The compliance review process begins when the Department sends a request to the MLTC plan to schedule a date and time for the review. The request is sent six (6) weeks in advance and whenever possible, the Department attempts to schedule reviews to coincide with the MLTC plan’s annual evaluations.

The MLTC plan must respond to the Department’s request within three (3) business days to confirm the selected date and time for the review. The response must include the names of the MLTC plan and SADC representatives who will attend. Due to the large number of reviews that must be completed within a specified timeframe, the Department is unable to accommodate requests for alternate dates or times.

Note: If the MLTC plan does not have any members enrolled at the SADC, please notify the Department as soon as possible.

Once the date and time are confirmed, the Department will send a meeting invitation to the MLTC plan via Webex, along with the compliance review questions attached.

The Department expects the MLTC plan representative to discuss the questions with the SADC representative prior to the date of the review. Further, the MLTC plan representative should confirm that the SADC representative understands the purpose of the review, and all the requirements being verified for compliance.

The Department will send a subsequent email with the SADC Compliance Member Experience Survey attached, the link to access the Preliminary Information Checklist and a request for a member roster. MLTC plans should use the checklist to ensure all required documents are submitted to the Department within ten (10) business days of receiving the request.

The Department Responsibilities

• Email the MLTC plan to offer two potential dates and times for the compliance review.
• Send a Webex invitation to the MLTC plan representative(s) for the agreed upon date and time.
• Request preliminary documentation, including member experience surveys and completed PCSPs, from the MLTC plan.
• Review supporting documentation for adequacy and request additional or missing information, if necessary.

MLTC Plan Responsibilities

• Contact the SADC representative to choose a preferred date/time for the review and confirm the selected date and time with the Department within three (3) business days.
• Ensure the representative understands the purpose of the compliance review and all standards to be verified.
• Complete the SADC Compliance Member Experience Survey with the SADC member(s).
• Prior to the day of the compliance review, verify the following:
  • The SADC has an adequate Wi-Fi connection.
  • A translator is available to assist, if needed. A translator can be a trusted third-party vendor, or an individual identified by the MLTC plan that is qualified to provide in-person translation service.
  • The SADC has a fully charged, video capable device to log into the Webex meeting.
• Collect all necessary supporting documentation, review the materials for compliance, and submit them to the Department by the due date.
• Respond promptly to any additional requests for information from the Department.
• The MLTC plan is responsible for keeping all the SADC records (site visit records and documents ex. certificate of occupancy) and should be ready to produce them when requested by the Department, within two (2) business days.

Note: Review the Department’s expectations and the compliance review questions that will be asked with the SADC representative before the review date.

SADC Responsibilities

• From the options provided by the Department, select and confirm the date and time for the compliance review with the MLTC plan.
• Understand the purpose of the SADC compliance review and all compliance standards being reviewed.
• Schedule a meeting with the MLTC plan representative to get answers to questions regarding the review process and the compliance review questions.
• Prior to the day of the compliance review, verify the following:
  • There is an adequate Wi-Fi connection.
  • Work with the MLTC plan to arrange for a language translator, if necessary. The translator can be a trusted third-party vendor, or an individual identified by the MLTC plan that is qualified to provide in-person translation service.
  • A fully charged, video capable device is available to access the Webex meeting.
• Provide the most recent version of ALL necessary supporting documentation to the MLTC plan by the specified due date and have duplicate copies of the documents available on the day of the review.

On the day of the review, the MLTC plan and SADC representatives should arrive at least fifteen minutes before the review start time to set up for the meeting.

Compliance reviews may last up to three hours. During the interview portion of the review, MLTC plan representatives may assist SADC staff by providing clarification to questions/answers when needed and take notes or photos when appropriate. Occasionally, the Department’s reviewer will request additional supporting documentation, and the MLTC representative should catalogue any such requests and submit to the Department by the agreed upon date.

For example, the reviewer may observe public transportation information posted on the SADC bulletin board that was not previously submitted to the Department. The reviewer may request that the MLTC representative take a photograph of the missing information and submit it to the Department following the review. The plan representative should also photograph any area that requires remediation during the visit. During the walkthrough of the SADC, MLTC and SADC representatives should be able to provide explanations and answers to any questions or observations by the reviewer.

The Department Responsibilities

• Log-in to the Webex at least fifteen (15) minutes prior to the scheduled start time.
• Verify compliance during an interview with the SADC and MLTC plan representatives.
• Conduct a walkthrough of the facility to verify compliance.
• Document any questions or concerns and/or missing documentation to be requested.

MLTC Plan Responsibilities

• Arrive for the visit at least fifteen (15) minutes prior to the scheduled start time.
• Assist the SADC representative during the interview portion of the compliance review by clarifying questions posed by the Department’s reviewer, as needed.
• Note any missing documents requested by the Department and submit by the agreed upon deadline.
• During the walkthrough portion of the review, take photos as requested by the reviewer.
• Take photos of any areas requiring remediation.

