All SADC sites contracted with MLTC plans must be reviewed via the Ongoing Monitoring and Compliance (OMC) process to ensure initial and ongoing compliance with the Centers for Medicare and Medicaid (CMS) Home and Community Based Services (HCBS) Settings Final Rule. The Department of Health (DOH) is responsible for determining compliance through compliance reviews and a comprehensive assessment of the SADC Person Centered Service Plan (PCSP).

The HCBS Final Rule requires all Home and Community Based Settings meet the following requirements:

• Setting is integrated in and supports full access of individuals receiving Medicaid HCBS to the greater community, including opportunities to seek employment and work in competitive integrated settings, engage in community life, control personal resources, and receive services in the community, to the same degree of access as individuals not receiving Medicaid HCBS.
• Setting ensures an individual's rights of privacy, dignity, respect, and freedom from coercion and restraint.
• Setting optimizes, but does not regiment individual initiative, autonomy, and independence in making life choices, including but not limited to, daily activities, physical environment, and with whom to interact.
• Setting facilitates individual choice regarding services and supports, and who provides them.
• Setting ensures individuals have the freedom and support to control their schedules and activities; and have access to food at any time.
• Setting ensures individuals are able to have visitors of their choosing at any time.
• Setting is physically accessible to the individual.

The compliance review process begins with a request from DOH to the MLTC plan to schedule a date and time for the HCBS compliance review. The request is sent six weeks in advance, and whenever possible, DOH attempts to schedule reviews to coincide with the MLTC plan's annual site evaluations. The MLTC plan should respond to the request from DOH within three (3) business days with a confirmation of the SADC's selected date and time for the review and the representative who will attend. If the MLTC plan does not have any members at the SADC, please inform DOH at this stage of the process.

Once the compliance review date has been confirmed the MLTC plan will receive two emails from DOH. The first will be a confirmation of the scheduled visit along with a copy of the SADC HCBS Compliance Review Questions. MLTC plan staff should review the questions with the SADC representative prior to the day of the visit and confirm that they understand the purpose of the review, and all the requirements being verified for compliance.

The second email will be a request for preliminary documentation including completed PCSP and Member Experience Surveys for three MLTC plan members attending the SADC. A detailed Preliminary Information Checklist will be attached to the email. MLTC plans should utilize the checklist to ensure that all required documents are submitted to DOH by the due date, which is five business days after receiving the request.

Before submitting the documents to DOH review them for accuracy, ensure they are the latest updated versions, and that they have been translated into English if necessary. All documents should be received by the due date.

The MLTC plan may reach out to the SADC for any documents they need from the Preliminary Information Checklist. The SADC should submit the most current versions of the requested documents to the MLTC plan, have documents translated into English if necessary, and in instances where documents are handwritten such as PCSP's, make sure the handwriting is clear and legible.

If the SADC representative has any questions about the compliance review process, they should submit their questions to the MLTC plan representative.

DOH Responsibilities

• Email the MLTC plan requesting a date for the compliance review with their contracted SADC by offering three potential dates and times for the review.
• Send a WebEx invitation to the MLTC plan representative(s) for the agreed upon date and time.
• Request that the MLTC plan submit the required supporting documentation.
• Review the supporting documentation for adequacy and request additional or missing information, if necessary.

MLTC Plan Responsibilities

• Contact the SADC to choose a preferred date/time for the review and confirm with DOH within three (3) business days.
• Ensure the SADC's understanding of the purpose for the review and all applicable requirements to be verified.
• Verify the following, prior to the day of the compliance review:
  • The SADC has an adequate Wi-Fi connection.
  • A translator is available to assist, if necessary. A translator can be a trusted third-party vendor or someone the MLTC plan has identified with the skills to provide in person translation service.
  • A video capable device to log into the WebEx meeting and is fully charged.
• Collect all necessary supporting documentation from the SADC, review the documentation for adequacy, and submit to DOH by the due date.
• Respond timely to any further DOH requests for information.

TIP: Before the visit with DOH, please review DOH's expectations and the questions that will be asked with the SADC representative.

SADC Responsibilities

• Confirm with the MLTC plan the date and time available for the compliance review.
• Work with the MLTC plan to understand the HCBS Final Rule.
• Understand the purpose for the review and all applicable requirements to be verified for compliance.
• Schedule a meeting with the MLTC plan representative to answer any questions about the review.
• Review the SADC HCBS Compliance Review Questions with the MLTC plan.
• Verify the following, prior to the day of the compliance review:
  • The SADC has an adequate Wi-Fi connection.
    • Work with the MLTC plan to arrange for a language translator (if necessary). A translator can be a trusted third-party vendor or someone the MLTC plan has identified with the skills to provide in person translation service.
  • Ensure there is a video capable device available to log into the WebEx meeting and is fully charged.
• Provide ALL necessary supporting documentation to the MLTC plan by the due date and have duplicate copies of the documents ready on the day of the review.

On the day of the visit, the MLTC plan representative should arrive at least fifteen minutes before the review start time to assist the SADC with setting up for the meeting.

MLTC plan representatives may assist SADC staff during the interview by offering clarification to answers when needed. MLTC representatives should take notes and photos, if necessary. Occasionally, analysts will request additional supporting documentation during the visit, MLTC representatives should catalogue any such requests and plan to submit to DOH by the agreed upon time (For example, the reviewer may observe information regarding public transportation that was not previously submitted to DOH on the SADC bulletin board. The reviewer can request for the MLTC to take a picture of the missing information and submit to DOH after the review).

Finally, the MLTC representative should assist SADC staff with the on-site walkthrough by providing explanations and directions as needed during the review.

