CAADS - California Association for Adult Day Services


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Community Based Adult Services (CBAS)

Coordinated Care Initiative (CCI) / Cal MediConnect

Legal Updates


CAADS FALL CONFERENCE: Exhibitors, Sponsors Invited to Participate!

CAADS is pleased to invite Exhibitors and Sponsors to participate in Adult Day Services: Partnering for Success, CAADS Fall Conference and Annual Meeting, November 16-18, 2015, at the Westin Hotel in Long Beach, CA. Act by September 11, 2015 for best opportunities:

  • EXHIBITORS with signed contract and full payment by SEPT 11, receive $100 discount, plus additional advertising exposure!
  • SPONSORS with support confirmed by SEPT 11, get listed in Conference brochure and event marketing materials!

What's New . . .

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 communications@medicareadvocacy.org.

________________________________________
[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 https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c08.pdf and Ch. 7, Sec. 40.1 et seq. https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/bp102c07.pdf
________________________________________


New Report -- Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity

AUG 28, 2015 | View: Report | Source: Office of Health Equity, California Department of Public Health

In this this document, the California Statewide Plan to Promote Health and Mental Health Equity (“Plan”), we present background and evidence on the root causes and consequences of health inequities in California. We explore and illustrate how a broad range of socioeconomic forces, including income security, education and child development, housing, transportation, health care access, environmental quality, and other factors, shape the health of entire communities — especially vulnerable and underserved communities — resulting in preventable health inequities for specific populations. With a better, data-based understanding of the causes and consequences of health inequities, Californians will be better prepared to take the steps necessary for promoting health across California’s diverse communities and building on the great strengths that our diverse population brings. M O R E


Fresh Data on ACA 411 Show Impact of Health Reform in California

2014 Numbers Illuminate How Access to Care Is Changing
AUG 26, 2015 | View: Data | Source: California Healthcare Foundation

The California HealthCare Foundation (CHCF) has updated its ACA 411 interactive web tool with new survey data to track the impact of the Affordable Care Act on insurance coverage, access to health care services, and affordability in California in 2014. The numbers suggest improvements in access to care, including that the uninsured rate is at a new low and fewer Californians are delaying or skipping necessary medical care. ACA 411 makes it easy to compare data and see trends. M O R E


New 50 State Survey of Dementia Training Requirements

AUG 24, 2015 | View: Survey Findings | Source: Justice in Aging

With more than 5 million people living with Alzheimer’s and other dementias, there’s a growing need for robust training standards for health care professionals in the special needs of people with cognitive impairment. For example, though 64% of nursing home residents have dementia, only 23 states have laws prescribing training requirements for direct care staff in nursing homes and, of those, only one state requires staff to pass competency examinations. Only ten states require dementia training for law enforcement.

We looked at dementia training requirements for professionals in a variety of health care and community settings and found wide variation among states in both the amount and the content of required training. We compiled our findings in a five-paper series, Training to Serve People with Dementia: Is our Health Care System Ready?. M O R E


How Consumers Find Information About Prescription Coverage

AUG 19, 2015 | View: Report | Source: California Healthcare Foundation

When shopping for health plans, consumers face many challenges in finding information on prescription drug benefits. Publicly posted formularies are often difficult to navigate due to lack of standardization, may be presented in arcane terminology, provide incomplete and inaccurate information, and frequently are not available in languages other than English.

Hidden From View: How Consumers Find Information About Prescription Coverage provides insight into the consumer experience of accessing prescription drug coverage information, pinpoints consumer priorities and preferences for display of relevant benefit information, and identifies opportunities for making benefit information more accessible and easy to comprehend. Consumer input yielded many recommendations for making prescription drug benefit information easier to find and use. M O R E


Cal MediConnect Health Risk Assessment Data - August 2015

AUG 20, 2015 | Source: Sarah Brooks, Deputy Director, Health Care Delivery Systems, Department of Health Care Services (DHCS)

Today, the Department of Health Care Services (DHCS) is releasing new data on Health Risk Assessment (HRA) completion rates in the Cal MediConnect program. You can find the new Cal MediConnect HRA Dashboard and more information about HRAs here. Starting with this release, a new dashboard will be available quarterly.

