Quick Links. . .
• Alliance for Leadership & Education (ALE)
• Community Based Adult Services (CBAS)
• CCI / Cal MediConnect
• Member Associates--Vendors, Consultants, Health Plans, Networks
Top-of-Mind . . .
CAADS WEBINAR MAY 26 | 2:30 PM - 4:00 PM (Pacific)
Adult Day Services in the Managed Care Environment: A Primer for Prospective Providers or New Managers | Updated Information / Registration Form (PDF / Word) [Deadline: 4 PM, MAY 24]
CBAS CERTIFICATION FOR NEW ADHC CENTERS:
The California Department of Aging (CDA) is accepting requests from prospective applicants to begin the process to be certified to provide Community Based Adult Services (CBAS). CAADS members click here and use Handouts from Events/Webinars Quick Link for NOV 18, 2015 course, Pre-Screening & Application Process for the Certification of New CBAS Centers. To learn about membership in CAADS, click here.
HELP II LOAN PROGRAM -- AFFORDABLE CAPITAL:
The HELP II Loan Program, administered by the California Health Facilities Financing Authority (CHFFA) within the State Treasurer’s Office, offers low cost loans to assist eligible health facilities wanting to expand and improve services to their clients and the greater community. Learn more at www.treasurer.ca.gov/chffa/programs/help.
What's New . . . May 20, 2016
CBAS Updates - May 2016
MAY 20, 2016 | Source: California Department of Aging (CDA), Community Based Adult Services Branch (CBAS)
Upcoming Training Opportunity
Webinar: “Adult Day Services in the Managed Care Environment: A Primer for Prospective Providers or New Managers” (May 26th, 2:30 p.m. to 4:00 p.m.)
On May 26th from 2:30 p.m. to 4:00 p.m., CDA will participate in the California Association of Adult Day Services’ (CAADS) webinar on “Adult Day Services in the Managed Care Environment: A Primer for Prospective Providers or New Managers.” The presenters will be Lydia Missaelides, Executive Director of CAADS and the Alliance for Leadership Education (ALE), Gretchen Brickson, Senior Director, Managed Long-Term Services & Supports, L.A. Care Health Plan and Denise Peach, Chief, CBAS Branch, California Department of Aging.
The webinar will orient prospective new providers and new staff members to the evolving managed care environment and the credentialing, contracting, electronic billing, service authorization, auditing, and other requirements associated with being a contracted managed care provider. It also will address the state’s expectations for communication with managed care plans during the pre-screening process and L.A. Care Health Plan’s internal process for analyzing the need for new CBAS centers.
Webinar registration information is available on the CAADS website.
Please Note: The New CBAS Provider Start-Up Training (sponsored by CAADS in partnership with the California Department of Aging and the Department of Health Care Services) that was tentatively scheduled for June 6th and 7th in Sacramento is on hold until further notice. Please contact the CBAS Branch if you have any questions cbas@email@example.com; (916) 415-7545.
Expanded FSLA Overtime Standards to be Effective DEC 1, 2016
MAY 20, 2016 | Source: National Adult Day Services Association (NADSA)
On May 18th the President and the Department of Labor announced changes to the Federal Fair Labor Standards Act (FLSA) regulations. Dubbed the “White Collar Overtime” rule, the new regulations will expand present overtime protections by increasing the salary levels under which they will apply. Initially, this expansion is expected to encompass approximately four-million employees nationally.
Generally, the Rule affects executive, administrative, professional, outside sales, and computer employees by raising the salary and compensation base under which these employees either must be paid overtime for more than 40 hours of work per week or must be given reduced hours.
The new base for most employees will be $913/wk (from $455/wk) and for Highly Compensated Employees it will be $134,004/yr (from $100,000/yr). The formal Rule is scheduled for publication in the Federal Register on May 23rd and will become effective on December 1, 2016.
Please visit the Department of Labor Blog for more information and to access additional links for specific information categories. If you are interested in how this rule effects non-profits, click here.