SADC Responsibilities

• Answer the questions from the Department’s reviewer with clarity.
• Direct the reviewer to all areas of the building that are utilized by members.
• Be prepared to show copies of documents requested during the visit.
• Take notes of any questions or concerns and/or missing documents that may be requested by the Department’s reviewer.

Following the compliance review, the Department reviewer will determine compliance based on all the information gathered. During this period, the reviewer may request additional documentation, which must be submitted by an agreed upon due date.

Compliant
When the SADC is found compliant with all compliance standards and has met New York State Office for Aging (NYSOFA) compliance regulations, all MLTC plans contracted with the SADC will be notified. The SADC compliance review process for that year is considered complete.

Not Compliant
If the Department identifies areas of non-compliance, the MLTC plan that attended the compliance review will be informed of the determination, and a request for a remediation plan will be sent to the plan.

Note: Refer to the Proof of Remediation Handling section for the responsibilities of all contracted MLTC plans.

The Department Responsibilities

• Complete a comprehensive review of the SADC using all information gathered before and during the compliance review.
• Request additional information as needed.
• Notify the MLTC plan of compliance review findings.
• Request a remediation plan from the MLTC plan if necessary.

MLTC Plan Responsibilities

• Submit any missing documentation or photos requested by the Department.
• Inform the SADC of the compliance findings and if a remediation plan is required, meet with the SADC to develop an acceptable remediation plan.

SADC Responsibilities

• Submit any documents to the MLTC plan that were requested by the Department.
• Work with the MLTC plan to develop an appropriate remediation plan, if required.

If the SADC is determined to be non-compliant in one or more areas, the MLTC plan that attended the compliance review will be sent a list of the findings and a plan to remediate non-compliance will be requested. The remediation plan is an action plan developed by the SADC and the MLTC plan together. It must include detailed steps on how all areas of non-compliance identified during the compliance review will be addressed.

The MLTC plan and SADC should work together to develop a remediation plan that brings the SADC into compliance and submit it to the Department within ten (10) business days.

For detailed guidance on the remediation plan process, please review the Guidance on SADC Compliance Remediation Plans and Proof of Remediation webpage.

Once the remediation plan is approved by the Department, all MLTC plans contracted with the SADC will be notified of the determination and will receive a copy of the approved remediation plan for their records.

The Department Responsibilities

• Send a remediation plan request which identifies areas of non-compliance to the MLTC plan that attended the compliance review.
• Review the submitted remediation plan to verify it includes all necessary actions to achieve compliance.
• Send final determination letters, including a copy of the approved remediation plan, to all MLTC plans contracted with the SADC.

MLTC Plan Responsibilities

• Collaborate with the SADC to create a remediation plan which addresses all areas of non-compliance.
• Submit the completed remediation plan to the Department within ten business days.
• Respond promptly to any other requests from the Department.
• Submit proof of remediation to the Department when requested.

Note: All MLTC plans contracted with the SADC are responsible for ensuring remediation activities are implemented, for obtaining proof of completion, and monitor ongoing compliance.

SADC Responsibilities

• Work with the MLTC plan to develop an appropriate remediation plan to address all areas of non-compliance.
• Submit the completed remediation plan to the MLTC plan.
• Ensure the remediation plan is implemented.
• Submit proof of remediation to the MLTC plan, when requested.

Proof of remediation refers to documentation or other evidence that demonstrates the actions outlined in the approved remediation plan have been fully implemented. The Department will request proof of remediation after the target completion date specified in the remediation plan.

For example, if the remediation plan indicates that the actions to remediate non-compliance will be fully implemented by December 13th, 2025, the request for proof of remediation will be sent after that date.

For detailed guidance on the proof of remediation process refer to the Guidance on SADC Compliance Remediation Plans and Proof of Remediation webpage.

Once the remediation plan is approved, all MLTC plans contracted with the SADC will be notified of the determination and will receive a copy of the approved remediation plan for their records. All MLTC plans are responsible for collecting and saving documentation relating to proof of remediation.

For example, if a remediation plan indicates that a missing menu will be placed on a bulletin board, it is the responsibility of ALL contracted MLTC plans to collect proof of the remediated action (in this example, a photograph of the menu on the bulletin board).

The Department Responsibilities

• Request proof of remediation from MLTC plan.
• Review submitted proof of remediation for compliance.
• Inform the MLTC plans of acceptance or non-acceptance of the proof of remediation.
• Request additional proof of remediation if needed.

MLTC Plan Responsibilities

• Collect and submit proof of remediation to the Department when requested.
• Retain proof of remediation for audit purposes.
• All MLTC plans contracted with the SADC are responsible for ensuring the remediation actions are implemented and obtain proof of these actions. This responsibility applies to all contracted MLTC plans even if they did not attend the review where the remediation issue was identified.
• Monitor the SADC for ongoing compliance with all state and federal requirements.

SADC Responsibilities

• Submit proof of remediation to the MLTC plan when requested.
• Maintain ongoing compliance with all applicable standards.

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