Note: HCBS SADC Compliance reviews may take up to three hours.

DOH Responsibilities

• Log-in to the Webex at least fifteen minutes before the visit start time.
• Review the questions with the SADC representative regarding HCBS compliance.
• Walk through the facility to observe site compliance.
• Take notes of any questions or concerns and/or missing documents that will be requested.

MLTC Plan Responsibilities

• Arrive for the visit at least fifteen minutes before the visit start time.
• If needed, assist the SADC representative by clarifying the questions asked by the DOH reviewer.
• Make a note of any missing documents requested from DOH and submit by the agreed upon time.
• Take photos for any questions or concerns and/or missing documents as requested by the reviewer.

SADC Responsibilities

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

After the compliance review, the DOH reviewer will determine compliance based on all the information gathered. During that period, please submit any missing documentation by the agreed upon due date.

Compliant: When the SADC is found compliant with all HCBS Final Rule standards, all contracted MLTC plans will be notified, and the SADC HCBS Compliance review process is complete, however, the SADC is still required to meet New York State Office for Aging (NYSOFA) compliance regulations.

Not Compliant: If there are areas of non-compliance, only the MLTC plan that attended the compliance review will be informed of the determination, and a request for a plan to remediate will be sent. The MLTC plan must meet with the SADC representative to review the non-compliant findings and collaboratively create a remediation plan.

DOH Responsibilities

• Review all information gathered before and during the HCBS SADC compliance review.
• Request more information if needed.
• Inform the MLTC plan of compliance findings.
• Request a remediation plan from MLTC plan if needed.

MLTC Plan Responsibilities

• Submit any missing documents or photos requested during the compliance review.
• Inform the SADC of compliance findings and if required, work with them to develop an appropriate remediation plan.

SADC Responsibilities

• Submit any documents requested during the SADC HCBS compliance review to the MLTC plan.
• Work with the MLTC plan to develop an appropriate remediation plan, if required.

If the review determined non-compliance in one or more areas, the MLTC plan that attended the SADC HCBS compliance review will be notified that a remediation plan is required.

The Remediation Plan is an action plan which describes how the SADC will rectify the areas of non-compliance identified during the compliance review.

The MLTC plan and SADC will collaboratively develop a remediation plan to bring the site into compliance and submit it to DOH for review within fifteen business days. The remediation plan must include a detailed description of the steps that will be taken to bring the SADC into compliance, the date by which remediation will be completed, and who is responsible for ensuring compliance is met.

If the remediation plan does not appropriately address all areas of non-compliance, DOH will return the remediation plan to the MLTC plan with feedback. The MLTC must work with the SADC to update the remediation plan based on the feedback and resubmit within two business days. This process will repeat until DOH verifies the remediation plan will address all areas of non-compliance.

Once approved, all MLTC plans contracted with the SADC will be notified via email of the determination with the approved remediation plan attached for their records. Each contracted MLTC plan is responsible for ensuring the SADC completes all remediation activities, provides proof of remediation when requested, and monitors ongoing compliance.

DOH Responsibilities

• Send a remediation plan template which identifies areas of non-compliance to the MLTC plan.
• Review the submitted remediation plan to verify that it contains all necessary actions to bring the SADC into compliance.
• Work with the MLTC plans as needed, to ensure understanding of requirements.
• Send final determination letters with a copy of the 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 DOH within fifteen business days.
• Respond promptly to any requests from DOH.
• Submit proof of remediation to DOH, if requested.

Please Note: ALL MLTC plans contracted with the SADC are responsible for ensuring remediation activities are implemented, and for obtaining proof of completion.

SADC Responsibilities

• Work with the MLTC plan to develop an appropriate plan to rectify all areas of non-compliance.
• Submit the completed remediation plan to the MLTC plan.
• Ensure the remediation plan is implemented and the SADC is compliant with all HCBS Final Rule requirements.
• Submit proof of remediation to the MLTC plan, when requested.

Proof of remediation is documentation or other evidence which demonstrates that the actions described in the approved remediation plan have been implemented. DOH will request proof of remediation after the date of completion indicated on the remediation plan. For example, if a SADC indicates that a remediation plan will be fully implemented by December 13^th, 2024, the request for proof of remediation will be sent after that date.

The MLTC plan will have five business days to submit proof of compliance to DOH. If DOH determines that the proof of remediation demonstrates full compliance, the review process is considered complete, and all MLTC plans contracted with the SADC will be notified.

If the documentation submitted is inadequate to demonstrate full compliance, additional or amended proof of remediation must be submitted. Once DOH approves the proof of remediation, all MLTC plans contracted with the SADC will be informed that the review process is complete.

Examples of proof of remediation are as follows:

• Updated SADC policies and procedures that meet the HCBS Final Rule requirements.
• An updated SADC PCSP template that meets the HCBS Final Rule requirements.
• Evidence of facility improvements, posted notices, staff training logs, etc.

DOH Responsibilities

• Request proof of remediation from MLTC plan.
• Review submitted proof of remediation for compliance.
• Work with the MLTC plan as needed, to ensure understanding and completion of requirements.

MLTC Plan Responsibilities

• Collect and submit a copy of the proof of remediation to DOH when requested.
• Retain proof of remediation efforts for audit purposes.
• All MLTC plans contracted with the SADC are responsible for ensuring the remediation actions are implemented and should obtain proof of these actions.
• Monitor ongoing compliance with the HCBS Final Rule requirements.

SADC Responsibilities

• Submit proof of remediation to the MLTC plan when requested.
• Maintain compliance with the HCBS Final Rule requirements.