Medicaid and SSI in Need of Retooling
MAY 11, 2016 | Source: Justice in Aging Health Network Alert
Medicaid and SSI are two essential programs that fight senior poverty by ensuring that low-income older Americans can meet their basic needs and maintain their health. In operation for 50 years (Medicaid) and 40 years (SSI), these workhorse programs are indispensable for seniors. But as the population ages and income inequality increases, both programs need retooling to improve benefits and increase access for more people who need them.
Justice in Aging attorneys Georgia Burke, Jennifer Goldberg, and Kate Lang published “Medicaid and Supplemental Security Income Eligibility: Time for a Tune-Up,” in the spring issue of the National Academy of Elder Law Attorneys (NAELA) Journal.
This article recommends improvements for both programs to ensure that they continue to meet the needs of low-income older Americans now and into the future. You can learn more about the SSI Restoration Act here, and Justice in Aging's health care policy work here.
IMPORTANT CCI ANNOUNCEMENTS
MAY 6, 2016 | Source: Health Care Delivery Systems, Department of Health Care Services
In early April, DHCS shared for stakeholder comment a comprehensive strategy for the Coordinated Care Initiative (CCI) focused on improving the quality of care and care coordination in Cal MediConnect for beneficiaries, ensuring that beneficiary satisfaction remains high and increases, and generating sustainability for the program.
In total, DHCS received letters and comments that represented the views of more than 40 stakeholder groups. This robust stakeholder engagement is critical to the success of the CCI, and DHCS appreciates everyone who participated in the comment process.
Today, DHCS is sharing an update on its policy decisions, as well as additional materials for stakeholder comment. MORE
Cal Duals Update
APR 2016 UPDATE (PDF) (Word) | Source: CalDuals.org (4/30/2016)
Social Security’s Rep Payee Program for Consumers
APR 28, 2016 | Source: Justice in Aging
The Social Security Administration’s Representative Payee program is an important program for ensuring that older adults who can no longer manage their finances have someone trustworthy and competent to do it for them.
As the population ages and the prevalence of cognitive challenges among the older adult population increases, the Rep Payee program will become even more critical and will play an important role in preventing elder financial abuse.
At Justice in Aging, we are working on creating a series of Fact Sheets about Social Security’s Representative Payee program and ways it can be improved. Our Fact Sheet for Consumers, What is a Social Security Representative Payee and how are they chosen? provides an overview of the basics of the program for consumers and other lay audiences.
If you’re a direct service provider for seniors, people with disabilities, and their family members, feel free to print up multiple copies of the Fact Sheet to distribute.
Third Wave of National Study of Long-Term Care Providers to Begin Summer 2016: All ADS Centers are Invited to Participate
APR 26, 2016 | Source: National Adult Day Services Association (NADSA)
Starting this summer, the U.S. Centers for Disease Control and Prevention’s (CDC) and National Center for Health Statistics (NCHS) will conduct the third wave of a biennial nationally representative survey of ADS centers, as part of its groundbreaking National Study of Long-Term Care Providers (NSLTCP). NSLTCP is an ongoing federally funded data collection effort to gather and report national and state information about the characteristics of ADS centers, other paid, regulated long-term care services providers, and the people they serve.
CDC uses the information collected through NSLTCP to produce publicly available reports and findings on the major long-term care services sectors including adult day services centers, assisted living and other residential care communities, home health agencies, nursing homes, and hospices. Reports from the second wave of the NSLTCP survey conducted in 2014 include Long-Term Care Providers and Services Users in the United States: Data from the National Study of Long-Term Care Providers, 2013-2014, reports with national results on ADS centers and participants, and tables with state information on ADS centers and participants. CDC thanks all of the ADS centers that completed and submitted your questionnaires in the second NSLTCP wave. Your participation made it possible to provide these accurate and relevant findings to you, other providers, policy makers, advocates, and researchers. MORE
Discovering What the ADS Financial Indicator Results Can Reveal About our Field
APR 26, 2016 | Source: National Adult Day Services Association (NADSA)
NADSA, CARF International, and Reinsel Kuntz Lesher LLP are conducting the 2016 ADS financial indicators study in fulfillment of the goal to develop financial benchmarks for the Adult Day Services field. This is the 7th year of this study and NADSA offers Annual Meeting presentation to reveal the study findings as well as a webinar for members. ADS centers that participated in the study also receive complementary individualized reports with their benchmarking data.