Cal MediConnect HRA Dashboard

Earlier this year, DHCS released an initial HRA dashboard with data from April to September 2014. At that time, the Cal MediConnect health plans were reporting data in different ways, making it difficult to understand individual health plan performance or compare across plans. Since that initial dashboard was released, DHCS and the Centers for Medicare and Medicaid Services (CMS) have worked with the Cal MediConnect health plans to clarify reporting requirements and standardize definitions. All Cal MediConnect health plans resubmitted data for April to September 2014, and that revised data is reflected as part of this dashboard. The previous dashboard should no longer be used to understand plan performance.

The data shows that from April 2014 through March 2015, Cal MediConnect health plans completed 89 percent of HRAs within 90 days of enrollment for beneficiaries who took part in the HRA process and could be reached by the health plan. The data also showed that 35 percent of beneficiaries were unreachable, and 10 percent of beneficiaries were unwilling to participate.

DHCS, CMS, and the Cal MediConnect health plans are working together to share best practices and improve the health plans' ability to reach their beneficiaries in order to complete the HRA process. For example, health plans are partnering with other providers, such as pharmacies, that may have more up-to-date contact information for beneficiaries. M O R E


Golden Castle ADHC Center and Institute on Aging Selected to Host Screening of "Being Mortal"

FRONTLINE documentary shares the experiences of patients and families at the end of life.
AUG 2015 | Source: California Healthcare Foundation (CHF)

SEPT 9 | 6:00 PM to 9:00 PM
Golden Castle Adult Day Health Center
1137 San Antonio Road, Suite B, Palo Alto, CA 94303

SEPT 10 | 2:00 PM to 5:00 PM
Institute on Aging
3575 Geary Boulevard, San Francisco, CA 94118

In 2014 Harvard surgeon and writer Atul Gawande published the best-seller Being Mortal about modern medicine and the larger culture's difficulty with accepting death. In February 2015, a FRONTLINE documentary also called "Being Mortal" aired on public television stations nationwide. The program, which follows Dr. Gawande, shares the close-up experiences of several patients and families at the end of life, including his own.

The California HealthCare Foundation (CHCF) and the Harman Foundation have teamed up to promote community screenings of "Being Mortal" and assess their impact. Thirty-nine organizations across the state were selected to receive up to $2,000 to host events before the end of September 2015, and some will screen the film more than once. Held in a variety of community settings and targeting diverse audiences, the screenings and post-screening discussions are intended to educate participants about choices they might make if they had a serious illness and encourage them to identify and communicate their wishes to those who matter.

View the interactive map for a list of "Being Mortal" screenings scheduled as of AUG 10, 2015.


Micheal Pope to Receive 2015 National Adult Day Services Director Award

AUG 11, 2015 | Source: National Adult Day Services Association (NADSA)

Micheal Pope, Executive Director/Administrator of Alzheimer's Services of the East Bay, has been selected for the 2015 National Adult Day Services Director Award. She will be recognized on Friday, October 16, 2015, at a luncheon during the NADSA Annual Conference at the Hilton Squaw Peak Resort in Phoenix, Arizona.

This award recognizes adult day center administrators/directors who have demonstrated outstanding leadership within their centers and their communities, in such areas as management skills, effective stewardship with budgets and fundraising, program development, and team building.

CAADS congratulates Micheal for being named to receive this prestigious and well-deserved award!


CMS Report Finds Widespread Illegal Billing of Low-Income Medicare Beneficiaries

AUG 11, 2015 | Report | Source: Justice in Aging

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:


CUFF Act Put to Bed—for Now

AUG 6, 2015 | CUFF Act Analysis by Justice in Aging | Source: Justice in Aging

Mid-way through June, Social Security and SSI benefits were on the Congressional chopping block as an offset for a transportation bill. We mobilized our network on this issue and you responded by contacting your representatives and delivering the message loud and clear: we should not finance highways by cutting off Social Security and SSI benefits to the low-income seniors and people with disabilities who need them the most.

Thankfully, we were able to build enough opposition in the Senate to get the Social Security and SSI cuts removed from the transportation bill. However, cuts to these vital programs, transparently mislabeled as the "Control Unlawful Fugitive Felons Act of 2015" or CUFF Act, are likely to be proffered again as offsets on other bills in this Congress. Please watch for future action alerts.


