Resources for SADC Person Centered Planning

The purpose of this webpage is to provide a quick reference to resources available for Managed Long Term Care (MLTC) plans and Social Adult Day Cares (SADCs) on person centered planning. This webpage includes links to resources available in the New York State (NYS) Department of Health (the Department) resource library, that offer guidance and information to support the completion and implementation of person centered planning.

SADC PCSP Template

Description: The Department, in conjunction with the New York State Office for the Aging (NYSOFA), has developed a service plan template to be utilized by SADCs contracted with Managed Long Term Care (MLTC) plans. The template includes sections to ensure all key topics related to the person centered planning process are addressed. The template was designed to assist SADCs in developing PCSPs that are compliant with the Centers for Medicare and Medicaid Services (CMS) Home and Community Based Services (HCBS) Settings Final Rule, and all other state and federal requirements related to person centered planning.

SADC/SADS PCSP Template User Guide

Description: This reference guide created by the Department, in conjunction with NYSOFA, is intended to be used as a resource to assist SADCs and SADS programs with completing the SADC/SADS PCSP Template.

Resource Library

Description: The Person Centered Planning and Practice Resource Library is a collection of free resources on person centered care planning and practice across all HCBS sectors in New York State. There are materials available such as leading research papers, policy guidance, and training webinars which are organized in a user-friendly manner.

The resource library is intended to support the development and understanding of person centered thinking, planning and practice skills, and concepts.

Person Centered Planning Statewide Training Initiative

Description: The Department's Person Centered Planning Statewide Training Initiative webpage provides information and resources to individuals and organizations involved in delivering and overseeing person centered services. It offers information on how to register for live training sessions, access to recorded webinars, and related resources and learning support materials.

The Art & Science of Creating SMART Person Centered Goals

Description: This resource, presented by the Health Plan Collaborative Workgroup on October 26, 2018, offers an overview of how to use SMART goals in the PCP process. The Health Plan Collaborative Workgroup is a self-initiated group of health plans from Minnesota that began working together in February of 2007. It explains the SMART acronym and how to apply it in care planning practice, how to convert identified needs into SMART person centered goals, and how to identify common pitfalls when creating SMART person centered goals.

Thinking Differently About Person Centered Planning

Description: This webpage provides a brief overview of the history of person centered planning. SADC providers and MLTC plans can learn about the five steps of the person centered planning process, the differences between traditional care planning and person centered planning, and how to integrate person centered planning into community based service systems.

SMART Goals and Mental Health

Description: This article from the Mental Health and Developmental Disabilities (MHDD) National Training Center covers goal setting as a mental health tool and emphasizes SMART goals. SADC providers and MLTC plans can use this resource as a baseline for creating quality goals.

Promoting Meaningful Person Centered Practices in Home and Community-Based Service Delivery

Description: The National Center on Advancing Person-Centered Practices and Systems (NCAPPS) is an initiative from the Administration for Community Living (ACL) and the Centers for Medicare & Medicaid Services (CMS) that helps States, Tribes, and Territories implement person-centered thinking, planning, and practice in line with U.S. Department of Health and Human Services policy. In this webinar, hosted by the NCAPPS, September 22, 2022, panelists who receive or have received HCBS, share their experiences with person centered supports and services. SADC providers and MLTC plans can learn from the discussion on topics related to rights, choice, and control and how these critical elements can be improved and fully integrated into service delivery practices.

Person Centered Thinking and the HCBS Final Rule

Description: The Department presented a two-hour long training on Person Centered Thinking and the HCBS Final Rule. This recorded training provides an overview of the HCBS Final Rule and its application to NYS services and supports. The training helps MLTC plans and SADC providers identify the expectations of the HCBS Final Rule for performing person centered planning, it describes the process for making modifications to the additional standards of the HCBS Final Rule and explains the difference between what matters to someone and what is good for them.

Goals to Care: How to Keep The Person In "Person Centered"

Description: This report, from the National Committee for Quality Assurance, May 31, 2018, equips SADC providers and MLTC plans with tips and tricks for coordinating goal-based care to individuals with complex needs. It also contains examples from organizations experienced in providing person centered care.

Fact Sheet Person Centered Planning and The Home and Community Based Services (HCBS) Rule

Description: A fact sheet from the Department, designed to provide an overview of the person centered care planning requirements for HCBS Final Rule.

Electronic Dementia Guide for Excellence (EDGE) Project: Strength Based Care Planning

Description: The EDGE Project's webpage of the Department is dedicated to individuals diagnosed with dementia. It will equip SADC providers and MLTC plans with comprehensive information on care planning for members experiencing dementia. Additionally, it offers tools and worksheets to help develop strength-based care planning skills.