Social Adult Day Care Site Compliance with Home and Community Based Services Final Rule

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Frequently Asked Questions (FAQ)

February 22, 2024

Revision History
Change No. Description Change Date
1.0 Initial Version 02/22/2024
     
     
     

Table of Contents

Section 1: SADC HCBS Compliance Review Process
Q1.1: Does DOH send a letter to the sites that are deemed fully compliant?
Q1.2: What is the timeframe that DOH allows a SADC to develop their remediation plan with their contracted MLTC?
Q1.3: Are all HCBS compliance reviews conducted virtually?
Q1.4: Will HCBS compliance reviews be conducted annually?
Q1.5: If sites were already compliant, why are they being reviewed again?
Q1.6: How are the SADCs being chosen for a review in 2024?
Q1.7: For plans that contract with new SADC providers that are already compliant, can DOH issue SADCs a letter evidencing compliance that they can share with plans?
Q1.8: Can you confirm if striving to employ male staff members is adequate, or if a SADC site must employ a male staff, and, if so, point us to the specific language on the CMS HCBS Final Rule that explicitly states this?
Section 2: Person-Centered Service Planning
Q2.1: Would it be possible to send everyone a well completed sample PCSP hitting all the HCBS points?
Q2.2: Does every contracted SADC have to comply with the new Person-Centered Care Plan Template, or only the SADCs that are considered non-compliant?
Q2.3: How many years are SADCs required to keep member records (such as annual assessment/PCSP)?
Section 3: Community Integration
Q3.1: Is a SADC site responsible for having staff escort members to outings with friends, or just for ensuring that transportation is scheduled?
Q3.2: If a SADC site coordinates group outings for meals, does this count as community integration?
Q3.3: How does DOH suggest handling a situation where a member has dementia and is not able to articulate the activities they wish to participate in and is limited in their ability to independently access the community.
Q3.4: If a client wishes to go out into the community during SADC program hours and, does not want a staff member present, and is gone for several hours, should the SADC still bill MLTC since the member is not technically receiving SADC services?
Appendix
Glossary & Acronyms

Section 1: SADC HCBS Compliance Review Process

Q1.1: Does DOH send a letter to the sites that are deemed fully compliant?
Once the compliance review is completed, DOH sends determination letters on a bi-weekly basis to all MLTC plans contracted with the SADC.

Q1.2: Are all HCBS compliance reviews conducted virtually?
Currently, on-site compliance reviews are conducted virtually by DOH.

Q1.3: Will HCBS compliance reviews be conducted annually?
Yes. Visits will be conducted annually.

Q1.4: If sites were already compliant, why are they being reviewed again?
To ensure continued compliance, SADCs will continue to be monitored annually until further notice.

Q1.5: How are the SADCs being chosen for a review in 2024?
New SADC sites are reviewed first, followed by the SADCs that were reviewed earliest in the previous year.

Q1.6: For plans that contract with new SADC providers that are already compliant, can DOH issue SADCs a letter evidencing compliance that they can share with plans?
DOH provides compliance determination letters to MLTC plans for each of their contracted SADC sites. Plans are encouraged to share the letters with their contracted SADC site, as DOH does not communicate directly with SADC sites.

Q1.7: Can you confirm if striving to employ male staff members is adequate? Or if a SADC site must employ a male staff and if so, point us to the specific language in the CMS HCBS Final Rule that explicitly states this?
To meet compliance for standard 42 CFR 441.301(c)(4)(v): "Setting facilitates individual choice regarding services and supports, and who provides them." Members must be offered a choice of staff to render services, especially personal care services. The SADC should make every effort to employ more than one gender of staff to accommodate the preferences of their members.

Q1.8: What is DOH's specific expectation regarding staffing to ensure compliance with both Equal Employment Opportunity Commission (EEOC) and HCBS ruling?
SADCs are encouraged to employ enough qualified staff that will support the needs of all enrolled members. A 1:7 staff ratio is recommended as stated in the NYC Department of Aging Social Adult Day Services Standards of Operation and Scope of Services, § 2, Stan.14.1 Model Social Adult Day Service (SADS) (nyc.gov)

Section 2: Person-Centered Service Planning

Q2.1: Are SADC sites expected to share their own SADC person-centered care plan with the MLTC plan through which service authorization was received?
That condition would be at the discretion of the MLTC plan, and the requirements as stated in the SADC/ MLTCP contract.

