Managed Long Term Care (MLTC) Policy 25.05: Enhanced MLTC Plan Oversight of Contracted Social Adult Day Cares (SADCs)

Office of Health Insurance Programs
Division of Health Plan Contracting and Oversight

Managed Long Term Care (MLTC) Policy 25.05: Enhanced MLTC Plan Oversight of Contracted Social Adult Day Cares (SADCs)

Date of Issuance: September 08, 2025
Effective Date: September 08, 2025

Purpose: The purpose of this policy is to provide MLTC Partial Capitation Plans (MLTCP) and Medicaid Advantage Plus (MAP) plans guidance and instructions pertaining to monitoring, record keeping, and oversight of contracted SADC service providers. This policy does not apply to Program of All-Inclusive Care for the Elderly (PACE) plans.

Introduction: The New York State Department of Health (the Department) is providing guidance and instructions by requiring the below for MLTC plan oversight of contracted SADCs. These requirements are to ensure that MLTC plans are appropriately overseeing contracted SADCs for compliance with all federal and state regulations.

SADC National Provider Identifier (NPI) Requirements:
By December 8, 2025, MLTC plans MUST do the following:

  • Require that all SADCs where members receive services obtain an organization NPI via the National Plan & Provider Enumeration System (NPPES) and verify that the NPI meets the following requirements:
    • Be at the site/location level.
      • Therefore, if a SADC has two locations, each location MUST have a separate NPI.
    • List the physical location of the SADC as the "Primary Practice Address".
      • The business location, if different from the SADC address, may be listed as the "Mailing Address".
    • Be in the name of the SADC.
      • Note: A "DBA" may be included in the name, if appropriate.
        Ex. Z Corporation DBA 123 Social Adult Day Care
    • Have the appropriate Taxonomy for SADCs.
      • The appropriate taxonomy is: 261QA0600X - Clinic/Center - Adult Day Care.
  • MLTC plans must report this validated NPI on the quarterly Provider Network Data System (PNDS) report for the quarter ending December 31, 2025, which is due January 28, 2026.
  • The validated NPI must also be included on all claim/encounter data submitted by the MLTC plan for members receiving SADC services.

SADC Network Reporting Requirements:

  • MLTC plans must report all single-case agreements with SADCs that are not contracted network providers, on a quarterly basis, starting with the PNDS report for the quarter ending December 31, 2025.
    • This information should be submitted quarterly via email to the SADC HCBS Compliance team at HCBSSADCSiteAssessments@health.ny.gov and include the MLTC plan’s assigned plan manager.
      • This is due by the same date as the quarterly Provider Network Data System (PNDS) submission due date.
    • All of the fields reported in the quarterly PNDS submission should be included in this email.
      • A validated NPI must also be reported with these submissions.
  • Reminders:
    • Even SADCs not contracted in network must be evaluated prior to a single-case agreement being established and annually thereafter.
    • The Department expects that after 5 or more MLTC plan members begin receiving SADC services via a single-case agreement, that the MLTC plan will then contract with the SADC.

SADC Monitoring Requirements:
The below items must be monitored during the initial and all subsequent SADC site evaluations conducted by the MLTC plans:

  • MLTC plans must verify that the SADC has, and maintains, a current certificate of occupancy (COO) for the correct SADC ownership and physical location, prior to the SADC’s enrollment into the MLTC plan contracted network and annually thereafter.
    • A copy of this valid COO must be maintained by the MLTC plan as evidence of verification and for surveillance and audit purposes.
  • MLTC plans must observe occupancy levels during the site visit portion of the SADC site evaluation and collect and review attendance (sign-in/out) records that indicate at minimum the member's name, date, and start and end times, to ensure compliance with maximum occupancy standards, per the valid COO.
    • The MLTC plan must also maintain a copy of the records reviewed for surveillance and audit purposes.
    Note: Protected Health Information (PHI) and Personally Identifiable Information (PII) may be redacted by the SADC, for members not enrolled with the MLTC plan conducting the evaluation. For example, member names may be redacted.
  • MLTC plans must verify that SADCs are maintaining documentation as required by the New York State Office for the Aging (NYSOFA) regulation Title 9 NYCRR 6654.20 (d)(2)(iii) - Records.
    • This includes records of service delivery, which the MLTC plan is required to verify and obtain a copy of for all MLTC plan members receiving services at the SADC.
    • The MLTC plan must also verify that all records are kept and available upon request for surveillance and audit purposes.
  • MLTC plans must collect and review member documentation including the member’s SADC Person Centered Service Plan (PCSP) to confirm person centered planning has been performed correctly and within the required timeframe.
    • Per NYSOFA regulation 9 NYCRR 6654.20 (d)(1)(iii)(b) - Service Plan, a SADC PCSP shall be developed no later than 30-days after a member’s admission to the program and reviewed as necessary or at least once annually thereafter.
  • MLTC plans must also verify that contracted SADCs have and do provide training per NYSOFA regulation Title 9 NYCRR 6654.20 (d)(2)(iv)(c) - Training Requirements for All Staff and the Home and Community Based Services (HCBS) Final Rule, which requires SADCs to conduct training on the HCBS Final Rule and person centered planning, practice, and thinking.
    • MLTC plans must ensure the contracted SADCs retain documentation proving trainings were attended by staff and that the SADC has a compliant policy regarding training frequency and topics.
    • If the SADC created and gives a training directly, the MLTC plan must also obtain copies of the training materials and review them for compliance.
    • MLTC plans must obtain copies of the documentation reviewed for surveillance and audit purposes.

Additionally, for instances where SADC remediation is required, MLTC plans must collect and maintain documentation and evidence that the SADC has remediated. For example, updated policies showing a change was made.

The Department encourages all MLTC plans use the Suggested SADC Site Evaluation Tool (or its equivalent) and the corresponding user guide during the annual evaluation of contracted SADC, to ensure SADC compliance with state and federal regulations.

Reminder: Records, supporting documentation, evidence of remediation, and SADC site evaluation tools must be maintained for at least 6-years for audit and surveillance purposes.

Questions should be directed to MLTCInfo@health.ny.gov and copy the SADC HCBS Compliance team at HCBSSADCSiteAssessments@health.ny.gov.