CAADS - California Association for Adult Day Services

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Regulatory Review of Adult Day Services

NOV 20, 2015 | Source: US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE)

The US Department of Health and Human Services, Office of the Assistant Secretary for Planning and Evaluation (ASPE) recently released a report on Adult Day Services. The Regulatory Review of Adult Day Services, 2014 Edition provides information about each state’s approach to regulating this key community service. Adult day services (ADS)--a non-residential service provided outside an individual’s home for less than a full day--provides direct care to older adults and younger adults with physical disabilities.

The report was authored by RTI International including Janet O'Keeffe, Christine O'Keeffe and Madhu Shresthra.


Health Care Costs 101: A Spending Plateau

NOV 2015 | Source: California HealthCare Foundation (CHF), California Health Care Almanac

Health Care Costs 101: A Spending Plateau details how much is spent on health care in the US, which services are purchased, and who pays. View Infographic.


Cal Duals Update

OCT 2015 | Source: | View: Update


Tell Congress The Elderly Need Additional Funding for Housing and Community-Based Services

NOV 12, 2015 | Action Alert | Source: LeadingAge

Thanks to advocacy efforts, LeadingAge has achieved a preliminary victory on 2016 funding for senior housing and services programs. Now it is time to make sure these essential services get the funding increases they need.

For the last several months, LeadingAge has advocated for Congress to lift the spending caps that threatened severe cuts in housing and home- and community-based services. Late last month Congress passed a budget measure to do just that. Let's make sure that senior housing and services get the fair share of extra money this new budget allows.


Contact your lawmakers and tell them it is crucial that essential services for the aging get appropriations increases.


  • Sufficient funding is needed to cover the cost of renewing all existing rental assistance subsidy contracts for senior housing, including vouchers and project-based Section 8, project-based rental assistance (PRAC) under Section 202, and senior preservation rental assistance (SPRAC).
  • Full funding for the annual contracts is necessary in order to maintain the existing housing stock and prevent displacement of seniors or put scarce housing at risk.
  • These programs affect over 100,000 senior households. The typical Section 202 resident has an income of less than $11,000 per year, and needs assistance with housing and services in order to safely age in place.
  • The Section 202 PRAC projects operate on a very narrow margin. Nonprofits provide quality, affordable housing where seniors can receive the services they need.
  • Provide additional funding for home- and community-based services programs under the Older Americans Act. These services include congregate and home-delivered meals, chronic disease self-management, transportation, falls prevention and other cost-effective services that enable seniors to live independently in their communities.
  • Include adequate funding for the Social Services Block Grant that states use to serve seniors.

Your voice is important.


Justice in Aging Files Comments on Nondiscrimination In Health Programs

NOV 12, 2015 | Health Network Alert | Source: Justice in Aging

Recent proposed regulations issued to implement Section 1557 of the Affordable Care Act constitute a significant step in addressing discrimination in health care settings, including new provisions to address language access, gender identity discrimination, and access for individuals with disabilities. While the proposed regulations from the Department of Health and Human Services include many important protections, they leave some glaring gaps that remain to be addressed.

On November 9, Justice in Aging submitted extensive comments on the proposed rule, pointing to areas where the rules can be strengthened.

Our four key regulatory recommendations are:

  1. Include Medicare Part B providers as covered entities;
  2. Set bright line population thresholds to trigger requirements to translate vital documents;
  3. Ensure the prohibition of sex discrimination is sufficiently broad to encompass all sexual orientation and gender identity discrimination; and
  4. Strengthen enforcement and compliance by setting clear and specific standards.

Though HHS will take many months to issue final regulations, Section 1557 of the ACA is already law. Discrimination complaints based on the statute can be filed with the HHS Office of Civil Rights. The statute also, importantly, provides for a private right of action for covered discrimination claims.


