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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
Cal Duals 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.
THIS IS HOW YOU CAN HELP:
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:
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
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
Medi-Cal 2020: New Waiver in Sight, But Long-Term Vision Needed
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.
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!
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CAADS Submits Comments on DHCS' Health Homes for Patients with Complex Needs Concept Paper Version 2.0
Medicare Coverage of Skilled Care: Nine Services that are Skilled by Definition
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. Medicare regulations also list nine specific services that are defined as skilled and covered by Medicare. 
The nine services, which apply to both skilled nursing facilities and to home health care, are:
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 email@example.com.
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:
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:
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.
The CAADS Members Only page features information and technical assistance specific to Adult Day Services, as highlighted below. For membership information, click here.
The 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.
NATIONAL ADULT DAY SERVICES ASSOCIATION (NADSA)
CAADS is a proud member of the National Adult Day Services Association.
Three representatives from California currently serve on the NADSA Board of Directors:
CARING FOR A VETERAN?
For help, call the VA Caregiver Support Line (toll-free):
Mon - Fri 8 AM - 11 PM (EST) || Sat 10:30 AM - 6 PM (EST)
TO REPORT FRAUD AND ABUSE
Call DHCS Medi-Cal Fraud Hotline:
The call is free and you can remain anonymous.
California Association for Adult Day Services
Human Kindness--it just flows around here[Download Real Player]
Brown Signs $167.7B Budget With Few Line-Item Vetoes
Protest Rises Over Medi-Cal Rates
SCOTUS: Providers Cannot Sue Over Low Medicaid Reimbursements
Brown Administration Continues Efforts To Replace MCO Tax
LAO Report Predicts $11.5B Surplus for FY 2016-2017
Half of State's Undocumented Likely To Qualify for Medi-Cal Coverage
Calif. To Pay Overtime Wages to Home Care Workers Starting in Feb.
Long-Range Outlook for Long-Term Care
$6 Billion Waiver Gets Federal Approval
Local Drug Take-Back Programs Could Be Pre-Empted by State Regulations
Poll Asks Duals for Opt-Out Reasoning
Decision on Social Security Could Affect Health Care Costs for State's Seniors
Developmental Disability Program Funding Efforts Could Be Stalled
Calif., Other States Nab $22.9M for Community Mental Health Clinics
State Scales Back Medicaid Waiver Request From $17 Billion to $7 Billion
Report: Record Medicaid Growth, Reforms
California Adopts Statewide Data Breach Notification Requirements
Your Money, Your Life
Marin Adult Day Health Care
Lydia Missaelides, MHA