THE CDPAP PROGRAM INFORMATION GUIDE & PERSONAL ASSISTANT HANDBOOK

Direct Personal Care, Inc.
Fiscal Intermediary
Consumer Directed Personal Assistance Program

WHAT IS THE CONSUMER DIRECTED PERSONAL ASSISTANCE PROGRAM (CDPAP)?

A Consumer Directed Personal Assistance Program (CDPAP) is an alternative to traditional home care. The Consumer Directed Personal Assistance program is a Medicaid program that enables selfdirecting individuals or their Designated Representative, to assume the responsibilities of their own care. The Consumer who you work for and/or their Designated Representative is responsible for recruiting, interviewing, hiring, training, supervising, scheduling and termination.

THE ROLE OF THE PERSONAL ASSISTANT (PA)

As a PA you are hired by the Consumer and/or Designated Representative to assist the Consumer with their individual needs to live safely in their home within the approved hours authorized by NYS Medicaid/Managed Care. By accepting this position, you are agreeing to accept training and supervision at the direction of the Consumer or their Designated Representative. You are responsible to complete the full application and submit the documents needed to work for a Consumer participating in the Direct Personal Care, Inc.As a PA you are employed by the Consumer or their Designated Representative and notDirect Personal Care, Inc.

You may not begin working for any reason for a Consumer until your application forms are completed and you have visited Direct Personal Care, Inc. office to complete the hiring process. Your Consumer will be notified by Direct Personal Care, Inc. when the approval for you to begin working can commence.

As a PA, the Department of Health requires that you pass and submit a physical within the past year, provide proofof immunizations, a PPD or Chest x-ray (if you have a history of a positive PPD), and complete a healthassessment. All forms are in the PA application. It is your responsibility to keep yourcompliance up to dateyearly.

THE ROLE OF THE Direct Personal Care, Inc. CDPAP PROGRAM

Direct Personal Care, Inc. is the Fiscal Intermediary. As the Fiscal Intermediary, Direct Personal Care, Inc. will keep a record which consists of the PA's original application forms, annual health assessments and the information needed for payroll processing and benefit administration. Direct Personal Care, Inc. only acts as the "employer of record" for processing the payroll, and administering any insurance, unemployment and worker compensation benefits for the PA.

WORKING SAFELY IN THE CONSUMERS HOME

In the case of accidents that result in injury, regardless of how insignificant the injury may appear, PA's should immediately notify your Consumer or Designated Representative andDirect Personal Care, Inc.

TRANSPORTATION FOR CLIENT

If your Consumer has asked you to drive for them, you must provide Direct Personal Care, Inc.with your current unexpired driver's license and insurance card in order to be authorized to transport your Consumerin your car or your Consumer's car.

CORPORATE COMPLIANCE: FEDERAL & STATE FALSE CLAIMS POLICY

Direct Personal Care, Inc.is to be in compliance with all Federal and State rules, laws and regulations to prevent,detect and correct any fraud, abuse or waste in connection with Federal and State funded health care programs and private health plans.

This includes compliance with all reimbursement rules as required by Medicare, Medicaid, and relevant third party payers. It also includes compliance with relevant Federal and State abuse laws, including but not limited to the Deficit Reduction Act of 2005 and the Federal and NYS False Claims Act. Compliance issues relating to accurate and truthful documentation, honest and lawful dealing with others and prohibitions against receiving or giving remuneration in turn for referrals are also included. As part of this compliance program, all PA's are urged to raise any concerns about the accuracy or propriety of any documentation or billing practice or any other compliance issue without concern for retaliation. Such issues may be raised toDirect Personal Care, Inc. Compliance Officer. All concerns will be reviewed and appropriate action will be taken.

PREVENTING MEDICAID FRAUD & ABUSE: THE DEFICIT REDUCTION ACT OF 2005

It is the objective of Direct Personal Care, Inc. to provide information to all employees, contractors and agents about the Federal and State False Claims Acts remedies available under these acts and how employees and others can use them. Information is also provided about whistleblower protections available to anyone who claims or witnesses a violation of Federal or State false claims acts. We also will advise our employees, contractors and agents of the steps the Direct Personal Care, Inc. has in place to detect health care fraud and abuse.

This act is designed to improve, federal and state oversight and enforcement actions against fraud and abuse in the Medicaid program. It requires any entity receiving Medicaid funds to instruct their workforce on the following issues:

  • The Federal Program Fraud Civil Remedies Act.
  • The Federal False Claims Act.
  • Whistleblower protections under such laws.
  • State laws pertaining to civil or criminal penalties for false claims and statements.
  • The role of such laws in preventing and detecting fraud, waste and abuse.
  • Policies and Procedures ofDirect Personal Care, Inc. forpreventing and detecting fraud, waste and abuse.

