COVID-19 Guidance for Medicaid Providers

Questions and Answers Related to COVID-19 Guidance for Providing Adult Social Day Care (SDC) Services Telephonically

  • Guidance is also available in Portable Document Format (PDF)

May 16, 2020

On April 7, 2020, the NYS Department of Health issued a letter to all Adult Social Day Care (SDC) Administrators and Managed Long Term Care Plans (MLTCP), "Re: COVID-19 Guidance for Providing Adult Social Day Care (SDC) Services Telephonically" ("the SDC Guidance"), available here. The guidance offered below addresses a number of questions that have arisen from that guidance:

Question 1: Is a MLTCP required to cover SDC services delivered telephonically or via permitted telehealth?

Yes. Medicaid Managed Care Plans (MMCPs), including MLTCPs, must cover telehealth/telephonic delivery of all Benefit Package services members are otherwise eligible for that are appropriate through telehealth/telephone. The Department has posted telehealth guidance in a Medicaid Update Special Edition March 2020 Volume 36 and Frequently Asked Questions.

SDC is included in the MLTC Partial Plan and Medicaid Advantage Plus benefit packages. The SDC Guidance identifies the types of SDC activities that may be delivered telephonically or via telehealth.

Question 2: Does the member need to agree to receive SDC telephonically or via telehealth? If SDC services are provided telephonically for a member, do they need to be re -authorized?

The SDC Guidance indicates the member may elect or decline to receive SDC services telephonically or via telehealth. The member´s preferences, goals, and interests should be documented in the SDC care plan.

Plans do not need to reauthorize SDC services for members receiving SDC prior to March 18, 2020. Members authorized to receive SDC prior to March 18, 2020 should be contacted by the Plan to determine the member´s preference for receiving SDC telephonically or via telehealth during the COVID-19 state of emergency. Plans should document the member´s preference in the member´s MLTC care plan.

Question 3: Can an SDC provider offer home delivered meals?

The SDC Guidance requires that home delivered meals be arranged by the MTLCP. If the SDC provider and the MLTCP agree, the SDC provider may offer home delivered meals.

Question 4: Can MLTC plans negotiate rates for the provision of telephonic SDC services? Which codes should be used for SDC delivered telephonically or via telehealth? In which Lane of the Telephonic Reimbursement Overview section of the Medicaid Update Special Edition: Comprehensive Telehealth Guidance is SDC?

Yes. The SDC Guidance provides that SDC services shall be reimbursed under the provisions of the contract between the MLTCP and the SDC provider. Plans may negotiate rates for the range of SDC services their contracted SDC providers can provide telephonically or via telehealth, and in accordance with the SDC Guidance. At the same time, plans remain responsible for ensuring that they possess a network of SDC providers that is adequate to offer the SDC benefit to their members. Based on the contracted rates, plans should provide SDCs with billing guidance, which may include using the current procedure codes for SDC and using the "Modifiers to be Used When Billing for Telehealth Services" included in section VII of the Medicaid Update Special Edition: Comprehensive Telehealth Guidance.

As SDC is only available in the benefit packages of the MLTC Partial Plan and Medicaid Advantage Plus, there are no fee-for-service rate codes or rates for SDC. The Billing Lanes provided in the "Telephonic Reimbursement Overview" refer to fee-for-service rates and rate codes for services that are provided in fee-for-service and, as such, can be illustrative of payment options but are not expressly applicable to SDC.

Question 5: Do MLTC plans have the ability to review and approve the SDC providers plan for the provision of services telephonically?


Question 6: What is the effective date of the SDC Guidance?

The Guidance went into effect on the date of issuance, April 7, 2020.