C4SD Comments on OPWDD Fiscal Intermediary ADM-07R
“Service Documentation for Fiscal Intermediary Services”
From The Coalition for Self-Direction and other SD Advocates
The draft “ADM Service Documentation for Fiscal Intermediary Services”, dated March 7th, was sent out by OPWDD for comment on March 26th. We appreciate the opportunity to comment before the ADM is finalized, and at the same time we are disappointed by the content of the draft. From our perspective, the draft ADM does not remedy the concerns about IDGS that have been raised by the advocacy community over the past 15 months. Specifically, the ADM does not remedy four major issues:
Denial of Fair Hearing appeal rights.
Compliance-focused criteria for Community Classes that are vague and subjective.
Delegation of decision-making authority to Fiscal Intermediaries.
Imposition of financial accountability on to the Fiscal Intermediaries.
Our request is that you withdraw this ADM, and re-write it in collaboration with a representatives of the Fiscal Intermediaries and the Self-Direction advocacy community.
Recommended Remedies:
Concern: Denial of Fair Hearings.
Action: Acknowledgement by OPWDD of the right to Fair Hearing when IDGS items are denied. We believe this right to due process is a human right, and that New York’s current position is morally wrong. It also seems that the right to a Fair Hearing is an inherent component of the Medicaid system as detailed in CFR 42, which means that New York’s attempt to deny due process is also legally wrong.
Concern: Compliance-focused Community Class Criteria.
Action: Reform of the criteria. We hope to see a change to focus on individual choice, and to eliminate vague and subjective criteria.
Concern: Delegation of authority to Fiscal Intermediaries.
Action: Create a new choice-centered policy which includes a simple, clear-cut checklist—is this the choice of the individual, and is the vendor independent of Medicaid service providers? Or even better, change the design of the system in New York to mimic New Jersey, with a web-based system for submitting decisions to a governmental department.
Concern: Imposition of financial accountability on to FIs.
Action: Relieve FIs of financial accountability if that checklist is followed. Or, even better, change the system design to put accountability back on the State.
Original OPWDD Excerpt and Link to Full Document
This Administrative Memorandum describes the payment standards and service documentation requirements to support a provider’s claim for reimbursement for Fiscal Intermediary services. Fiscal Intermediary services are available for Home and Community Based Services (HCBS) Waiver authorized participants who self-direct their services. A participant self-directing his/her services receives an individualized budget that (s)he directs pursuant to an approved plan.
In addition to the requirements specified in this Administrative Memorandum (ADM), Fiscal Intermediary providers must continue to comply with all other applicable State and Federal requirements. This includes, but is not limited to, ADMs for Supported Employment (SEMP), Community Habilitation, Support Brokerage, Community Transition Services and Moving Assistance, Individual Directed Goods and Services, and Respite when the Fiscal Intermediary is the provider that is billing for such services.
