The Department of Health (DOH) updated Managed Long Term Care (MLTC) plans on the status of MLTC plan evaluations of social adult day care (SADC) program compliance with the federal Home and Community-Based Services (HCBS) Settings Final Rule last week. There were some minor updates to the suggested SADC site evaluation tool for MLTC plans. DOH also released a Frequently Asked Questions (FAQ) document on the tool, which is available here. Further, DOH has been issuing letters to MLTC plans regarding specific SADC sites contracted with them and their compliance with the rule. FAQs on the compliance notification letters are posted under MLTC Policy 21.05 here. Note that there are several 2022 SADC HCBS documents and resources within the 2021 policy section.

SADC programs should note that they should be working with MLTC plans to demonstrate compliance with the federal rule. DOH and MLTC plans will carry out virtual and in-person visits and will be reviewing and requiring: SADC person-centered service plans, SADC plans of care, member experience surveys, requests for site documentation, and descriptions of the SADC sites for Centers for Medicare and Medicaid Services (CMS) reporting.

SADC programs should note that if a program is in an MLTC's network, then that site is required to be in compliance with the HCBS Settings Final Rule. A completed SADC site self-assessment tool and supporting documentation is required to be submitted. Every contracted SADC site must provide evidence of HCBS Settings Final Rule compliance before members can receive services at that SADC site.

A self-assessment is not required for sites that are permanently closed or when a plan and an SADC site are no longer contracted. DOH should be notified of any SADC sites that are permanently closed or no longer contracted with a plan, and the Provider Network Data System (PNDS) should be updated to remove them from the plan’s network.

If a plan is unable to obtain a completed self-assessment and supporting documentation from an SADC site, to verify HCBS Settings Final Rule compliance, the plan would need to remove the SADC site from its network and update the PNDS. Plans should ensure that members are transferred to an SADC site that is determined HCBS compliant. Upon reopening, the MLTC plan must verify that the SADC site is 100 percent compliant with the HCBS Settings Final Rule before members can receive SADC services again at that SADC site.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871