CDPAP excessive hours review in New York: what the 2026 policy means when one assistant works very long weeks

On July 22, 2026, the New York State Department of Health issued MLTC Policy 26.02 for Managed Long Term Care plans and GIS 26 MA/11 for local districts. Both cover Consumer Directed Personal Assistance Program (CDPAP) cases where one personal assistant works "excessive hours." The Department defines that as "more than 16 hours per day every day, or 112 or more hours in a single week." The fiscal intermediary, PPL, now sends plans and districts a report every two weeks that lists assistants at 84 hours or more.

Say one relative does all the care in your family, and the plan or district calls. This is what they are checking: whether there are enough assistants to cover the hours safely. The policy does not cut hours by itself. Any change to hours still has to arrive as a written notice with appeal rights. Below: what the plan or district must do, what you can do, and where the limits are.

The excessive hours policy is MLTC Policy 26.02 for plans. Its twin for local districts is GIS 26 MA/11. Both are dated July 22, 2026 and took effect that day, and they say the same thing in nearly the same words. A local district means the county Department of Social Services, or HRA in New York City, for people who get CDPAP outside a plan.

One point of confusion. MLTC Policy 26.01 is a different document about involuntary disenrollment from a plan. It does not mention CDPAP hours or assistants. If someone calls 26.01 the hours policy, they mean 26.02.

The policy is written to plans and districts, not to consumers. That is useful. It tells them what to do, so you can tell whether they are doing it.

The Department's definition: "Excessive Hours: Any instance in which a Consumer Directed Personal Assistant (PA) works more than 16 hours per day every day, or 112 or more hours in a single week." Sixteen hours a day for seven days is 112 hours, so the two halves line up.

PPL's report sorts assistants into three bands. From the Department's own table:

168 hours is every hour of the week. The policy also says PPL "will be required to report all instances of PAs working over 112 hours per week" to the Office of the Medicaid Inspector General (OMIG) "for further investigation." It says nothing about what OMIG does next, so this page does not either.

The policy rests on one rule in the CDPAP regulation, 18 NYCRR 505.28(h). The consumer, or the designated representative, must handle "recruiting and hiring a sufficient number of individuals" to provide the authorized services. The same rule requires "substitute coverage when a consumer directed personal assistant is temporarily unavailable for any reason." The Department's consumer page puts it simply: "Arranging back-up coverage when necessary."

The policy turns that duty into a number: "As a best practice, it is recommended that there is at least one (1) PA regularly available for every forty (40) authorized hours of service." The Memorandum of Understanding every consumer signs with PPL says it another way: "If your authorization exceeds 16 hours in one day more than one PA is required."

The Department frames this as safety. The regulation defines a live-in 24-hour assistant as one person who "would be likely to obtain, on a regular basis, five hours daily of uninterrupted sleep." Care above that level, called continuous care, is care "by more than one consumer directed personal assistant." One person covering 168 hours fits neither definition. That is why the top band gets the fastest review.

Each band has its own checklist. Knowing it lets you ask, on the call, which step they are on.

One assistant at 168 hours. Within three business days, the plan or district must:

1. Contact you or your designated representative and review your obligation "to hire sufficient caregivers, provide a safe environment," and return "any overpayment or inappropriate payments."
2. Approve a designated representative "for members who are unable to self-direct."
3. Confirm "a statement of medical necessity for continuous care is on file for the current authorization period." That comes from the plan's Medical Director (or the district's Local Professional Director), or from the Independent Review Panel if the state's Independent Assessor did the last assessment.

If no statement exists, the plan or district "must complete a new Person Centered Service Plan" and look at whether other services or informal supports can fill the gap. If continuous care is found not medically necessary, "authorization hours must be modified accordingly," with a notice "on a form required or approved by the Department."

One assistant at 112 to 167 hours. Within seven calendar days, the plan or district must:

1. Contact you and review the same obligations.
2. Confirm you or your representative "remain willing and able to fulfill their program responsibilities."
3. Verify "that sufficient PAs and voluntary informal support(s) are regularly available to provide care."
4. Ensure you or your representative are "self-directing and cooperative."

