A home care agency cannot send a caregiver into a Medicaid recipient’s home and finish the caregiver’s personnel file later. If the required qualifications, screenings, and clearances were not documented before the caregiver began providing services, the Medicaid claims associated with that caregiver may be subject to recoupment.
New York has begun a statewide revalidation of every Medicaid-enrolled provider. At the same time, the State has imposed a temporary moratorium on new enrollments for several provider categories, including Licensed Home Care Services Agencies (LHCSAs).
The New York State Department of Health (DOH) and the New York City Department of Health have reported a significant increase in Cyclospora infections throughout New York. Public health officials indicate that the number of reported cases has increased substantially compared to the same period last year, prompting ongoing investigations into potential sources of exposure.
A federal court has granted preliminary approval of the proposed settlement in the wage-and-hour litigation involving Public Partnerships LLC (PPL), the Statewide Fiscal Intermediary (SFI) for New York’s Consumer Directed Personal Assistance Program (CDPAP). Although the settlement has not yet received final court approval, it represents another significant development in the ongoing transition to New York’s single fiscal intermediary model and serves as a reminder of the legal and operational challenges that continue to affect the program.
The New York State Department of Health (DOH) has submitted State Plan Amendment (SPA) 26-30 to the Centers for Medicare & Medicaid Services (CMS), proposing significant changes to the reimbursement methodology for personal care services provided under the State’s Medicaid program.
The New York State Department of Health (DOH) has begun the process of seeking federal approval for a five-year extension of the State’s Section 1115 Medicaid Demonstration Waiver, commonly referred to as the Medicaid Redesign Team (MRT) Waiver. The current waiver is scheduled to expire on March 31, 2027, and the proposed extension would continue many of the State’s existing Medicaid transformation initiatives while establishing priorities for the coming years.
The New York State Department of Health (DOH) continues to implement significant regulatory and operational changes affecting managed care organizations, home care agencies, behavioral health providers, and other healthcare organizations across the state. During its July 2026 Managed Care Policy and Planning meeting, DOH addressed several topics that providers should closely monitor, including behavioral health reimbursement increases, fiscal reporting obligations, Social Adult Day Care (SADC) reporting requirements, transition-of-care rules, and managed care contract updates.
The Centers for Medicare & Medicaid Services (CMS) recently released its proposed Calendar Year (CY) 2027 Home Health Prospective Payment System (HHPPS) rule, outlining proposed reimbursement and policy changes that would affect Medicare-certified home health agencies beginning next year.
The New York State Department of Health (DOH) recently issued important guidance regarding Home Care Worker Wage Parity reporting obligations for Licensed Home Care Services Agencies (LHCSAs), Fiscal Intermediaries (FIs), Certified Home Health Agencies (CHHAs), and Medicaid Managed Care Organizations (MMCOs).
After months of delays and negotiations, New York State has finalized its budget. While many anticipated significant changes to the home care industry, the final budget leaves several major initiatives untouched, postpones action on others, and creates ongoing uncertainty in key reimbursement areas.