NADSA Announces Executive Director Search

NOV 9, 2015 | Job Description | Source: National Adult Day Services Association (NADSA)

The National Adult Day Services Association (NADSA) is seeking a visionary and dynamic individual to lead our organization as Executive Director. Interested candidates are encouraged to visit the NADSA website to gain further insight into our mission, vision and strategy. M O R E


Medi-Cal 2020: New Waiver in Sight, But Long-Term Vision Needed

NOV 3, 2015 | The CHCF Blog by Christopher Perrone | Source: California HealthCare Foundation

The California Department of Health Care Services (DHCS) has announced a conceptual agreement with the Centers for Medicare & Medicaid Services (CMS) on a new Medicaid 1115 waiver. CMS has also approved an extension of California's current "Bridge to Reform" waiver through December 31, 2015. This is good news; it allows the flow of federal funds under the existing waiver to continue without interruption while state and federal officials finalize the scope and terms of the new five-year waiver, dubbed "Medi-Cal 2020."

Although the size of the new waiver ($6.2 billion with the potential for more) is considerably lower than the $17 billion California initially requested and less than the current $10 billion waiver, it nevertheless provides an important opportunity for California to leverage federal funds to advance several key initiatives. At the heart of Medi-Cal 2020 is the Global Payment Program for services to the uninsured in designated public hospital systems and an updated Delivery System Reform Incentive Payment (DSRIP) program. The new DSRIP program, called PRIME (Public Hospital Redesign and Incentives in Medi-Cal), provides up to $3.7 billion to public hospitals and district/municipal hospitals over five years. Other elements of the new waiver include an incentive program to improve dental care, a voluntary pilot program to support whole-person care at the county level, and independent studies of access to care and uncompensated care.

Numerous other important initiatives proposed by DHCS were dropped during negotiations with CMS, including incentive programs to improve access and quality in managed care, integrate physical health and specialty mental health, improve maternity care, expand provider participation in Medi-Cal, and provide housing and support services to Medi-Cal enrollees experiencing homelessness. While this outcome is disappointing, many of these initiatives do not require a federal waiver and can and should be advanced outside of the waiver process. M O R E


Social Security Improves Appeals Form

OCT 30, 2015 | Income Network Alert | Source: Justice in Aging

The Social Security Administration (SSA) has updated its Request for Reconsideration form (Form 561) . The form includes an improved explanation of the three types of appeals (case review, informal conference and formal conference) available for Supplemental Security Income (SSI) recipients.

It also has enhanced “Goldberg Kelly” information at the bottom of the form regarding due process protections for SSI recipients to be completed by SSA personnel in local offices documenting how they are handling the appeal. In addition, SSA removed the question “Claimant insists on filing?” from the section of the form to be completed by SSA personnel.

SSA made these revisions to Form 561 in response to the concerns raised in our issue brief, Why SSI Needs An Appeal Process That Works. The new Form 561 can be accessed from the forms page of the Administration’s website. The interactive form is available here.


New HCBS Heightened Scrutiny Q & A

OCT 27, 2015 | Income Network Alert | Source: Justice in Aging

Seniors and people with disabilities who receive Medicaid should have access to the home and community-based services (HCBS) that enable them to live with dignity and independence in their homes. Recent federal regulations require states to review their HCBS settings to determine if they are appropriately integrated in the community. As states conduct their reviews, stakeholders are encouraged to provide public comment.

A new HEIGHTENED SCRUTINY Q&A can help consumer advocates participate in the public comment process. This resource explains when a setting presumed to have institutional qualities may be approved to continue providing Medicaid HCBS through a process called “heightened scrutiny.”

Since the federal guidance and state transition plans are complex, disability and aging organizations prepared this Q&A to empower consumer advocates to get involved and weigh in on whether a setting is institutional.

For more on the state HCBS transition process, see Justice in Aging’s HCBS transition information is available here.


Advocacy Fund

Urgent help is needed to reach our fundraising goal of $45,000 to support efforts to restore Medi-Cal Funds! DONATE NOW to the California Adult Day Services State Advocacy Fund. (Contributions are NOT tax deductible). Thank you!

What's Trending . . .