If your organization is an Adult Day Services provider, you are invited to participate in this complementary study. Instructions for participation are included in this article along with why this is valuable for your organization, and highlights from last year’s study. FULL ARTICLE
CMS Releases Final Medicaid Managed Care Regulation
APR 25, 2016 | Source: Justice in Aging
Today, the Centers for Medicare and Medicaid Services (CMS) issued a final regulation updating federal Medicaid managed care regulations. The final regulation is the first major update to Medicaid managed care in more than 10 years. Significantly, this regulation details, for the first time, federal expectations for states contracting with managed care plans that deliver long-term services and supports.
CMS issued the proposed rule last summer and received over 850 comments from the public. The regulations go into effect on July 6, 2016 and states and managed care plans will need to come into compliance with the rule by July 1, 2018.
Justice in Aging will analyze this sweeping regulation with an eye toward the impact on low-income older adults. The regulation has the potential to significantly change the way states, managed care organizations, aging network providers, advocates, and beneficiaries interact in the long-term services and supports delivery system.
Stay tuned for forthcoming Justice in Aging analysis and trainings on the regulation’s impact on older adults and long-term services and supports.
The regulation will be published in the Federal Register on May 6, 2016. The document is available here: https://s3.amazonaws.com/public-inspection.federalregister.gov/2016-09581.pdf.
For background on the previous proposed regulation, please see our issue brief. Justice in Aging’s MLTSS Tool Kit, MLTSS Contract Library and more advocate resources are available on our website.
DHCS Releases a New Provider Bulletin on Continuity of Care and Billing
APR 18, 2016 | Source: California Department of Health Care Services (DHCS), Health Care Delivery Systems
In order to ensure that beneficiary transitions into Cal MediConnect are smooth and do not result in disruptions of care, the CCI continuity of care policy gives beneficiaries in Cal MediConnect plans the right to continue seeing non-participating physicians for a limited period of time.
DHCS has developed a Provider Bulletin which explains how current out-of-network physicians can continue seeing Cal MediConnect beneficiaries, and the process for billing the correct entity for payment. It also provides information to help combat balance billing.
More information and additional resources for providers can be found on CalDuals.org.
IHSS Workers Who Fail to Return Provider Enrollment Form by April 15 Will NOT be Terminated From Program
APR 11, 2016 | Source: California Department of Social Services (CDSS)
The California Department of Social Services (CDSS) released a letter on April 8, 2016 to the County Welfare Directors and County IHSS Program Managers announcing that CDSS will NOT terminate IHSS providers (workers) from the program if they fail to return the “IHSS Provider Enrollment Agreement” form by the April 15th deadline.
However, all IHSS workers must submit the Provider Enrollment Agreement (SOC 846) form which was updated to include information regarding overtime and travel time pay, weekly hour maximums and the violations process.
Adult Day Services providers are urged to inform their center participants who have IHSS workers about this development, and refer them to the SOC 846 form and 7-page document “Important Information for the IHSS Provider.”
Special Report: Prevent and End Homelessness Among Older Adults
APRIL 11, 2016 | Source: Justice in Aging Health Network Alert
More older adults are homeless or at risk of homelessness than at any time in recent history. As the population ages, more adults are aging into poverty. The lack of affordable housing and higher costs for health care and other necessities are also leaving greater numbers of older adults at risk of poverty and homelessness, and systemic economic problems are contributing to the problem. A Special Report by Justice in Aging, How to Prevent and End Homelessness Among Older Adults, created in partnership with The National Alliance to End Homelessness, outlines the problem and recommends policy solutions that can be put in place now to ensure that all older adults have a safe place to age in dignity, with affordable health care, and sufficient income to meet their basic needs.
Read the paper and watch the accompanying video about Bill, a 67 year-old Oakland, CA resident who has struggled with homelessness. Please share the report with others.
