For a New York Social Adult Day Care provider, a Certificate of Occupancy is not just a building document sitting in a file. Current SADC certificate of occupancy requirements connect the facility's permitted capacity with the people actually receiving services there.
Under MLTC Policy 25.05, Managed Long Term Care plans must verify current occupancy documentation for the correct SADC location and review attendance records against the maximum occupancy allowed for the space.
That creates an important operational question: if someone compares your facility's permitted capacity, time-stamped attendance, and Medicaid encounter data for the same date, do those records tell a consistent story?
A February 2026 New York State Comptroller audit shows why this matters. At one reviewed SADC with documented maximum capacity of 323 people, auditors identified hundreds of service dates where encounter data indicated more participants than the facility's capacity.
What Are New York SADC Certificate of Occupancy Requirements?
Under MLTC Policy 25.05, MLTC plans must verify that a contracted SADC has and maintains current Certificate of Occupancy documentation for the correct ownership and physical location.
Verification is required before enrollment into the MLTC plan's contracted network and annually thereafter. The MLTC plan must also retain a copy as evidence for surveillance and audit purposes.
An adult day care certificate of occupancy establishes how the physical location is permitted to be used and the occupancy limitation applicable to that space.
OMIG's current SADC certification process also asks providers to certify whether the SADC has a current, valid Certificate of Occupancy approved for the premises.
For a multi-location organization, do not assume the building document from one center automatically covers another site. The documentation needs to apply to the physical location being evaluated.
What Makes a Certificate of Occupancy Valid Under Current New York Guidance?
NYSDOH's MLTC Policy 25.05 FAQs provide additional guidance about the municipal documentation plans should review.
If the original Certificate of Occupancy does not contain everything needed, NYSDOH says a combination of official municipal documents may be used to establish the required information.
| Item | What the Documentation Should Help Establish |
|---|---|
| SADC / location | The documentation applies to the correct facility |
| Ownership / name | The correct operating entity is identified where applicable |
| Validity | The documentation is current under applicable guidance |
| Maximum occupancy | The official allowable occupancy for the applicable space |
| Permissible use | The use classification is appropriate for SADC operations |
| Physical address | The documentation corresponds to the site being evaluated |
NYSDOH's current FAQ explains that generic commercial or residential classifications are not sufficient for the permissible-use check described in Policy 25.05 guidance.
Providers should review the actual municipal documents with the appropriate local authorities and their MLTC plans rather than assuming that having any Certificate of Occupancy in the file is enough.
How Does SADC Maximum Occupancy Connect to Attendance?
This is where the building record becomes an operational record. Policy 25.05 requires MLTC plans to observe occupancy during site evaluations and collect and review attendance records to determine whether the SADC is operating within the maximum allowed occupancy.
The SADC attendance records reviewed for this purpose should include, at minimum, the member name, date, start time, and end time.
- Member name
- Service date
- Start or arrival time
- End or departure time
Start and end times are especially important because maximum occupancy generally concerns how many people are in the applicable space at a given time. That is different from simply counting every unique participant who appeared at any point during an entire operating day.
For example, a center could have separate groups attending at different times without all of those participants being inside the facility simultaneously.
So the better operational question is not simply whether 120 unique people attended a location with a capacity of 100. The stronger question is whether the attendance timeline shows more people in the applicable space at one time than the permitted maximum.
Providers should confirm the applicable interpretation with their MLTC plan and municipal requirements. If your center still depends on paper sheets or editable spreadsheets, see how adult day care attendance tracking can preserve time-stamped arrivals, departures, and correction history.
What Did the 2026 New York SADC Audit Find?
The February 2026 New York State Comptroller SADC audit provides a concrete example of how occupancy and Medicaid encounter data can conflict.
At one location operating across three floors, the Certificate of Occupancy showed a combined maximum capacity of 323 people.
The Comptroller reported 386 service dates where encounter data indicated the number of members exceeded that capacity.
For September 28, 2022, encounter claims data showed services for 530 members. That was 207 above the facility's documented maximum capacity, with $47,255 in payments associated with that day's encounter data.
The Comptroller recommended that DOH review improper and questionable encounter payments and make recoveries where appropriate.
This does not mean that every high daily claim count automatically proves over-occupancy, fraud, or an improper payment. It does mean that a major discrepancy between permitted capacity and SADC Medicaid encounter claims demands an explanation supported by reliable underlying records.
Does a Claim Count Above Capacity Automatically Mean the Center Was Over Capacity?
Not necessarily. Claims or encounter records tell you what was reported for Medicaid purposes. They are not, by themselves, a minute-by-minute physical census of the building.
If one location has a maximum occupancy of 100 but encounter records show services for 120 unique members on the same date, your first step should be reconciliation rather than an assumption.
- Were all participants actually at the same physical location?
- Did some participants attend at different times?
- Do arrival and departure records show overlapping occupancy?
- Were any encounters assigned to the wrong site?
- Is the correct location-specific provider information on the encounter?
- Are there duplicate, adjusted, or corrected encounters?
- Does the occupancy documentation apply to the correct space?
- Is the maximum occupancy figure current?
If your records cannot answer those questions, the discrepancy becomes much harder to explain or correct.