Health Homes

CAADS Submits Comments on DHCS' Health Homes for Patients with Complex Needs Concept Paper Version 2.0
MAY 1, 2015 | Source: CAADS & CA Department of Health Care Services (DHCS) | View CAADS Letter | DHCS California Concept Paper Version 2.0 (Draft 4/10/2015)



In Compliance with HIPAA Omnibus Rule Effective September 23, 2013?
Source: CAADS | View Notice | Order Form for CAADS Updated HIPAA Manual for ADHC



Medicare Coverage of Skilled Care: Nine Services that are Skilled by Definition
AUG 2015 | Source: Center for Medicare Advocacy

The Center for Medicare Advocacy is concerned that Medicare beneficiaries are being denied Medicare coverage for skilled services that are specifically listed as covered by Medicare in federal regulations. Medicare covers various skilled therapies (physical, speech–language pathology and occupational) and skilled nursing services, including observation and assessment, management and evaluation of a care plan, or patient education.[1] Medicare regulations also list nine specific services that are defined as skilled and covered by Medicare. [2]

The nine services, which apply to both skilled nursing facilities and to home health care, are:

  1. Intravenous or intramuscular injections and intravenous feeding;
  2. Enteral feeding (i.e., “tube feedings”) that comprises at least 26 per cent of daily calorie requirements and provides at least 501 milliliters of fluid per day;
  3. Nasopharyngeal and tracheostomy aspiration;
  4. Insertion and sterile irrigation and replacement of suprapubic catheters;
  5. Application of dressings involving prescription medications and aseptic techniques;
  6. Treatment of extensive decubitus ulcers or other widespread skin disorder;
  7. Heat treatments which have been specifically ordered by a physician as part of active treatment and which require observation by nurses to adequately evaluate the patient's progress;
  8. Initial phases of a regimen involving administration of medical gases; or
  9. Rehabilitation nursing procedures, including the related teaching and adaptive aspects of nursing that are part of active treatment, e.g., the institution and supervision of bowel and bladder training programs.[3]

The Center recently received a denial of Medicare coverage for skilled nursing services for intramuscular injections of vitamin B-12 for an approved diagnosis in a home health case. This patient was homebound and met all the criteria for Medicare coverage of home care. So far, at each level of appeal, the Medicare Contractor or judge has inappropriately denied Medicare coverage. The latest reason for denial is that the “Vitamin B-12 injection products are often purchased without a prescription and self-injected by individuals without medical training.” This reason for denying a skilled nursing service is improper, and we will pursue the case.

Most often the nine skilled services are automatically covered by Medicare, however, denials seem to be occurring more frequently for services that Medicare recognizes as “per se” skilled. We are seeing denials most often for tube feedings, wound care and intramuscular injections, but any of the nine per se skilled services may be improperly denied.

We encourage people to appeal improper denials of skilled care, particularly of per se skilled care. We want to monitor instances of these denials, whether in traditional Medicare or with Medicare Advantage companies. Please let us know by emailing

[1] 42 CFR 409.33(a)
[2] 42 CFR 409.33(b)
[3] See also CMS Medicare Benefit Policy Manual, Pub. 100-02, Ch. 8, Sec. 30.3 and Ch. 7, Sec. 40.1 et seq.

CMS Report Finds Widespread Illegal Billing of Low-Income Medicare Beneficiaries
AUG 11, 2015 | Source: Justice in Aging | View Report

A new report by the federal Centers for Medicare and Medicaid Services (CMS) verifies a troubling trend for poor seniors: across the country, health care providers are illegally billing low-income Medicare beneficiaries.

The practice, known as “balance billing,” occurs when health care providers are billing low-income Medicare beneficiaries for portions of their medical bills. Qualified Medicare Beneficiaries (QMB) are protected against balance billing. However, as the report demonstrates, QMBs are frequently illegally balance billed. For years, Justice in Aging has provided guidance to attorneys and advocates assisting clients with stories like this:

“My medical bills never seem to be right. I often get bills that I should not be receiving. I get so frustrated fighting the system that I just pay them. I am a master at going without things that I need.” In this first-of-its-kind federal report, CMS identifies problems at both the health care provider and Medicaid systems level driving this inappropriate billing practice.

Justice in Aging applauds CMS for highlighting the stories of beneficiaries who are illegally balance billed and for providing detailed data and research to explain this problem. As CMS, Justice in Aging, and advocates across the country work to end balance billing, the information in this report is an invaluable tool for understanding the problem and its many complexities.

