overall, while conducting background checks may require additional time and resources, it can provide significant benefits for all involved parties in ensuring safety, reducing liability, and building trust.

Conclusion

In conclusion, while CDPAP itself does not require background checks for Personal Assistants (PAs), there are various situations where they may be required or recommended for the safety and well-being of both the consumer and the PA. Fiscal Intermediaries (FIs) may require them as part of their hiring process, and consumers may choose to request them as an added precaution.

Finding a reliable and trustworthy FI is also an important step in the CDPAP process. By following these tips and requirements, consumers can navigate the CDPAP program with confidence and peace of mind.

References:

• https://www.health.ny.gov/health_care/medicaid/redesign/mltc_policy_14-03.htm

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