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DOH Initiates ARPA eFMAP Directed Payment Process for Social Adult Day Care Programs

The Department of Health (DOH) recently notified Partially Capitated Managed Long Term Care (MLTCP) and Medicaid Advantage Plans (MAP) plans that certain Social Adult Day Care (SADC) sites in network are potentially eligible for funding from Home and Community-Based Services (HCBS) Enhanced Federal Medical Assistance Percentage (eFMAP) funds slated for SADCs. SADC programs should be receiving information from specific plans about the funding opportunity. Certain attestations must be completed to participate, as well as compliance with spending guidance. Awards for funding will be contingent upon achievement of performance measures for the period June 1st – Nov. 30, 2023 as delineated in the spending guidance. The initial notification letter to plans is available here. The initial DOH letter to SADC programs is here.

Back in November 2022, the State communicated to LeadingAge NY that SADC programs would receive approximately $14 million ($7 million State share/$7 million federal share) in eFMAP funding for SADC programs contracting with plans.

Plans are supposed to communicate with programs by Nov. 8th about the funding opportunity. Funding will flow to programs through directed payments from plans.

The communication indicates two main responsibilities for plans:

Plan Responsibility #1: Remit Payments to SADC Sites

  • The Department will make a lump sum payment to MLTCP and MAP plans in the first quarter of calendar year 2024.
  • MLTCP and MAP plans will be expected to remit payments to SADC sites as directed by DOH.
  • The payment will be based on each site’s achievement of performance measure requirements, which will be evaluated at the end of the performance period (June 1st – Nov. 30, 2023).
  • For the directed payment, each unique SADC site will be aligned to only one MLTCP or MAP plan with which the SADC site has a contract.

DOH will notify plans of any further instructions that will be required for payment. Payment schedules will be received in the first quarter of 2024 that lists all of the payments a plan is responsible for making. 

Plan Responsibility #2: Communicate State Directed Payment Information to SADC Sites

In addition to remitting payments to certain aligned SADC sites in their network, plans are responsible for communicating all information regarding the State Directed Payment provided by DOH with their SADC sites.

Plans must send out an “Initial Email to SADC Sites” by Nov. 8, 2023. The documents must be shared with each SADC site on the SADC Site List. These documents notify SADC sites of the eFMAP investment and includes the following attachments: 

A link to the DOH attestation can also be found in the “Initial Email to SADC Sites.”

Plans received their own SADC Site Lists. Each list is only a subset of a plan’s entire contracted SADC network. Each SADC site has been uniquely aligned to one plan for the purposes of communication and payment remittance. Plans must respond to DOH confirming that the documents provided have been sent with contact information listed.

For SADC programs, the following responsibilities are expected:

SADC Site Responsibilities: Required Attestations

To maintain eligibility for the SADC eFMAP Directed Payment investment opportunity, SADC sites must complete two separate attestations. The attestations are described below. A copy of the attestation to MLTC plans and a link to the DOH attestation is included in the materials plans must send to the SADC sites.

  1. SADC Site Attestation to DOH:

SADC sites are required to attest that they will spend their payment on State-directed programs and/or services. SADC sites will complete this attestation using an online form. The attestations will be collected directly by DOH via an online survey. Plans will not have access to the submissions and are not responsible for collecting this attestation. However, DOH will send additional communications to the SADC if any follow-up is needed with their plan’s aligned SADC sites.

  1. SADC Site Attestation to MLTC Plans:

SADC sites are required to complete an attestation confirming that their SADC site:

  1. has received and reviewed the directed payment application;
  2. understands the terms and requirements of participation; and
  3. acknowledges that the directed payment is incorporated into the provider agreement between SADC sites and respective plans.

This attestation covers the relationship between plans and providers pursuant to Section B.9 of the Standard Clauses for MLTC Provider/Independent Practice Association (IPA)/Accountable Care Organization (ACO) Contracts, which incorporates pertinent plan obligations under the plan’s contract with DOH into the Provider Agreement. Therefore, plans do not need to amend contracts with SADC sites in order to remit their funding; the attestation will be the document to meet this contracted provider obligation.

DOH is requiring SADC sites to sign and submit an attestation to plans regarding the directed payment before the MLTC or MAP plan transfers any funds to that SADC site.

Plans must receive a signed attestation from their plan’s assigned eligible SADC sites by Nov. 22, 2023. If a plan does not receive this attestation from their aligned SADC sites, please contact DOH at SADC.FMAP@health.ny.gov.

Webinar Slated for Nov. 16th at 10 A.M.

DOH will be holding a webinar for MLTCP and MAP plans and potentially eligible SADC sites. Currently, it is tentatively scheduled for Nov. 16, 2023 at 10 a.m. EST.

Additional information and a webinar link will be sent to plans and the SADC sites when details are finalized.

For questions, contact SADC.FMAP@health.ny.gov.

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