DAL NH 15-11: Adult Day Health Care Program Survey Tool

December 31, 2015

Subject: DAL NH 15-11 Adult Day Health Care Program Survey Tool

Dear Nursing Home Administrator:

The purpose of this letter is to inform you of changes in the New York State Department of Health (the Department) oversight of Adult Day Health Care Program (ADHCP) providers in the Medicaid program and to reinforce provider documentation requirements and billing guidelines. The focus of this communication is on the common areas where providers may be out of compliance with State and Federal billing and reimbursement requirements.

With this letter, the Division of Nursing Homes and ICF/IID Surveillance is distributing the revised Adult Day Health Care Program (ADHCP) Survey Tool that was implemented on June 1, 2015. The New York State Department of Health (DOH) undertook this effort to ensure that registrants attending ADHCP's receive the highest level of care, with accurate and adequate reimbursement for the service provided. This revised tool will enable the DOH to collect more accurate information regarding program compliance with the regulatory documentation requirements. Please review the attachment and please re-examine your systems to ensure that adequate controls are in place for all aspects of operation of your ADHCP.

While the survey process is not typically used to monitor billing and payment-related items, document review is a major part of that process. ADHCP providers must remember that proper documentation and record keeping is crucial and will help ensure the appropriate utilization of services and improved outcomes for program registrants, as well as more accurate billing and timely reimbursement for ADHCP's. While ADHCP providers should have a strong grasp of all relevant State and Federal regulatory requirements, the Department encourages ADHCP providers to review Title 10 NYCRR, Part 425 as related to documentation and record keeping requirements as well as payment to ADHCP providers. Specifically, some of the relevant sections to review include:

  • Section 425.19 General records;
  • Section 425.20 Clinical records;
  • Section 425.21 Confidentiality of records; and
  • Section 425.23 Payment.

It is imperative that ADHCP providers remember that all decisions made regarding program registrants should be well documented.

With regard to the benefit of ADHCP under Managed Long Term Care (MLTC), payment is negotiated between the ADHCP provider and the MLTC plan directly, and should be made in accordance with such agreement. This must also be properly documented and retained as part of the ADHCP records.

The Department acknowledges and appreciates the progress made in operating the Adult Day Health Care Programs. We encourage your efforts to provide our registrants with a safe environment that allows them to enjoy a meaningful and satisfying quality of life. Please contact Michelle Louy for surveillance questions at 518-408-1267 and Jennifer Alhart for billing questions at 518-474-6965.


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

Shelly Glock, Director
Division of Nursing Homes and ICF/IID Surveillance
Center for Health Care Provider Services & Oversight