CMS Tells Medicare Advantage Plans They Must Do More To Stop Plan Providers from Balance Billing
APRIL 7, 2016 | Source: Justice in Aging Health Network Alert
The Centers for Medicare and Medicaid Services (CMS) recently issued strong guidance to Medicare Advantage plans about their obligations to protect dual eligibles and Qualified Medicare Beneficiaries (QMBs) from balance billing by plan providers. Federal law and regulations prohibit providers from charging deductibles, co-pays and co-insurance to all Qualified Medicare Beneficiaries (QMBs) and to almost all dual eligibles. In its annual Call Letter, released April 4, CMS emphasized several important points:
- Plans must educate their providers about the prohibition on billing dual eligibles and QMBs deductibles, co-pays and co-insurance.
- Plans must include a prohibition on balance billing in their contracts with providers.
- The prohibition applies to all Medicare Advantage plans, not just Dual Eligible Special Needs Plans (D-SNPs).
- Plans should emphasize that all providers—not just those that accept Medicaid—are bound by balance billing restrictions and that balance billing prohibitions apply even if the provider does not get any additional payment from the state Medicaid program.
- Plan providers may not discriminate against beneficiaries who are protected from balance billing. In other words, plan providers may not deny services to plan members just because they are QMBs and can’t be charged co-pays.
The Call Letter offers an opportunity for advocates to collaborate with plans to educate providers about balance billing. You can also share the document with plan personnel who may not understand their obligation to assist when advocates bring balance billing violations to their attention. Note that CMS states clearly that in-network providers may not discriminate against plan members with balance billing protection.
For more information on balance billing protections, visit Justice in Aging’s balance billing page where you can watch our webinar, review slides, and find our toolkit of demand letters. Additional information specifically for California advocates is also available.
New Department of Labor Resource on Home Care Rules
APRIL 5, 2016 | Source: Justice in Aging Health Network Alert
In January 2015, the Department of Labor updated the Fair Standards Labor Act (FSLA) rules for home care workers. Under this new Home Care Final Rule, most home care workers must be paid the federal minimum wage and receive overtime pay. To help consumers and families understand their new responsibilities, the Department of Labor has released a new resource to explain the rules, Paying Minimum Wage and Overtime to Home Care Workers: A Guide for Consumers and their Families to the Fair Labor Standards Act.
The Guide outlines who needs to follow the new rules and explains to consumers and caregivers how to comply with the rules with helpful examples and checklists.
Last fall Justice in Aging worked with a group of advocates to create action steps for advocates around the new rule and a Home Care Rule Advocacy Fact Sheet. More information about the home care rule for advocates can be found here. A state by state chart from the perspective of home care workers can be found here.
California's Uninsured: Coverage Expands, but Millions Left Behind
MAR 22, 2016 | Source: California Health Care Foundation (CHCF) | View: Report • Infographic
The latest edition of California's Uninsured finds that implementation of the Affordable Care Act (ACA) helped lower the uninsured rate in California from 16% in 2013 to 11% in 2014, but 3.8 million Californians under 65 remained without coverage.
A related infographic shows who gained coverage in California, who remains without it, and why.
Among the key findings from the new report:
- From 2013 to 2014, the percentage of Californians who had individually purchased insurance or Medi-Cal increased.
- Californians age 21 to 24 experienced the largest drop of any non-elderly age group in the percentage that was uninsured, from 25% in 2013 to 16% in 2014.
- Of the state's remaining uninsured, 1 in 4 was between the age of 25 and 34, and more than half (57%) were Latino.
- Within the employed population, more than 2 million workers, about 1 in 8, were uninsured.
This report is part of the CHCF California Health Care Almanac, an online clearinghouse for key data and analysis examining California's health care marketplace. Find all Almanac reports at www.chcf.org/almanac.
New: Balance Billing Toolkit for Advocates
MAR 2, 2016 | Source: Justice in Aging Health Network Alert
Balance billing occurs when doctors, hospitals, or other providers charge beneficiaries with both Medicaid and Medicare for Medicare co-pays, co-insurance, or deductibles. Balance Billing is illegal under federal law, yet it is a common practice as some providers are confused about their obligations under the law.
