LeadingAge NY Meets with DOH on HCBS Settings Rule
LeadingAge NY, the NYS Adult Day Services Association (NYSADSA), and Managed Long Term Care (MLTC) plan representatives met with the Department of Health (DOH) on May 7th to get answers to questions and concerns posed to the Department regarding Social Adult Day Care (SADC) compliance with the Home and Community-Based Services (HCBS) Settings Rule and plan compliance with primary benefits under MLTC, particularly whether MLTC beneficiaries can provide SADC only when personal care services are not wanted in the home.
The Department shared several policies that clarify their position on this question:
- MLTC Policy 13.03: Community-Based Long Term Care (CBLTC) Definition
- MLTC Policy 13.05: Social Daycare Services Questions and Answers (Q&A)
- MLTC Policy 13.11: Social Day Care Services Q&A
MLTC plans had asked for clarification on whether they can honor beneficiaries’ requests, provided through the person-centered service planning (PCSP) process, to receive only SADC services under the MLTC benefit. Currently, one has to receive a qualifying benefit before being able to access SADC. The Department clarified that all MLTC beneficiaries must be assessed and qualify as having a certain level of need to access primary services under the benefit. SADC services do not require such a level of need and thus are only a secondary benefit in the package and may not be provided as the only service.
The Department clarified their positions on a number of requirements under the HCBS Settings Rule. LeadingAge NY and NYSADSA had inquired about several Rule requirements and their appropriateness for SADC in two letters to the Department (here and here).
Regarding community integration, the Department stated that they considered facilitating and coordinating access to the community activities outside of program hours sufficient for complying with the Rule. Programs could also arrange for transportation to enable this access. Sharing of local activities and opportunities is encouraged. LeadingAge NY had communicated the difficulty staffing one-on-one and small group community integration for participants. One-on-one and small group integration could also be provided.
Regarding employment and volunteering, the Department also clarified that programs are not required to provide full matching services for participants if they are interested in employment or volunteering. However, programs should offer support with taking steps to accessing options for this participation and accommodate this interest if needed.
Regarding coming and going from program, LeadingAge NY communicated its concern about participant safety relating to the Rule’s requirement that participants should be able to come and go from program as they please. The Department stated that there should be no blanket policies that limit the freedom of participants to come and go. Limitations must be documented in the PCSP for individuals on a case-by-case basis. We still have concerns with the requirements, as they could trigger liability for programs and Office of the Medicaid Inspector General (OMIG) billing concerns.
LeadingAge NY emphasized that both SADC providers and MLTC plans should be aware of these nuances in the requirements. Further, MLTC plans should be required to share their PCSPs with HCBS providers, especially SADC programs, to obtain modifications per the plans’ assessments that identify limitations for participants.
DOH shared that SADC programs will have annual surveys from each MLTC plan with whom they contract, and one plan will be utilized by DOH to drill down and assess compliance with the HCBS Settings Rule.
Meeting attendees will be submitting additional questions for DOH to answer. LeadingAge NY will be sharing these with members.
Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871