Unfortunately, as the report demonstrates, balance billing happens everywhere. Advocates are encouraged to review Justice in Aging’s balance billing materials and tell us about problems you are seeing. We covered the report on our blog and you can access all of our Balance Billing resources for advocates below:

Transition Policies for Medicare Part D: 2015 Update
JAN 7, 2015 | Source: Justice in Aging | View Update


California Association for Adult Day Services, a 501 (c) 6 non-profit grassroots-driven organization, advocates for the growth and development of adult day services in California and nationally. CAADS was the first state association formed in the United States for the purpose of advancing adult day services. Centers in membership with CAADS provide innovative day programs that support individuals with physical or mental disabilities and older adults with Alzheimer's disease and their families.

A nationally recognized leader in the field of aging, the Association is governed by the CAADS Board of Directors and provides timely information, analysis, advocacy, technical assistance, education, and networking opportunities for its members. CAADS members agree to abide by the Association's Bylaws, Code of Ethics, and Anti-trust Policy.

Board of DirectorsBylawsCode of EthicsAnti-trust Policy2014 Annual Report

The CAADS Members Only page features information and technical assistance specific to Adult Day Services, as highlighted below. For membership information, click here.

  • State Budget Proposals, Legislative Alerts & Advocacy
  • CBAS Waiver
  • Medi-Cal Issues
  • Medicare and Medi-Cal Dual Beneficiaries News & CCI / CalDuals Updates
  • Managed Care Health Plans & CA Dept of Managed Health Care Updates
  • ADHC / CBAS Licensing & Regulations (DPH, DHCS, CDA)
  • Adult Day Program (ADP) Licensing & Regulations (DSS, CCLD)
  • Funding Sources
  • Education & Training Materials / Webinar Recordings
  • Membership Roster


ALE logoThe Alliance for Leadership and Education (A.L.E.) is a non-profit 501(c)(3) public benefit arm of CAADS. Its mission is to advance innovation and quality in Adult Day Service through research and analysis, education and training, and leadership for the benefit of consumers and their caregivers.


CAADS is a proud member of the National Adult Day Services Association.

Three representatives from California currently serve on the NADSA Board of Directors:

Corinne Jan, RN, PHN
CEO, Family Bridges / Hong Fook Centers

Lydia Missaelides, MHA
Executive Director, CAADS

Amanda Sillars, MSW, LCSW
CEO, Total ADHC Solutions, Inc.


For help, call the VA Caregiver Support Line (toll-free):


Mon - Fri 8 AM - 11 PM (EST) || Sat 10:30 AM - 6 PM (EST)


Call DHCS Medi-Cal Fraud Hotline:


The call is free and you can remain anonymous.



California Association for Adult Day Services
1107 9th Street, Suite 701 || Sacramento, CA 95814-3610
T: (916) 552-7400 || F: (866) 725-3123

Human Kindness--it just flows around here
[Download Real Player]

Click to view the clip from CAADS 25th anniversary video
Honoring Adult Day Services pioneers and those they serve.


Brown Signs $167.7B Budget With Few Line-Item Vetoes
California Healthline

Protest Rises Over Medi-Cal Rates
California Healthline

SCOTUS: Providers Cannot Sue Over Low Medicaid Reimbursements
California Healthline


Brown Administration Continues Efforts To Replace MCO Tax
NOV 20, 2015
California Healthline
Key Words:
managed care organization | Medi-Cal | Medicaid | MCOs | Medi-Cal budget | health care | tiered system of taxation | health plans

LAO Report Predicts $11.5B Surplus for FY 2016-2017
NOV 19, 2015
California Healthline
Key Words:
health-related services | surplus | State HHS Spending | health and human services programs | Medi-Cal | managed care organization tax | Medicaid | In-Home Supportive Services | DSS Spending

Half of State's Undocumented Likely To Qualify for Medi-Cal Coverage
NOV 10, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
Medi-Cal health coverage | federal poverty level | health care assistance | extend Medi-Cal to undocumented adults who qualify | how to budget for it

Calif. To Pay Overtime Wages to Home Care Workers Starting in Feb.
NOV 9, 2015
California Healthline
Key Words:
Department of Social Services | overtime pay to home care workers | in-home care services | DSS | In-Home Supportive Services workers | IHSS | Service Employees International Union-California | SEIU Local 2015

