Social Adult Day Care Programs to Engage in HCBS Settings Rule Self-Assessment and Compliance Process

The Department of Health (DOH) recently distributed several documents to Managed Long Term Care (MLTC) plans setting forth the background and process for Social Adult Day Care (SADC) compliance with the federal Home and Community-Based Services (HCBS) Settings Rule. The rule, a federal regulation effective March 17, 2014, set requirements for the qualities of settings to be eligible for federal financial reimbursement for Medicaid HCBS. These HCBS are provided in New York under the 1915(c), 1915(k), and 1115 waivers.

DOH issued a Fact Sheet and Timeline, which includes key provisions of the rule; an SADC Self-Assessment Tool to be jointly completed by the SADC and its contracting MLTC plan; a DOH slide presentation on the compliance process and timelines; and MLTC Policy 21.05: Social Adult Day Care HCBS Final Rule Implementation.

The federal standards seek to distinguish HCBS settings from institutional settings by identifying settings that isolate or have the effect of isolating individuals from the community. States must be able to prove that a setting is not institutional (a setting that isolates) and is truly home and community-based in order to receive federal Medicaid dollars to fund the program. Providers must also implement person-centered planning for participants in their program, establish policies and procedures for compliance with the rule, and carry out remediation activities if the heightened scrutiny process finds that a program is not in compliance with the setting standards.

The final rule identifies settings that are presumed to have institutional qualities and do not meet the rule’s requirements for HCBS settings. These settings include those in a “publicly or privately-owned facility that provide inpatient treatment; on the grounds of, or immediately adjacent to, a public institution; or that have the effect of isolating individuals receiving Medicaid-funded HCBS from the broader community of individuals not receiving Medicaid-funded HCBS.” SADC programs co-located with nursing homes will likely undergo “heightened scrutiny” and have to demonstrate that their program is in fact home and community-based, a process that includes input and information from the public.

Please note the following key dates:

• Fri., Dec. 3, 2021: MLTC plans should have confirmed their SADC provider network.
• Thurs., Dec. 9, 2021, 2:30 to 4:30 p.m.: DOH webinar for MLTC plans and their contracted SADC providers. Have the SADC Self-Assessment Tool available. Pre-registration is encouraged here.
• Thurs., Dec. 30, 2021: Plans submit the aggregate report as well as each individual SADC Site Self-Assessment to DOH via the Health Commerce System (HCS).

DOH's communication to plans includes the following overview of the process:

There are multiple steps upcoming to ensure all SADC sites meet the HCBS Settings Final Rule compliance standards before March 2023 to continue to remain in a MLTC plan’s network and continue to receive HCBS funding. The webinar will review the HCBS standards as they apply to SADCs, the SADC Site Self-Assessment tool, how MLTC plans are to submit the completed tools back via HCS, templates for aggregated progress reporting and timelines.

Phase I steps of the HCBS SADC compliance assessment:

1. MLTC plans should have confirmed their SADC provider network by December 3, 2021.
2. Individual SADC Site Self-Assessment tools are distributed by the plans, completed by the SADC sites and returned to each contracted MLTC plan by plan required due date.
3. Each contracted plan reviews each individual SADC Site Self-Assessment for accuracy and completeness.
4. Each contracted plan aggregates all SADC site compliance/ analysis reporting
5. Each contracted plan submits the aggregate report as well as each individual SADC Site Self-Assessment to DOH via HCS by December 30, 2021.
6. Individual SADC Sites and contracted plans begin immediate remediation activities with individual SADC sites.
7. SADC sites that have contracts with multiple plans must inform all contracted plans of remediation activities to meet HCBS SADC standards and remain in each plan network.
8. Each contracted plan and the NYS DOH will begin validation of individual SADC site compliance reporting.

Phase II begins including ongoing 2022 monitoring, progress reporting, heightened scrutiny activities, and working closely with individual SADC sites to continue to complete remediation activities in parallel to updated reporting to DOH.

Any questions should be directed to: HCBSSADCSiteAssessments@health.ny.gov.

Programs should also review the remediation items and encourage staff to attend person-centered planning training if they have not already done so. Resources for this training are available here.

Please contact LeadingAge NY if you have questions or concerns. 

Contact: Meg Everett, meverett@leadingageny.org, 518-929-9342