Q2.2: Would it be possible to send everyone a well completed sample PCSP hitting all the HCBS points?
PCSPs are unique and person-centered so it would not be useful to provide a sample for an individual. However, an updated SADC PCSP template was developed collaboratively by NYSDOH and NYS Office for the Aging which contains every component to meet compliance with the HCBS Final Rule standards when fully completed.

DOH and NYSOFA require all SADC/SADS sites to utilize the issued SADC PCSP template or update their SADC PCSP template to include at minimum all questions and areas covered in the DOH/NYSOFA issued SADC template. MLTC plans are required to verify that their contracted SADC/SADS sites comply with the new SADC PCSP template requirements, and when contracting with a new SADC/SADS site, MLTC plans must verify the DOH/NYSOFA SADC template or corresponding template is already in use or will be once members begin attending.

Additional resources:
Person-Centered Service Planning Home and Community-Based Services Final Rule Implementation webinar (recording)

Person-Centered Service Planning Home and Community-Based Services Final Rule Implementation webinar (slides)

Q2.3: Does every contracted SADC have to comply with the new SADC Person-Centered Care Plan Template, or only the SADCs that are considered non-compliant?
DOH and NYSOFA encourage all SADC and SADS sites to utilize the new SADC PCSP template. If a SADC chooses not to use the issued SADC template, the SADC and the MLTC Plans must ensure the SADC PCSP template is updated to include, at minimum, all the questions and sections listed in the DOH/NYSOFA issued SADC template.

Q2.4: How many years are SADCs required to keep member records (such as annual assessment/PCSP)?
The MLTC/MAP contract specifies that: "The Contractor shall preserve and retain all records relating to Contractor performance under this Agreement in readily accessible form during the term of this Agreement and for a period of ten (10) years thereafter. All provisions of this Agreement relating to record maintenance and audit access shall survive the termination of this Agreement and shall bind the Contractor until the expiration of a period of ten (10) years commencing with termination of this Agreement or if an audit is commenced, until the completion of the audit, whichever occurs later. "

Section 3: Community Integration

Q3.1: Is a SADC site responsible for having staff escort members to outings with friends, or just for ensuring that transportation is scheduled?
If the member requests assistance with transportation, SADC staff may assist the member. If member is determined to be safe and competent, the member would not need an escort unless they requested one.

Q3.2: If a SADC site coordinates group outings for meals, does this count as community integration?
SADC sponsored group outings do not count as community integration. An example would be a bus trip to a restaurant where SADC staff are in attendance to monitor members and members are expected to stay with the group. Community integration is considered when a group of members choose to visit a restaurant whereby the SADC staff only assist with arranging reservations or transportation, and do not attend as monitors for the group. In this scenario, members are given autonomy to interact with persons who are not SADC staff, to select their own meals, to select their own seating, and to make their own decisions.

Q3.3: How does DOH suggest handling a situation where a member has dementia and is not able to articulate the activities they wish to participate in, and is limited in their ability to independently access the community?
The member's representative/guardian should support the member in the PCSP planning process. The process should include the member's preferences for community integration, and SADC activities, in addition to documenting the supports required to ensure they can participate in their preferred activity. For members determined to be unsafe or incapacitated, the SADC may provide safety support by coordinating services such as transportation, providing staff or arranging for the member's caregiver to accompany them in the community.

Q3.4: If a client wishes to go out into the community for several hours during SADC program hours and does not want a staff member present, should the SADC still bill MLTC since the member is not technically receiving SADC services?
Please contact the MLTC plan(s) with whom you are contracted to discuss billing, CDPAS or PCS for this scenario.

Appendix

Glossary and Acronyms
Acronym / Word Definition
DOH Department of Health (NYS)
HCBS Home and Community-Based Services
CMS Centers for Medicare and Medicaid Services
MLTC Managed Long-Term Care
NYS New York State
SADC Social Adult Day Care