LeadingAge NY and NYSADSA Provide Joint Public Comment Regarding Implementation of HCBS Rule for SADCs

LeadingAge NY and the NYS Adult Day Services Association (NYSADSA) submitted a joint letter to the Department of Health (DOH), Office of Health Insurance Programs (OHIP), last week providing comment on the State’s implementation of the Home and Community-Based Services (HCBS) Rule for Social Adult Day Care (SADC) programs.

The oversight and implementation process of the Rule has largely been delegated to Managed Long Term Care (MLTC) plans, which has resulted in a very disjointed process for both plans and SADC programs. While evidence packages have been published for programs and the call for comment was on their posting, the joint letter focused on more overarching issues with the oversight and implementation process for programs. The letter is available here.

The letter focuses on the following concerns:

• The Person-Centered Service Plan (PCSP) template proposed by DOH for SADCs requires medical information and care planning around various diagnoses that fall outside of the scope of SADC staff.
• Community integration definitions communicated to plans by the Department state that group outings for participants do not qualify as community integration. This language does not align with requirements for other HCBS Rule providers. Both individual and group trips into the community are acceptable forms of community integration. The requirement does not consider the staffing and reimbursement challenges necessary to provide individual integration.
• Freedom of SADC participants to come and go from program is a concern for programs, as it conflicts with contractual requirements to provide care and services and causes concern for the safety of participants and the liability of programs.
• SADC and other HCBS providers would greatly benefit from the sharing of MLTC PCSPs of participants.
• Ensuring habilitation and employment opportunities for an MLTC beneficiary is better suited for providers or plans, not the SADC provider.
• Adequate reimbursement to facilitate compliance with the HCBS Rule is necessary.

Members should feel free to contact Meg Everett with additional concerns or questions regarding compliance. The evidence packages indicate compliance challenges with the Rule and require remediations by July 2024. Only one non-member program did not pass heightened scrutiny. LeadingAge NY will keep members abreast of this process as it unfolds.

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