Long-Range Outlook for Long-Term Care
NOV 9, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
long-term care policy issues | Long-Term Services and Supports | Select Committee on Aging | home health pilot | new 1115 waiver | greater coordination and better integration of care | person-centered vision of care

$6 Billion Waiver Gets Federal Approval
NOV 2, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
CMS | California's Medicaid program | Medi-Cal | Affordable Care Act | whole-person pilot project | "Medi-Cal 2020" | Department of Health Care Services | safety-net system | low-income Medi-Cal and uninsured patients in California

Local Drug Take-Back Programs Could Be Pre-Empted by State Regulations
NOV 2, 2015
California Healthline
George Lauer
Key Words:
disposal of prescription drugs | California Board of Pharmacy | statewide drug take-back | health care problem | FDA

Poll Asks Duals for Opt-Out Reasoning
OCT 28, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
Californians dually eligible for Medi-Cal and Medicare | care coordination | Cal MediConnect | duals demonstration project

Decision on Social Security Could Affect Health Care Costs for State's Seniors
OCT 22, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
Seniors | Medicare | Social Security Administration | dually eligible for Medicare and Medi-Cal | Medicare Part B | health care | protect seniors from premium hikes

Developmental Disability Program Funding Efforts Could Be Stalled
OCT 22, 2015
California Healthline
Key Words:
developmental disability programs | Lanterman Developmental Disabilities Services Act | regional centers

Calif., Other States Nab $22.9M for Community Mental Health Clinics
OCT 22, 2015
California Healthline
Key Words:
community mental health clinics | Excellence in Mental Health Act | federally qualified community behavioral health centers | Medicaid

State Scales Back Medicaid Waiver Request From $17 Billion to $7 Billion
OCT 21, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
1115 Medicaid waiver | Department of Health Care Services | CMS | Medi-Cal program | managed care plans

Report: Record Medicaid Growth, Reforms
OCT 16, 2015
California Healthline
Capitol Desk
Rebecca Veseley
Key Words:
Medicaid | Affordable Care Act | Medi-Cal | delivery system reforms | managed care contracts | managed care plans | all-payer claims database

California Adopts Statewide Data Breach Notification Requirements
OCT 15, 2015
California Healthline
Key Words:
personal health records | medical information | health care identity protection services | Data encryption standards (AB 964) | definition of personal information (SB 34) | language for data breach notifications (SB 570)

Prior Coverage


Easter Seals Supports Employment of Veterans
PSA Video Series
What to Wear
Morning Routine
The Bank

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Abraham Verghese
A doctor's touch
Physician and writer Abraham Verghese describes our strange new world where patients are merely data points, and calls for a return to the traditional one-on-one physical exam.

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"Forget About Living Paycheck to Paycheck. Let's talk about Day to Day"
1 in 5 senior women lives in poverty. Dollie, Myrtle, Sandy, and Lidia share stories about what life is like for low-income older women.

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San Ysidro Health Center, Inc.
Caring for Our Greatest Generations
Celebrating SYHC's 45th Anniversary

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Your Money, Your Life
What are Adult Day Services
Elder Law Attorney Ramsey A. Bahrawy interviews Amanda Sillars of Total ADHC Solutions
What Are Adult Day Services
Adult Day Services - a win, win, win opportunity
Resistance and Dementia
Adult Day Services vs. Home Care: "It's about value"

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PBS NewsHour
Innovating technology for the needs and health of elders
Featuring Institute on Aging

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Marin Adult Day Health Care
"A Day in the Life": LifeLong Medical Care's Marin Adult Day Health Care Center

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The Falling Monologues
Full Length
The Falling Monologues
The Ladder
The Bus
The Sidewalk
Scatter Rug
Don't Ask


Photo of Lydia Missaelides

Lydia Missaelides, MHA
Executive Director

Photo of Pamela Amundsen

Pamela Amundsen
Education & Events Manager

Photo of Kathryn Atkinson

Kathryn Atkinson
Membership & Communications Director

Photo of Coni Segretto-Ricci

Coni Segretto-Ricci
Office Assistant

Phyliss Regino
Office Assistant
not pictured)
Please Direct Questions and Comments to

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