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ADHCC Update - October 21, 2022

Good afternoon ADHCC members, 


Please see the following items of importance: 


DOH has posted ADHC Medicaid rates:  Attached above is the rate sheet and Dear Administrator Letter for the new rates. The January 2022 rates include the restoration of the 1.5% cut made back in 2020 and the April 2022 rates include the addition of last year's (meager) increase of 1%. It also includes a 5% cut in capital enacted back in 2020 which is based on NH cost reports from 2019. LeadingAge New York's data financial colleague states that basing the capital cut on 2019 utilization rates rather than 2020 utilization rates allows ADHC programs to fair much better. Please let me know if you have any questions about these rates.   ADHC rates are published on the web here - https://www.health.ny.gov/facilities/long_term_care/reimbursement/adhc/


MLTC Complaint Hotline and Email For ADHC programs concerned about MLTC practices, lack of referrals, changes in authorization please contact:  1-866-712-7197 or mltctac@health.ny.gov.  Our regional meetings this week yielded ongoing concerns with MLTCs and their practices to move ADHC registrants to social adult day.  Please feel free to utilize these numbers to report this activity and access the Fair Hearing process. Some resources on Fair Hearing are here - http://www.wnylc.com/health/entry/184/#V%20Fair%20Hearing


Complaints about Medicaid Transportation: For those having transportation vendor issues, please cc me on your emails.  We will be trying to come up with a more formal approach to tracking transportation challenges and mishaps.  In the meantime, contact the Department of Health by e-mail at medtrans@health.ny.gov or by phone at (518) 473-2160.   Please copy meverett@leadingageny.org on all emails. 


New DOH Guidance on Incident Reporting for Nursing Homes: DOH issued updated guidance this week on Incident Reporting.  The Dear Administrator Letter can be found here. This also applies to ADHC programs. The process now includes reporting on a web-based portal, not the Health Commerce System.  Please review this DAL carefully.


Reportable Incidents include, but are not limited to: 


• Abuse, neglect, mistreatment and exploitation 

• Misappropriation

• Injury of unknown origin 

• Physical environment incidents (ex. fire, loss of services) 

• Elopement 

• Death not due to natural causes 


In addition to an initial facility incident report that must be submitted following reporting timelines (42 CFR 483.12), nursing homes, effective October 24, 20222, must now submit to the Department the results of the facility investigation, called Investigation Summary Report, within 5 days of the incident occurrence.  The facility should include any updates to information provided in the initial report and the following additional information, including, but are not limited to, the following: 


1. Additional/Updated information related to the reported incident 

2. Steps taken to investigate the allegation 

3. A conclusion