Why the Correct SADC Location Matters to Medicaid Encounter Data
Multi-location operators have another layer to manage. NYSDOH's Policy 25.05 FAQs state that organizations with multiple SADC locations must obtain a separate NPI for each location and that the validated location NPI must be included in applicable claim and encounter reporting.
That means occupancy reconciliation should not stop at member count. You also need to ask whether the service was attributed to the correct physical SADC location.
A valid Certificate of Occupancy for Site A does not explain encounter volume attributed to Site B.
A useful operational chain is: participant → date → physical location → attendance times → applicable occupancy limit → encounter or claim.
Our adult day care Medicaid billing software guide explains why keeping billing closer to the operational record behind the service day can reduce manual reconciliation later.
What Records Should Support an Occupancy Review?
A useful occupancy review typically pulls information from several places. For a broader recordkeeping framework, see our adult day care documentation requirements guide.
| Record | Question It Should Help Answer |
|---|---|
| Certificate of Occupancy | What is the permitted maximum for this location? |
| Municipal supporting records | Is the documentation current and appropriate for the site's use? |
| Member attendance | Who was actually present? |
| Start and end times | Which participants overlapped in the building? |
| Site / location record | Which physical center provided the service? |
| Encounter data | Which members and services were reported for that date and site? |
| Claims | What was ultimately submitted for payment? |
| Corrections | Were attendance or billing records changed later? |
Do not treat these records as interchangeable. The Certificate of Occupancy establishes one type of fact. Attendance establishes another. Claims establish another. The goal is consistency across them.
Run a One-Day Occupancy Reconciliation
You do not need to start with months of data. Choose one recent service date and one SADC location.
- Locate the current Certificate of Occupancy or applicable municipal documentation
- Confirm the maximum occupancy for the applicable space
- Pull the day's attendance records
- Verify arrival and departure times are complete enough to evaluate overlap
- Determine the highest simultaneous participant census your records show
- Pull the encounter data associated with that location and date
- Compare the encounter population with actual attendance
- Investigate participants appearing in one record but not the other
- Confirm claims and encounters are associated with the correct site
- Review any corrections or later changes
Then repeat the exercise for several high-volume dates. For a wider internal review, use our adult day care audit checklist.
If you repeatedly discover missing departure times, duplicate attendance, wrong-site encounters, or claims that cannot be reconciled to actual presence, focus on fixing the workflow creating those mismatches.
How Can Adult Day Genie Help Connect Headcount With Claims?
Adult Day Genie starts the participant record with actual attendance. Staff can use consent-based face confirmation or manual check-in. Attendance events are time-stamped, and corrections append to the history rather than quietly replacing earlier entries.
Member information, authorizations, care plans and forms, attendance, daily documentation, reporting, and Medicaid billing can then remain closer together.
- See who was present at a particular time
- Identify which location the participant attended
- Review arrival and departure times
- See whether an attendance entry was corrected
- Compare the participant-day with the billing record
- Investigate why an encounter appears without matching attendance
You can review the broader workflow on the Adult Day Genie features page.
Adult Day Genie does not validate a Certificate of Occupancy, determine a municipality's legal occupancy calculation, guarantee compliance, or decide whether a Medicaid claim is payable. Those determinations belong to the relevant authorities, plans, payers, and qualified professionals.
Its operational value is simpler: attendance and billing do not have to live in completely separate systems.
What Should New York SADC Providers Do Now?
Start with each physical location. Confirm that the Certificate of Occupancy or other applicable municipal documentation being relied on is current and applies to the correct site.
Identify the maximum occupancy your MLTC plan is using, then test several busy days. Compare the permitted maximum with time-stamped attendance rather than relying only on schedules or a total daily count.
Compare attendance with encounter data. Confirm participants and claims belong to the correct location. Investigate unexplained differences instead of allowing them to accumulate.
The strongest approach to SADC certificate of occupancy requirements is not waiting until a reviewer identifies a number that looks impossible. It is making sure your facility record, attendance record, and Medicaid record can already explain one another.
If your team is still reconstructing that relationship from paper sign-in sheets, spreadsheets, and a separate billing system, see Adult Day Genie in a 15-minute walkthrough.
Frequently Asked Questions
What Certificate of Occupancy does a New York SADC need?
Under current MLTC Policy 25.05 guidance, MLTC plans must verify current official occupancy documentation that applies to the correct SADC location and supports the required location, maximum occupancy, and permissible-use information.
How often must an MLTC plan verify a SADC Certificate of Occupancy?
Policy 25.05 requires verification before a SADC enters the contracted MLTC network and annually thereafter.
What attendance information is used to check SADC maximum occupancy?
Current Policy 25.05 says attendance records reviewed for occupancy should include at least the member's name, date, start time, and end time.
Does serving more unique members in one day than the occupancy limit automatically mean a violation?
Not necessarily. Maximum occupancy concerns how many people are permitted in the applicable space at a given time. Time-stamped attendance can help establish whether participants overlapped above the permitted maximum.
Can Medicaid encounter claims create an occupancy red flag?
Yes. Encounter data that appears inconsistent with permitted capacity or attendance records can require further review and reconciliation with the underlying service-day and location records.
This article provides operational information, not legal, billing, building-code, or compliance advice. New York SADC providers should confirm current requirements with NYSDOH, their MLTC plans, applicable municipal authorities, Medicaid guidance, contracts, and qualified professional advisers.