THE FEDERAL FALSE CLAIMS ACT

The False Claims Act is a law that prohibits a person or entity from knowingly presenting or causing to be presented a false or fraudulent claim for payment or approval to the Federal Government. It prohibits a person from 'knowingly" making, using, or causing to be made a false record or statement to get a false or fraudulent claim paid or approved by the Federal Government. These prohibitions extend to claims submitted to federal healthcare programs, such as Medicare and Medicaid. A person or entity found guilty of violation can be obligated to civil penalty up to $11,000.00 plus three times the amount of actual damages. A person or entity can also find themselves excluded from the Medicaid programs if found in violation.

NEW YORK FALSE CLAIMS ACT

The NY False Claims Act closely tracts the federal False Claims Act. It imposes penalties and fines on individuals and entities that file false or fraudulent claims for payment from any state or local government, including health care plans such as Medicaid. The penalty for filing a false claim is $6,000.00 to $12,000.00 per claim and the recoverable damages are between two and three times the value of the amount falsely received.

PAYROLL INFORMATION

Federal and State laws require Direct Personal Care, Inc. to keep accurate records of time worked in order to calculate PA pay and benefits. Time worked is all the time actually spent on the job performing assigned duties within the authorized time. You are not permitted to work anywhere else at the same time you are working for your Consumer.

Personal Assistants are paid on a basis.

Timesheets to be submitted by:

The week starts on:

PAs must use the Electronic Attendance Verification System to call in when they arrive and to call out when they leave. On those occasions when calling from the Consumer’s home is not possible, permission maybe granted to use paper time sheets. Please be advised that all time sheets must be signed by theConsumer/Designated Representative and PA at the end of each day. Dates, times, signatures and Consumer information must be filled out correctly. We will not be able to process incomplete paperwork.

USE OF THE ELECTRONIC ATTENDANCE VERIFICATION SYSTEM (EAVS)

Direct Personal Care, Inc.requires the use of an EAVS when working with their Consumer. You are required to use the EAVS system when you report to work for the Consumer, and when you have completed your shift. At orientation you will be provided with an ID number and instruction on how to use the EAVS. It is prohibited to allow anyone else to use your ID number. PA's must call in and out for each shift that is worked. Failure to use the call in system properly will cause a delay in your pay due tothe additional processing time needed for timesheets.

Payroll checks will be mailed weekly to the Consumer’s home or you can choose to receive your pay via direct deposit. Direct Personal Care, Inc.highly recommends you choose the direct deposit benefit to avoid disruptions in check distribution due to weather or failed delivery methods.

COMPENSATION RATE

Your rate of pay is per hour.

Holidays are paid at regular rate time & ½, minimum wage.

LIVE-IN PERSONAL ASSISTANTS

Personal Assistants assigned to a live in case must be present in the Consumer's home for 24 hours each working day.

During each live-in day, PA's are to perform tasks in accordance with the verbal and written care plan. PA's may not work in excess of 13 hours in any day.During each 24 hour day, PA's are to take 11 (eleven) hours of personal time, which will include hours of sleep, meal breaks and other personal time, remaining on premises at all such times.

PERSONAL ASSISTANT APPLICATION CHECKLIST

Name of Personal Assistant:

Date:

Consumer's Name:

Consumer's Address:

Consumer's Phone Number:

  • Application Form
  • W-4 Form
  • Signed Consumer /PA wage agreement
  • Consumer Offer of Employment letter LJ Signature
  • Verification Form
  • DOL Acknowledgement of wage rate/payday
  • PA disclosure statement signed
  • Consumer Employment Letter signed
  • False Claims Acknowledgement
  • 1-9 Form
  • Driver's license / US Passport or other:
  • Social Security Card (original ID only)
  • Health Assessment
  • PPD Mantoux date:
  • Chest x-ray (if needed)
  • Physical (within the past year)
  • Rubella Titre
  • OrMMR lstdate: 2nd date:
  • Hepatitis B Acceptance /Declination Form Photo ID Direct Deposit Form completed

PERSONAL ASSISTANT APPLICATION

When a consumer enrolled in our program hires you, you must complete all the enclosed forms before you will be authorized and permitted to start working for the Consumer. Please note that approval to work for the Consumer will come from Direct Personal Care, Inc.

1. All PA enrollment forms enclosed must be completed and returned before employment can be authorized.

2. When completing the forms be sure that the Consumer signs the forms where their signature is required.

3. When you have completed all the forms you or your Consumer must contact Direct Personal Care, Inc.enrollment department and make an appointment to complete the PA enrollment process.

4. You must bring with you the following original documents when you come to the office for your appointment:

a. US Birth certificate or Passport, or Unexpired Foreign Passport, or an Alien Registration Card,

b. Valid Picture (Photo) ID,

c. Original signed Social Security Card (no copies),

d. Current Physical Exam, including a PPD for TB and a copy of the lab tests for Rubella. If you were born after 1957 you will also need a Rubeola (Measles) lab test; or proof of vaccination from your Doctor that has the lab values.

