State Issues Guidance Requiring Enhanced MLTC Oversight of SADC Programs

(Sept. 9, 2025) The Department of Health (DOH) issued new guidance for Managed Long Term Care (MLTC) Partial Capitation plans and Medicaid Advantage Plus (MAP) plans requiring additional oversight of contracted social adult day care (SADC) programs pertaining to monitoring, recordkeeping, and oversight of programs. This policy does not apply to Program of All-Inclusive Care for the Elderly (PACE) plans.

MLTC Policy 25.05: Enhanced MLTC Plan Oversight of Contracted SADCs is effective Sept. 8, 2025.

Please review the guidance for additional detail. It sets forth the following general requirements:

SADCs contracted with a MLTC plan MUST obtain a National Provider Identifier (NPI) by Dec. 5, 2025:
- NPI Requirements for SADCs:
  - Obtained via the National Plan and Provider Enumeration System (NPPES).
  - Must be at the site level in SADC’s name – one NPI per physical location.
  - Need to be validated by the MLTC plan and included in the Provider Network Data System (PNDS) report due on Jan. 28, 2026.
MLTC plans MUST report SADC single-case agreements corresponding with the January 2026 PNDS submission:
- Reports should be submitted quarterly to HCBSSADCSiteAssessments@health.ny.gov.
Initial and Annual Site Evaluations:
- Verify that the Certificate of Occupancy (COO) matches ownership and physical location.
- Observe occupancy level during site visit:
  - Review sign-in/out records.
- Confirm that SADCs maintain documentation required by NYS Office for the Aging (NYSOFA) regulation.
- Collect and review member documentation, including members’ Person-Centered Service Plans (PCSPs).
- Verify that contracted SADCs provide training per NYSOFA regulation Title 9 NY Codes, Rules, and Regulations (NYCRR) 6654.20 (d)(2)(iv)(c) and the Home and Community-Based Services (HCBS) Final Rule.

Any questions may be directed to HCBSSADCSiteAssessments@health.ny.gov.

Additional resources are available on the DOH SADC HCBS Compliance website and the DOH MLTC website.

Contact: Meg Everett, meverett@leadingageny.org