Social Adult Day Care Certification in New York State

An overview of the new Certification process and its impact on Social Adult Day Care (SADC) entities and Managed Long Term Care (MLTC) Plans

Mark L. Kissinger, Director
Division of Long Term Care
Office of Health Insurance Programs

Webinar Overview

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The New SADC Certification Process

  • The Department of Health (DOH), in conjunction with the Office of the Medicaid Inspector General (OMIG) and the New York State Office for the Aging (NYSOFA) have established a new Certification requirement for Social Adult Day Care (SADC) entities that wish to contract with Managed Long Term Care (MLTC) plans.
  • This new Certification has been implemented in order to ensure those entities involved in the delivery of SADC services are in compliance with relevant rules and regulations.
  • The goal is to ensure eligible individuals have access to safe SADC service settings.
  • Completion of the Certification will attest to a SADCs compliance with Title 9 NYCRR section 6654.20, as required under Article VII, section C of the Managed Long Term Care model contract.
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Who Must Complete the SADC Certification?

  • As of May 8, 2015, SADCs must complete Certification.
  • A Certification must be completed for each SADC site by June 30, 2015, and annually thereafter. New sites may certify at any time during the year.
  • The Certification must be completed electronically, via OMIG´s website: https://www.omig.ny.gov/sadc-certification
  • Certification must be completed on an annual basis, twelve (12) months from prior Certification.
  • In order to complete the Certification, a SADC will need to:
    • Provide the Federal Employer Identification Number (FEIN) and address for the SADC;
    • Provide the SADC owner and program director's information, including Social Security Number;
    • Answer a series of questions attesting to compliance;
    • List all MLTC Plans, if any, that the SADC contracts with; and
    • Attest that the information provided is true.
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What Happens After Certification is Complete?

  • After Certification is completed and submitted electronically, a confirmation page will appear indicating in red letters if the submission was accepted or not accepted.
  • The SADC must print and retain a copy of the confirmation as proof of completion. The SADC must also provide a copy of this confirmation to the MLTC plan. (Upon completion, the confirmation will be automatically sent to the email address provided on the electronic Certification form).
  • Any SADC seeking to enter into a new contract with a MLTC plan would need to successfully complete the Certification first, and provide a copy of the confirmation page to the MLTC plan as proof of completion.
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SADCs Contracting With MLTC Plans

  • Certification applies to existing contracts between MLTC plans and SADC entities, as well as any future contracts established.
  • It is the responsibility of the MLTC plan to ensure that SADCs under contract have completed the Certification - the MLTC plan must request and maintain a copy of the confirmation notice generated upon the SADCs successful completion of the electronic Certification.
  • A MLTC plan may not enter into a new contract with a SADC until Certification has been successfully completed.
  • In the event that a contract between a SADC and MLTC plan is terminated:
    • The MLTC plan should follow existing protocols for quarterly reporting.
    • The SADC must notify both OMIG and DOH by submitting an email to: SADCCertification@omig.ny.gov.
    • The information in this notification must include:
      • The SADC information - FEIN, SADC/Corporation Name or DBA name, address and phone number;
      • Owner and Director information - First and last name, Title, phone number and e-mail address; and
      • The name and phone number of the affected MLTC plan(s).
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Reminder on Previous Guidance

  • Previous Department guidance still applies, and documents may be found at: http://www.health.ny.gov/health_care/medicaid/redesign/mrt_90.htm
  • It is important to remember MLTC plans must consider the individual needs of each enrollee during the assessment process and must clearly identify the need for SADC as a service in the plan of care.
  • MLTC plans should not enroll a recipient in SADC unless the recipient has a functional or clinical need for community based long term care services (CBLTCS) - defined specifically as personal care services in the home, home health care, private duty nursing, consumer directed personal assistance services, and adult day health care.
  • SADC can contribute to the total care plan but cannot represent the primary service provided to the enrollee.
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Questions?

  • Questions should be submitted to: SADCCertification@omig.ny.gov.
  • FAQs will be posted to the MRT 90 webpage by May 22, and thereafter as needed. http://www.health.ny.gov/health_care/medicaid/redesign/mrt_90.htm
  • The online Certification form has been enhanced in two ways:
    • It can now be translated into several different languages.
    • The SADC owner information on the Certification webpage is not required for not-for-profit SADC entities, as now indicated on the form.
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Summary

  • As of May 8, 2015 SADCs must complete Certification.
  • A Certification must be completed for each SADC site by June 30, 2015, and annually thereafter.
  • The Certification site is: https://www.omig.ny.gov/sadc-certification
  • It is the responsibility of the MLTC plan to ensure that SADCs under contract have completed the Certification.
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Contact Information and Resources

SADC Certification webpage:

https://www.omig.ny.gov/sadc-certification

SADC Certification e-mail:

SADCCertification@omig.ny.gov

DOH Policy Documents:

http://www.health.ny.gov/health_care/medicaid/redesign/mrt_90.htm

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