After either. The plan or district reports its action to PPL, and PPL sends the Department a member-level report of responses. Plans that miss the deadline "will be subject to Statements of Deficiencies." That is between the Department and the plan, but it explains why the call may sound urgent.

The review asks one question: are there enough assistants for the authorized hours? These answers fit the policy.

Hire a second assistant. This is the fix the policy is built around. A second relative, a friend, or a neighbor can be an assistant if they meet the rules. The steps are in how to become a CDPAP personal assistant in New York. The rules on which relatives may be paid are in can a family member be a paid CDPAP personal assistant. PPL's FAQ says an assistant "can work for more than one consumer," so someone already registered for another household can be added.

Put the back-up plan in writing. The Memorandum of Understanding requires "a back-up plan, to ensure that services continue when a PA cannot work their shift." A named second assistant with a schedule is what the plan or district can record as sufficient coverage.

Sort out the designated representative. If the consumer cannot self-direct, the policy requires the plan or district to approve one. The regulation says the representative cannot be the personal assistant. For a non-self-directing consumer, a "responsible adult surrogate" needs the district's approval.

Count voluntary help carefully. The policy lets the plan or district count "voluntary informal support(s)" toward coverage. The regulation also lists informal supports "that are acceptable to the client" as a reason hours can be reduced. Say clearly what help is voluntary and what is not.

Ask for the plan of care. The regulation says the plan or district "shall provide the consumer with a copy of the plan of care" with the hours per day or week. You need it to divide the hours among assistants.

It is not a cut in hours. The policy tells plans and districts to engage, verify, and document. Where it leads to a change, the change must come as a notice. The regulation allows CDPAP to be discontinued only "after timely and adequate notice in accordance with Part 358 and Subpart 360-10," the fair hearing and plan appeal rules. The policy says the same. If there are not enough assistants, the plan "must discontinue the current authorization and send the required notice to the member, stating the relevant reason(s)." The plan then "is responsible for providing alternate support(s)." The district version says the caseworker "is expected to support the consumer in identifying an appropriate mechanism of support."

So a notice from this review works like any other reduction or discontinuance. Deadlines and steps are in home care hours cut appeals in New York. The rule that keeps services running while you appeal is in aid continuing and fair hearings when hours are cut. The Department's guidance says PPL "will accept and recognize the validity" of an aid-continuing authorization.

It is not a PPL decision. PPL runs the report because the Department asked for it. The regulation says the fiscal intermediary "is not responsible for fulfilling responsibilities of the consumer." How the roles split is in what PPL does and does not decide.

It is not a new pay rule. PPL's FAQ, updated August 2026, says overtime "is permitted when necessary to support continuity of care" and is paid at "1.5x the PA's base rate." It adds that assistants "must comply with any guidance, limitations, or directives set by the consumer's health plan or the Local Department of Social Services." PPL "is only able to pay for the hours the consumer is authorized for." The Department's July 2026 labor-law clarification says family members paid as assistants "cannot work more than the number of hours per week identified in the authorization."

It is not a finding against the assistant. The policy reviews the consumer's staffing duty. The one line about the assistant is the OMIG referral above 112 hours, and the policy does not say what follows.

• Ignoring the call. The 112 to 167 band asks the plan or district to confirm you are "cooperative." A consumer who is "unable or unwilling to fulfill the consumer's responsibilities" is a listed reason to reduce or discontinue.
• Treating the authorization as the assistant's hours. The hours belong to the consumer and can be split among several assistants.
• Naming the assistant as the designated representative. The regulation does not allow it.
• Letting the assistant work past the authorization. The Memorandum of Understanding says assistants "may not work more hours than what the service authorization allows." The consumer signs that they "may be removed from CDPAP" if they allow it.
• Waiting for the reassessment. Plans and districts must consider at each reauthorization whether the consumer "satisfactorily fulfilled the consumer's responsibilities." Fixing staffing now is easier than explaining it later.
• Assuming a change is final because it came with the review. A change is a notice, and a notice can be appealed.