The Adult Day Health Care Council (ADHCC) this week provided public comment on the Department of Health’s (DOH) revised Part 425 adult day health care (ADHC) regulations. The regulations were amended to incorporate changes to facilitate ADHC compliance with the federal Home and Community-Based Services (HCBS) Settings Rule, which requires person-centered planning and community integration of ADHC registrants. Other changes were made to the regulations as well. The proposed regulations are available here, and ADHCC’s comment letter is here.

ADHCC’s letter addressed several specific aspects of the revisions, but mostly emphasized that ADHC compliance should be reasonable in nature, as registrants already live at home and in their communities. In addition, the HCBS Settings Rule language and requirements are tailored to individuals with disabilities who typically live in group homes, which are unlike the settings and services that ADHC programs deliver.

In addition to the above, ADHCC's comments include:

• Support for a revision that allows ADHC programs to be established elsewhere in the community without requiring the nursing home to consider and assess where there is space on-site at the nursing home.
• Support to retain current regulation that allows a licensed practical nurse (LPN) to provide on-site services when a registered nurse (RN) is available in the nursing home. The proposed regulations allow LPN services when under RN supervision.
• Request for clarification on the Unbundled Services/Payment language that eliminates the reference to Managed Long Term Care (MLTC) plans, which may open this model up to other payers.
• Support for a Medicaid increase, as the HCBS Settings Rule requires programs to incur additional expenses for food, outing costs, additional transportation, and staff for community integration, despite the Regulatory Impact Statement stating otherwise.
• Support for ADHC program use of telehealth to serve registrants.
• Support for reasonable compliance with providing access to community outings and integration as individuals return home from ADHC program at the end of the day.
• Support for a reasonable approach to providing access to snacks and meals during program, freedom to come and go from program, and access and control over personal resources.

We encourage members to review the comment letter. ADHC programs that are currently open are providing person-centered care planning and providing registrants access to the community in compliance with the Rule. Evidence packages of reopened ADHC programs are currently posted on the DOH website. Several programs have been targeted for Plans of Correction due to limited access to transportation for community outings and have been granted a revised compliance deadline of July 1, 2024. The deadline for general compliance with the Rule is March 17, 2023.

Contact: Meg Everett, meverett@leadingageny.org, 518-867-8871