California Adult Day Services State Advocacy Fund

URGENT HELP NEEDED TO REACH OUR FUNDRAISING GOAL OF $45,000 BY AUG 31

Donate Now (Contributions NOT tax deductible) | Source: CAADS

Please Help Support Efforts to Pass AB 1261 and Restoration of Medi-Cal Funds!


What's Trending . . .

California State Budget

ASSEMBLYMEMBER LEVINE PROPOSES FUNDING FIXES FOR VITAL HEALTH CARE SERVICES
JUL 16, 2015 | Source: Press Release, Assemblymember Marc Levine, District 10

Today Assemblymember Marc Levine (D-San Rafael) introduced legislation to close a funding gap for Medi-Cal and other vital health services, bringing a needed solution to the legislative extraordinary session on health funding.

This fix would preserve $1.1 billion in federal matching funds that were threatened after the federal government rejected a sales tax on Medi-Cal plans that California had previously used to provide its share of Medicaid funding. Resolving the problem is vital to implementation of the Affordable Care Act. AB 4 (Levine) 2nd Ext. also provides needed funding for in-home support services and developmental services. M O R E

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SUMMAY OF THE GOVERNOR'S MAY REVISION OF THE 2015-16 BUDGET:
Impact on California's Older Adults and People with Disabilities

MAY 28, 2015 | Fact Sheet: | Source: The SCAN Foundation


Health Homes

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


HIPAA

IN COMPLIANCE WITH HIPAA OMNIBUS RULE EFFECTIVE SEPT 23, 2013?
Notice  |  Get CAADS Updated HIPAA Manual for ADHC! | Source: CAADS


Medicare

TRANSITION POLICIES FOR MEDICARE PART D: 2015 Update
JAN 7, 2015 | Update | Source: NSCLC


CAADS

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.

CAADS Board of Directors

CAADS Bylaws

CAADS Code of Ethics

CAADS Anti-trust Policy

CAADS 2014 Annual Report

The CAADS Members Only page features information and technical assistance specific to Adult Day Services:

  • State Budget Proposals
  • CBAS Waiver
  • Medi-Cal Issues
  • Medicare and Medi-Cal Dual Beneficiaries News
  • Managed Care Health Plans
  • Coordinated Care Initiative (CCI) and CalDuals Updates
  • CA Dept of Managed Health Care Updates
  • CA Dept of Public Health Licensing & Regulations for ADHC / CBAS Centers
  • CA Dept of Social Services Licensing & Regulations for ADP Centers
  • Legislative Alerts and Advocacy
  • Funding Sources
  • Education / Training Materials / Webinar Recordings
  • CAADS Membership Roster

Membership Information

CAADS - A.L.E.

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.

NINA M. NOLCOX SCHOLARSHIP FUND

Donate Today!

Photo of Nina Nolcox
Nina Martine Nolcox, RN, PHN
1965 - 2014
Forever In Our Hearts



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:

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.


CARING FOR A VETERAN?

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

1-855-260-3274

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:

1-800-822-6222

The call is free and you can remain anonymous.


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


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.

* * * * *

Highlighted Media Coverage

Brown Signs $167.7B Budget With Few Line-Item Vetoes
JUN 25, 2015
California Healthline

Protest Rises Over Medi-Cal Rates
JUN 2, 2015
California Healthline

SCOTUS: Providers Cannot Sue Over Low Medicaid Reimbursements
MAR 31, 2015
California Healthline

Recent Media Coverage

Report: Demographic Disparities in California Greatly Affect Health
AUG 28, 2015
California Healthline
Key Words:
disparities | physical and mental health | health outcomes | poverty
[View Report]


Rural Northern Counties Set To Launch Pilot Palliative Health Care Initiative
AUG 26, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
Partnership HealthPlan of California | Medi-Cal managed care | Napa Valley Hospice and Adult Day Services


Federal Court Sides With Home Workers
AUG 24, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
home health workers | overtime pay and minimum wage rates | In-Home Supportive Services workers