Recently, Justice in Aging released a toolkit of five model letters that advocates can use when their low income clients face illegal balance billing for Medicare co-pays, co-insurance or, deductibles. Accompanying the letters is a webinar that explains balance billing protections for dual eligibles (people with both Medicare and Medicaid) and for people who are Qualified Medicare Beneficiaries (QMBs). The webinar and slide deck walk advocates through the basics of balance billing and the federal protections for beneficiaries. They provide examples of how the problem comes up and how to get it fixed. The toolkit gives advocates some simple letters that they can use as they work with providers to prevent erroneous bills.
Access all the materials here. The webinars, toolkit, and other materials are broken out in tabbed sections.
Justice in Aging created additional balance billing materials for California advocates that incorporate a state law that reinforces federal protections.
Good News: CMS Issues Final Rule Prohibiting “Homebound” Requirement for Medicaid Home Health Services
JAN 29, 2016
Justice in Aging | Health Network Alert
On February 2, 2016, the Centers for Medicare and Medicaid Services (CMS) will issue a final rule codifying the homebound prohibition for Medicaid home health services, and clarifying the settings where homebound services may be provided. The final rule revises Medicaid home health regulations (42 C.F.R. § 440.70(c)(1-2)) to make clear that a Medicaid beneficiary does not need to be “homebound” in order to receive home health services. In addition, CMS explains that home health services may be provided in any setting where normal life activities take place, and are not limited to a hospital, nursing facility, or other institution.
In its commentary, the agency explains that the prohibition codifies longstanding agency policy, previously articulated in a 2000 letter to state Medicaid directors, that a Medicaid homebound requirement for home health services violates the Americans with Disabilities Act (ADA), as articulated in Olmstead v. L.C., 527 U.S. 581 (1999).
Unfortunately, the final rule is limited to Medicaid’s homebound requirement, and does not change the Medicare homebound requirement. The agency cites what it describes as an inherent difference between the Medicaid statute and Section 1814(a) and 1835(a) of the Social Security Act, which imposes a Medicare homebound requirement. Acknowledging the challenge that this Medicaid v. Medicare misalignment places on dual eligible individuals, the agency notes in the rule commentary: “we would permit states the flexibility to authorize additional hours of home health services to account for medical needs that may arise out of the home.” (pg. 56)
The clarification that Medicaid home health services should not be limited to services furnished in the home reflects principles set forth in two prior court cases, Skubel v. Fuoroli, 113 F. 3d 330 (2d. Cir. 1997) (finding a state could not limit coverage of home health services to those in an individual residence); and Detsel v. Sullivan, 895 F. 2d 58 (2d Circ. 1990) (invalidating a regulation that limited private duty nursing services to an individual’s residence).
Aging and disability advocates welcomed the final regulation’s codification of agency policy, which comes after over a decade of advocacy for more community-based options for long-term services and supports.
The rule’s other provisions include:
- Prohibiting absolute exclusions on medical supplies, equipment or appliances;
- Requiring states to provide and make available to individuals a reasonable and meaningful procedure for individuals to request items not on a preapproved list; and
- Greater alignment of the definitions of home health medical supplies, equipment and appliances with the Medicare definition of DME.
The rule will take effect July 1, 2016. CMS will delay enforcement until a state's legislature has had an opportunity to implement necessary changes (either one or two years, based on the state's legislative cycle).
For more on Justice in Aging’s community integration and Olmstead advocacy, read about our litigation to help 35,000 low-income seniors and people with disabilities stay healthy at home and in their communities, as well as our advocacy work to help low-income seniors age in place.
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!
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 Directors List | Bylaws | Code of Ethics | Anti-trust Policy | 2015 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
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:
Corinne Jan, RN, PHN (NADSA Treasurer)
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):
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.
BACK TO TOP
California Association for Adult Day Services
1107 9th Street, Suite 701 || Sacramento, CA 95814–3610
T: (916) 552-7400 || F: (866) 725-3123