SADC Compliance Verification Frequently Asked Questions (FAQs)

The FAQs below provide additional guidance and clarification on topics related to SADC HCBS Final Rule compliance verification. For additional guidance and information please reach out to the appropriate party and contact information is found on the Contact Us page.

Acronyms and Abbreviations

Acronyms
Acronym /
Abbreviation		 Definition
CMS Centers for Medicare and Medicaid Services
DFRS Division of Finance and Rate Setting
EEOC Equal Employment Opportunity Commission
HCBS Home and Community Based Services
MLTC Managed Long Term Care
NYC New York City
NYS New York State
NYSOFA New York State Office for the Aging
PACE Program of All-Inclusive Care for the Elderly
PCSP Person Centered Service Plan
SADC Social Adult Day Care
SADS Social Adult Day Services
TAC Technical Assistance Center
The Department The New York State Department of Health

Frequently Asked Questions

All HCBS compliance reviews are conducted on an annual basis beginning in January and are concluded by December for all SADCs. The Department will contact the MLTC plan to schedule a virtual site visit, facilitated by the Department, with participation from the MLTC plan and the SADC.

Prior to the virtual site visit, the Department will request documentation from the MLTC plan and the MLTC plan will work with the SADC to provide the documentation. During the virtual site visit, the Department will ask questions related to HCBS compliance, request a virtual walk through of the SADC, and observe the physical location, staff, and members at the SADC.

Although an SADC may have been compliant in previous years, the Department will continue to review SADCs regularly to ensure ongoing compliance with the HCBS Final Rule.

Once the compliance review is completed, the Department will send determination letters to the contracted MLTC plans with the results of the review, indicating if the SADC is found compliant or not compliant with the HCBS Final Rule. Determination letters are distributed to the contracted MLTC plans on a bi-weekly schedule.

Currently, all SADCs are subject to HCBS compliance reviews on an annual basis.

The Department provides HCBS compliance review determination letters to MLTC plans for each of their contracted SADCs as annual reviews are conducted.

If an MLTC plan is interested in newly contracting with an SADC, the MLTC plan is required to review the SADC and confirm compliance with all requirements, including the HCBS Final Rule, before members may attend the SADC. If the SADC is not in compliance, the MLTC plan must work with the SADC to remediate any non-compliant findings, prior to contracting with the SADC and allowing any members to attend the SADC.

For more information please visit MLTC Plan SADC Contracting and Oversight Roles and Responsibilities.

Yes, the Department can complete the review of the SADC regardless of members being present. However, the Department encourages the virtual site visit to be completed on a day when members are present. The MLTC plan should coordinate with the SADC and attempt to schedule the virtual site visit on a date and time that members are present at the SADC. If members will not be present on the day of the review, the MLTC plan should inform the Department of this information ahead of the scheduled review date.

It is at the MLTC plan's discretion which staff members attend the HCBS compliance reviews.

The HCBS Final Rule regulations are set forth by CMS and require that SADCs abide by the following regulations: 42 CFR 441.301(c)(4)(v): "Setting facilitates individual choice regarding services and supports, and who provides them." All members must be offered a choice of staff to render services, including but not limited to, personal care services. If the SADC has a limitation of staff and cannot accommodate the members preference, the member and MLTC plan must be made aware and the MLTC plan must work with the member to offer alternate SADC options, where their preference can be met.

If the member chooses to attend the SADC, even if their preference cannot be met, the following must be documented in the member's SADC PCSP:

  • The member's preference.
  • A notation that the member's preference cannot be met.
  • The member's acknowledgement that they were offered alternative SADC options where their preferences could be met, by the MLTC plan care manager.

Note: TheSADC/SADS PCSP Template, which was issued jointly by the Department and NYSOFA, contains a section for all of this information.

SADCs are encouraged to employ enough qualified staff that will support the needs of all enrolled members. The recommended staff to member ratio is 1:7 and in dementia specific programs, the ratio recommendation is 1:5. Please note, this includes only staff directly supervising the members during program activities and does not include volunteers, or a member's home care worker. Additional information on this recommendation can be found here: NYC Aging SADS Standards of Operation and Scope of Services, § 2, Stan.14.1 Model SADS (nyc.gov).

While PACE programs are currently not scheduled for HCBS compliance reviews with the Department, these entities are responsible to ensure all HCBS provided to members are in compliance with the HCBS Final Rule.

Per the HCBS Final Rule, members are allotted the following rights:

  • To have access to food and drinks at all times.
  • To control their own schedules.

Therefore, the SADC must ensure:

  • Members have access to food and drinks throughout the day.
  • Members are aware of food and drink availability.
  • Members must know how to access the food and drinks if they are not readily available.

So, while SADCs may choose to offer a "snack time", members are NOT required to take a snack break during this time and must still always have access to food and drinks.

To comply with the HCBS Final Rule, SADC staff and volunteers must complete the following trainings:

  • Person Centered Thinking and Practices
    • All staff must be trained in person centered thinking and practices, which demonstrates how to encourage and support members with expressing their unique goals, activities, and preferences.
    • For more information, please review the Person Centered Planning and Practice Resource Library.
  • Person Centered Planning
    • All SADC staff must be trained on person centered planning which illustrates how to develop a PCSP. This training must ensure members lead and direct the development of their plan for services and supports a planning process that is centered around the member and what is important to them.
    • For more information, please review the Resources for SADC Person Centered Planning webpage.
  • HCBS Final Rule
    • All SADC staff must receive training on the HCBS Final Rule that includes the principals of the rule and how to practically apply the rule.

Additionally, to comply with the NYSOFA regulation 9 CRR-NY 6654.20: Social Adult Day Care Programs, all SADC and SADS staff and volunteers must complete the required trainings as detailed in the regulation.

SADCs with questions regarding billing and reimbursements related to services provided by the SADC should direct their inquiries to the applicable contracted MLTC plan.

MLTC plans with questions regarding rates should contact the NYS Division of Finance and Rate Setting (DFRS) at mltcrs@health.ny.gov. DFRS is responsible for calculating costs into premium rates.

MLTC plans should direct encounter submission questions to the Managed Care Encounter Compliance Team at ManagedCareEncounterCompliance@health.ny.gov. General billing questions can be directed to eMedNY at (800) 343-9000.

If an SADC has a concern regarding reimbursement for provided services, the SADC should contact the contracted MLTC plan to discuss the reimbursement.

If after contacting the contracted MLTC plan, the SADC is unable to resolve the negotiable concern with the specific MLTC plan, the SADC may contact the MLTC Technical Assistance Center (TAC) at (866) 712-7197 or mltctac@health.ny.gov, or see the TAC website for additional information (If you Have a Complaint about MLTC). The MLTC TAC will reach out to the specific MLTC plan regarding the situation.

The member's schedule must be clearly documented on the member's SADC PCSP. The SADC and MLTC plan care manager must work together to resolve any conflicts in a member's schedule and align with the member's goals and preferences.

The Department does not require the SADC to replace their own documentation of member's rights. However, SADCs must ensure that members are informed of all their rights while attending the SADC including those afforded to them by the HCBS Final Rule. It is recommended that the SADC ensure all the HCBS Final Rule rights the Department sent out are located within the SADC's member's rights document.

For more information on these rights, please see the MLTC Plan Member's Rights While Attending SADC Notification.

The SADCs are required to retain members records for ten (10) years. For clarification on what information the SADC needs to retain, please refer to the NYS Rules and Regulations for SADC programs: 9 CRR-NY 6654.20: Social Adult Day Care Programs.

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