EMPLOYMENT APPLICATION

Last Name:First Name:Middle Initial:
Address:
City:State:Zip:
Home Phone:Mobile:
Email
Social Security:
High School:
City:
State:

College:
Special Training or Skills:
Certificates:

Emergency Contact Information

Name: Relationship:
Phone #:Alt Phone #:
Address: CityStateZip:

JOB OFFER LETTER

Date:

Name of PA:

Address:

Thank you for accepting the position as my Personal Assistant. Please note that Direct Personal Care, Inc.is not your employer. As a participant inDirect Personal Care, Inc. CDPAP Program, I am your employer. This letter will serve as your conditional letter of employment.

Direct Personal Care, Inc. is only responsible to process your payroll and administer your benefits on my behalf.

Your employment with me is contingent upon verification of your references, the submission of a completed physical examination, and your ability to provide acceptable proof of residency, identification and eligibility to work in the United States.

I have provided you with a job description and have reviewed the personal care tasks (and if necessary) the nursing procedures and other duties (light housekeeping, etc...) that you are required to perform according to my care plan. This plan of care was developed for me by my Physician and the Registered Nurse assessor working for my Managed Care Plan.

WAGE & BENEFIT INFORMATION

Hourly Compensation: $/hr.

Hire date is:

You will be paid weekly and your first pay date will be:

You agree to use the TELEPHONE Electronic Verification Call in system at all-time unless otherwise instructed not to. If the ETVS is not available you will complete and sign a time sheet and will forward it to Direct Personal Care, Inc. for payroll processing.

Consumer Name:

Date:

ATTESTATION TO COMPLY WITH REGULATIONS

Consumer:

Name of Personal Assistant:

1. I understand that it's against the New York State CDPAP regulations to work as a Personal Assistant inDirect Personal Care, Inc. if I am a spouse or parent of the Consumer.

2. I am at least 18 years old.

3. I agree to complete a pre-employment physical before I begin work, then annually.

4. I am not the Designated Representative of the Consumer enrolled in the Direct Personal Care, Inc.CDPAP PROGRAM.

5. I am not an employee of Direct Personal Care, Inc., agent or affiliated individual.

6. I understand that if my relationship with the Consumer changes and if I reside with theConsumer I will informDirect Personal Care, Inc.immediately.

7. I understand that I must inform Direct Personal Care, Inc. if I am related to a Consumer other than aparent or spouse enrolled in the

a. Do you reside in the home of the Consumer? YesNo

b. Are you related to the Consumer by blood, marriage or adoption? YesNo

If Yes,identify what your relationship is:

8. I understand that I must informDirect Personal Care, Inc.if my relationship with the Consumer changes.

9. I understandthat I must not work for a Consumer who is in the Hospital or Nursing Home or other health related facility other than the Consumers home.

I have read all the above statements, and will comply with these requirements. I also understand that failure to abide by the rules stated above could be considered Medicaid Fraud and could subject me to investigation and possible criminal prosecution by the Office of the Attorney General Medicaid Fraud Control unit, and the Medicaid Inspector General.

PA Signature

Date

ACKNOWLEDGEMENT OF RECEIPT OF INFORMATION

I have received, read and understand my role and responsibilities as Personal Assistant working for a Consumer or his/her Designated Representative participating in theDirect Personal Care, Inc.CDPAP Program.

I have had an opportunity to ask questions concerning my wage and benefit package.

  • I understand that is the Fiscal Intermediary and is responsible for processing on behalf of the Consumer the payroll and benefit administration for the PA.
  • I understand that Direct Personal Care, Inc.is NOT my employer.
  • I understand that I am hired, trained, supervised and receive my schedule by the Consumer and/or their Designated Representative.
  • I also understand it is the Consumer or Designated Representative who can terminate my services or dismiss me from working for them if they choose to do so.

Print Name of PA:

Signature:

Date:

Direct Personal Care, Inc.Witness:

Print Name of Witness:

HEPATITIS B VACCINE PROGRAM

Name:

Please choose one of the following, and acknowledge by signing name and date.

1. I do not wish to be given the Hepatitis B Vaccine at this time. I am aware that I may request to be provided the vaccine at a later date during my employment with the Consumer.

Signature

Date

2. I have already received the Hepatitis B Vaccine series.

Signature

Date

3. I am requesting to receive the Hepatitis B Vaccine. (Complete consent below)

HEPATITIS B VACCINATION CONSENT

I, , have been provided with information on the Hepatitis B vaccine and have been evaluated by Direct Personal Care, Inc. health professional. I have been presented with the opportunity to ask about the benefits and the risks of the Hepatitis B vaccine. I also understand that there is no guarantee that I will become immune and there is a possibility that I will experience an adverse side effect.

