CDPAP Billing and Reporting Setup

To comply with regulatory and reporting requirements from New York State Medicaid Billing, agencies performing administrative services for Consumer Directed Personal Assistance Program (CDPAP) on or after August 1, 2024, for MCO and October 1, 2023, for HRA, can be reimbursed for administrative costs Per Month Per Member (PMPM).

The PMPM reimbursement is based on members':

• Authorized hours for HRA per month.
• Serviced hours for MCO per month.

Important Note: Please refer to your payer guidelines for billing this administrative rate, as there may be different requirements, such as rate codes, timely filing, or billing process.

To enable this PMPM administrative service transactions, follow the setup and invoice process as stated in this document.

• Updated CDPAP PMPM Instructions 1.pdf3 MB