Republicans Balk at Revised MCO Tax
AUG 21, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
tax on managed care organizations | Senate Public Health and Developmental Services Committee | MCO | Medi-Cal provider rates and funds for the developmental disabled | health care proposals | protecting the most vulnerable citizens


Governor Signs Bill Allowing Mid-Level Practitioners To OK Resuscitative Edicts
AUG 19, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
nurse practitioners and physician assistants | resuscitative measures | AB 637 (Campos) | Physician Orders for Life Sustaining Treatment | POLST | end-of-life treatment options
(Law goes into effect 1/1/16)


Feds OK State's Drug Medi-Cal Waiver
AUG 18, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
CMS | Drug Medi-Cal waiver | Mental Health | integrated safety-net delivery system | Drug Medi-Cal Organized Delivery System


Effort Ramps Up To Establish MCO Flat Tax as Legislature Reconvenes
AUG 17, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
managed care organization tax | ABX2-4 | In-Home Supportive Services | restoration of the 10% Medi-Cal provider reimbursement rate cut from 2011 | health care


CMS extends two-midnight rule enforcement delay
AUG 13, 2015
Fierce Healthcare
Zack Budryk
Key Words:
Centers for Medicare & Medicaid Services | two-midnight rule | short stay rule | reimbursement cuts
CMS Announcement
AHA Statement


Advocates, CMS Warn Providers About Continuing Medicare 'Balance Billing'
AUG 13, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
CMS | "balance billing" | qualified Medicare beneficiaries (QMBs) | copayments | Seniors and people with disabilities | reduced access | cost-sharing
CMS Report:
Access to Care Among Qualified Medicare Beneficiaries


Duals Allowed To Designate an Assistant
AUG 10, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
enrollment assistant | Medi-Cal managed care plans | Medi-Cal beneficiaries | Health Care Options


Medicaid Recipients Continue to Use ED for Dental Work, Even With Coverage
AUG 6, 2015
California Healthline
Capitol Desk
David Gorn
Key Words:
Medicaid | adult dental care | Medi-Cal patients | Provider rates in California


California Home Health Agencies Get Medicare’s Star Treatment
AUG 3, 2015
Physicians News Network
Jordan Rau
Kaiser Health News
Key Words:
Medicare | quality measure | home health agencies | Centers for Medicare & Medicaid Services


The silver tsunami
JUL 29, 2015
Orange County Register
Key Words:
South County Senior Summit | Age Well Senior Services | adult day care | CalOptima


Prior Coverage


Videos

Easter Seals Supports Employment of Veterans
2015
PSA Video Series
What to Wear
[1:00]
Morning Routine
[0:30]
The Bank
[0:30]

- - -

TEDGlobal
2011
Abraham Verghese
A doctor's touch
[18:32]
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.

- - -

NSCLC
10/23/2014
"Forget About Living Paycheck to Paycheck. Let's talk about Day to Day"
[5:39]
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.

- - -

San Ysidro Health Center, Inc.
10/2014
Caring for Our Greatest Generations
[7:22]
Celebrating SYHC's 45th Anniversary

- - -

Your Money, Your Life
4/14-15/2014
What are Adult Day Services
Elder Law Attorney Ramsey A. Bahrawy interviews Amanda Sillars of Total ADHC Solutions
What Are Adult Day Services
[8:04]
Adult Day Services - a win, win, win opportunity
[13:23]
Resistance and Dementia
[9:19]
Adult Day Services vs. Home Care: "It's about value"
[7:17]

- - -

PBS NewsHour
3/20/2014
Innovating technology for the needs and health of elders
[7:35]
Featuring Institute on Aging

- - -

Marin Adult Day Health Care
1/29/2014
"A Day in the Life": LifeLong Medical Care's Marin Adult Day Health Care Center
[8:03]

- - -

The Falling Monologues
3/7/2012
Full Length
The Falling Monologues
[37:18]
Segments
Introduction
[2:53]
The Ladder
[7:28]
The Bus
[7:31]
The Sidewalk
[6:28]
Scatter Rug
[5:15]
Don't Ask
[7:45]

 



CAADS STAFF

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)

 


caads.org
Please Direct Questions and Comments to
caads@caads.org


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