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DOH Provides Additional Updates on ACF Form and EQUAL Process Change

The Department of Health (DOH) recently provided LeadingAge NY with updates on two issues of interest to adult care facilities (ACFs).

DOH Updates Chronological Admission and Discharge Form Again to Address Errors

As a result of feedback from the provider community, DOH recently updated DOH Form 5177, the Chronological Admission and Discharge Register. The form was initially updated based on a recently passed law requiring ACFs to collect race or ethnicity information, effective Sept. 28th; however, some errors were discovered after the initial revision. Specifically, under the race column, option 9 should read Vietnamese and option 12 should read Guamanian. In addition, a selection for “Prefer not to say” has been added. Members should immediately start using this new revised form.

LeadingAge NY had advocated for this data to be collected in the resident data form, as opposed to the DOH 5177; however, the law specifically names the Chronological Admission and Discharge Register.


Beginning with the 2020-21 Enhancing the Quality of Adult Living (EQUAL) Program year, ACFs that receive EQUAL funding are no longer required to submit receipts with their year-end fiscal documentation. Instead, ACFs are required to retain their receipts and provide them upon request. DOH randomly reviews 10 percent of the total number of ACFs funded in each region and reviews this documentation. Thus, members may receive outreach from DOH and should be prepared to provide this documentation. Questions regarding this new process can be directed to equal@health.ny.gov.

Future Changes

DOH is also exploring additional changes to update and consolidate the personal data forms and move processes to more user-friendly platforms. We will keep members apprised of these developments. 

Contact: Diane Darbyshire, ddarbyshire@leadingageny.org, 518-867-8828