I am not allergic to yeast or yeast products.

I am not currently immunosuppressed, neither by disease or medication.

Special notice for women: I have been advised that studies have not been conducted to determine the effect of the vaccine on a developing fetus. Therefore, the safety of the Hepatitis B vaccine relating to the developing fetus is currently unknown.

Employee Signature

Date

Witness Name and Signature

Date

DECLARATION OF PA TRAINING

I understand as a participant enrolled in Direct Personal Care, Inc.’s Program, I am responsible for the training of my PA. Included in my training is a discussion regarding the Hepatitis-B virus, the Hepatitis-B vaccine, and the use of Universal Precautions?

USE OF PERSONAL PROTECTIVE EQUIPMENT:

I understand the use of Personal Protective Equipment such as gloves, gowns or face masks may be necessary to care for me. I understand that these items must be provided by me to maintain Universal Precautions for my PA, and provided at NO cost to the PA. These items may be provided by me with or without the assistance of the Medicaid funded program.

I have informed my PA and he/she understands that due to his/her occupational exposure to blood or other potentially infectious materials, they may be at risk of acquiring Hepatitis- B virus (HBV) infection. The PA has been given the opportunity to be vaccinated with the Hepatitis-B vaccine at no charge to them, if they choose to receive the vaccine.

If a work related accident occurs, which may have caused my PA an exposure to Hepatitis-B virus, I agree to instruct the PA to contact their Physician or visit the local hospital Emergency Room immediately for treatment. I will also immediately notify Direct Personal Care, Inc. to report this occurrence.

Consumer/DR Signature

Date

EMPLOYEE HEALTH ASSESSMENT

Name:
Sex: MF Date of Birth:
Address:
Emergency Contact:Relationship:
Emergency Address:Telephone:

Indicate illnesses experienced by you or family

Condition

Diabetes

Kidney Disease

Heart Disease

High Blood Pressure

Arthritis

Tuberculosis

Mental Illness

Epilepsy/Convulsions

Cancer

Latex Allergy

TB Screen (History and PPD)

Chest Pain

Lingering Cough

Loss of Energy

Unexplained Weight Loss in past year

Blood in Sputum

Increased Sweating at Night

Indicate any illness experienced since last assessment

Condition

Migraine Headaches

Fainting or Dizziness

Weight Gain/Loss of 15+ lbs.

Change in Energy Level

Frequent Cough

Blood in Sputum

Shortness of Breath

Chest Pain/ Pressure in Chest

Swelling in Legs/Feet

Pain in calf when walking

Change in bowel habits

Back Pain

Pain when urinating or blood in urine

High Blood Pressure

Infectious Disease

Increased Thirst

Persistent Sores/ Lumps

Are you a smoker?
If yes. please state frequency and packs per day

Do you drink alcoholic beverages?
If yes. please state frequency and amount:

Do you take antidepressants, stimulants or narcotic drugs?
If yes, please specify:

Do you take prescription medications?
If yes, please list below:

Name of Physician:
Address:
Telephone:


I have carefully read and completed this form, and declare that I have no illness or injury, than listed above that will affect my performance while conducting my job’s responsibilities. I am not addicted to any stimulants, drugs or narcotics, including anti-depressants, or any other substances that may alter my behavior, including alcohol.

Signature:

Date:

ACKNOWLEDGMENT OF RECEIPT OF HANDBOOK

  1. I acknowledge that I have received a copy of the Handbook.
  2. I HAVE READ STATEMENTS PERTAINING TO FALSE CLAIMS AND FALSE STATEMENTS.
  3. I have been informed by my Consumer or Designated Representative regarding the policy for Federal and State False Claim Act and False
Consumer Signature:
PA Signature:

Print Name:

TERMINATION OF PERSONAL ASSISTANT

Consumers enrolled inDirect Personal Care, Inc. must complete this form immediately whenever you as the Consumer or your Designated Representative terminate the services of a Personal Assistant, regardless of the reason.

Please Print Name of Consumer or DR.

Hereby notify Direct Personal Care, Inc., that I wish to inform you of the termination of the servicesof:

Name of Personal Assistant:

Last Day of Employment:

The Termination is a: (Choose one)

Resignation Reason:

OR: Discharge Reason:

I authorize the release of information to the New York State Dept. of Labor pertaining to the discharge of my PA named above. If additional documentation/information is needed byregarding the reason for discharge should the PA file an unemployment claim, I will provide that information to Direct Personal Care, Inc. or NYS DOL if requested.

SIGNED BY CONSUMER:

Date:

Mail or fax this form back to:

Direct Personal Care, Inc.
251 East 5th Street – Unit 1, Suite 158
Brooklyn, NY 11218