Q1.1: How should Managed Long Term Care (MLTC) plans verify the Certificate of Occupancy (COO) is for the correct Social Adult Day Care (SADC) ownership?

To confirm a COO is for the correct SADC ownership, MLTC plans are to obtain a copy, and confirm the COO is currently valid (i.e. not expired) and has the correct SADC name and address listed.

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Q1.2 If an SADC is not able to acquire the original COO, is similar documentation, such as the operating certificate acceptable?

No, a copy of the current valid COO is required and other documentation such as an operating certificate is not acceptable.

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Q1.3 What makes a COO "valid"?

A COO is considered valid if the following information is included:

• SADC Name/Ownership
  • Some COOs do not list business/ownership information. If the COO does not have a place to indicate this information, the COO can still be valid.
• Expiration Date at least 30-days in the future
  • Some COOs do not have an expiration date. If the COO does not have an expiration date indicated, the COO can still be valid.
• Permissible Use / Occupancy Allowance accurately reflects that the space is being used by a SADC.
  • The exact use coding may not specifically list "Social Adult Day Care" but should be something similar. A standard "commercial" or "residential" COO is not acceptable.
    • E.g., "Daycare" or "Institutional Group I-4"

Reminder: The permissible use is essential because additional requirements related to occupancy (e.g., fire safety) are required based on this classification.

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Q1.4 What "records of service delivery" should be collected?

According to Title 9 NYCRR 6654.20 (d)(2)(iii) - Records:

"(iii) Records. The program shall:

• maintain the following information on file:
  • administrative and financial records.
  • participant personal records, including identifying, emergency, and medical information including physician name, diagnosis, and medications; and
  • services records, including the individual assessment, the service plan, and documentation of the delivery of services; and
• treat all information as confidential and shall not disclose or release information except as authorized by Federal or State laws and regulations, or pursuant to court order."

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Q1.5 Are MLTC plans responsible for obtaining records of service delivery for members attending the SADC?

Yes, MLTC plans are required to obtain copies of service delivery records for all the MLTC plan's members attending the SADC.

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Q1.6 What documents should be collected to confirm person centered planning has been performed correctly and within the required timeframe?

The MLTC plan must obtain and review person centered service plans for all members that include at minimum all fields within the Social Adult Day Services (SADS)/SADC Person Centered Service Plan (PCSP) Template, which was jointly issued by the New York State Department of Health (the Department) and the New York State Office for the Aging (NYSOFA). As part of the review, the MLTC plan must confirm the initial PCSP was created within 30-days of enrollment and subsequent PCSPs were conducted at least annually thereafter.

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Q1.7 What SADC training materials are MLTC plans required to collect and maintain?

The MLTC plans are required to collect and maintain all materials verifying staff have been trained in all required topics, including:

• Training Policy
• Training Materials
• Attendance Logs for Training Sessions

Q2.1 Are MLTC plans required to contract with a SADC if the MLTC plan has a single case agreement with that SADC?

If there are less than five (5) MLTC plan members attending a SADC, it is up to the MLTC plan to determine if a contract should be done with the SADC or if single case agreements are appropriate.

If there are five (5) or more MLTC plan members attending a SADC, then the Department requires the MLTC plan to contract with the SADC.

Reminder: If the MLTC plan only has a single case agreement with a SADC, the MLTC plan must still conduct an annual evaluation to confirm the SADC is compliant with all state and federal regulations.

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Q2.2 What is the purpose of receiving a quarterly file of those SADCs that completed a single case agreement with the MLTC plan?

The Department is requesting quarterly file details on single case agreements to confirm that all SADCs providing services to Medicaid members are monitored for compliance.

Reminder: MLTC plans are required to ensure that all SADCs, including those with only single case agreements, are compliant with all state and federal regulations.

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Q2.3 Are MLTC plans required to report single case agreements for SADCs in the quarterly Provider Network Data System (PNDS) submission?

No, MLTC plans should not report SADCs with single case agreements in the quarterly PNDS submission. Only SADCs where a formal contract exists between the MLTC plan and SADC should be reported in the quarterly PNDS submission.

Reminder: MLTC Policy 25.05 requires MLTC plans to send a separate listing (Excel file) of SADCs where the MLTC plan has at least one single case agreement to the HCBSSADCSiteAssessments@health.ny.gov mailbox as an addendum to the quarterly PNDS submission.

Q3.1 What is the requirement for organizations with multiple SADC locations?

MLTC Policy 25.05 requires MLTC plans to work with contracted SADCs to obtain a NPI at the location level. Therefore, if an organization has multiple SADC locations, each location MUST obtain a separate NPI.

Additional requirements from MLTC Policy 25.05 include:

• 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 begin reporting this validated NPI on the quarterly PNDS submission due January 28, 2026.
• MLTC plans must also include the validated NPI when reporting single case agreement SADCs.
• The validated NPI must also be included on all claim/encounter data submitted by the MLTC plan for members receiving SADC services.

Reminder: Organizations may maintain their ‘Organization NPI' and have separate subpart ‘Organization' NPIs for each SADC.

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Q3.2 If an SADC has an organizational NPI how should a claim/encounter submission be completed?

SADCs should use the "Billing Provider" field for the organizational NPI and the "Rendering/Servicing Provider" field for the SADC NPI.

Note: Provider taxonomy codes are not required to be entered when submitting claims/encounters.
Please see Q 3.1 What is the requirement for organizations with multiple SADC locations? for additional information on organizations and multiple SADC locations.

• MLTC Plan Policy 25.05: Enhanced MLTC Plan Oversight of Contracted SADCs
• Title 9 CRR-NY 6654.20
• NYS | SADC Compliance Website