Quick Links. . .
• Alliance for Leadership & Education (ALE)
• Associate Members (Vendors, Consultants, Health Plans, etc.)
• Community Based Adult Services (CBAS)
• Coordinated Care Initiative/ Cal MediConnect (CCI)
• Legal Updates
CAADS FALL CONFERENCE & ANNUAL MEETING
Adult Day Services:
Partnering for Success
November 16-18, 2015
Westin Hotel | Long Beach
View Brochure and Register early for best rates!
Fall Conference is the place to be for Providers, Prospective Providers and Managed Care Health Plan Representatives
CLINICAL topics include:
Palliative care • Behavioral health and substance use • Behavioral symptoms of dementia
ADMINISTRATIVE topics include:
Labor law • Cost containment and compliance • Collaborative negotiation
Diamond: Molina Healthcare of California || Platinum: Care 1st Health Plan • TurboTAR, Inc. || Gold: Health Net, Inc. • RTZ Associates, Inc. || Silver: A – Z Bus Sales, Inc. • Correlink Systems, Inc. – iLife Software
A – Z Bus Sales, Inc. • Heffernan Insurance Brokers • RTZ Associates, Inc. • Space Tables, Inc. • Total ADHC Solutions • TurboTAR, Inc.
Exhibitors and Sponsors -- there’s still time to be included in the printed program distributed at the event. For more information, email Pam Amundsen at firstname.lastname@example.org.
What's New . . .
DHCS Launches Updated Phone System for Medi-Cal Managed Care Beneficiaries
OCT 6, 2015 | Source: California Healthline
The California Department of Health Care Services has launched a new phone system that can handle hundreds of more calls from Medi-Cal managed care beneficiaries, HealthyCal reports. Medi-Cal is California's Medicaid program.
In June, a report released by the California State Auditor found that the phone system for Medi-Cal managed care beneficiaries was not adequate, with an average of 12,500 calls going unanswered each month from February 2014 to January of this year.
The audit called on DHCS to upgrade the system.
The fiscal year 2015-2016 state budget included funding to make nine temporary positions related to the phone system permanent, but it did not increase the number of staff in the office.
Details of New Phone System
The upgraded phone system was launched on Sept. 30, and DHCS plans to add more new features this month.
According to DHCS, the system can handle 500 calls at one time, compared with the previous system's maximum of 30 calls at a time (Guzik, HealthyCal, 10/5). The system also will:
- Determine the demand for services;
- Measure the number of abandoned calls and wait times; and
- Store data from calls and emails online (DHCS briefing, July 2015).
According to HealthyCal, it is unclear how the stored data will be used or who will have access to the information.
Advocates Still Have Concerns
Advocates are cautiously optimistic that the new system will help, but they say the phone system still is understaffed.
Linda Nguy, legislative advocate at the Western Center on Law and Poverty, said, "I look forward to seeing some of the data that comes out from the new phone system, but I don't think the current staffing is sufficient to address current demands," adding, "There's still the same number of people working the system so that doesn't mean people will necessarily get help sooner."
However, DHCS spokesperson Carol Sloan said the department has "the right processes and sufficient resources (employees) in place to staff the phone lines appropriately" (HealthyCal, 10/5).
CBAS Updates Issued by CDA, CBAS Branch
OCT 2, 2015 | Source: California Department of Aging (CDA), Community-Based Adult Services (CBAS) Branch
On October 2, 2015 the CDA CBAS Branch issued CBAS Updates, which covers the following:
- CBAS Home and Community-Based (HCB) Settings Rule Updates
- CBAS IPC Revision and Quality Strategy Work Groups
- New Center Updates (new pre-screening and application process)
- CAADS Annual Fall Conference - November 16, 17, and 18, Long Beach
- Recently Released Data from the National Study of Long-Term Care Providers
CAADS members may view the complete issue of CBAS Updates on the Members Only page.
Webinar -- Understanding and Commenting on the Proposed Federal Nursing Home Regulations | October 6, 11:00 AM - 12:30 PM (Pacific)
REGISTER (Registration is first come, first served, so register now! Although this webinar is FREE, your contribution of $10 or more - or your membership in Consumer Voice - will help support their Public Policy and Advocacy programs) | View: Sample Comment Letter | Extension Notice--CMS-3260-N | CMS Proposed Rule
Eric Carlson, Directing Attorney, Justice in Aging
Robyn Grant, Director of Public Policy and Advocacy, Consumer Voice
Justice in Aging has partnered with Consumer Voice on this FREE webinar to help advocates formulate comments on proposed federal nursing home regulations. These regulations, published by the Centers for Medicare and Medicaid Services (CMS) in July, will shape nursing home care for decades to come.
CMS needs to hear what consumers, their families, and advocates around the country think about the rule. This is one of the most important opportunities you will ever have to impact what these new federal nursing home regulations look like.
Comments are due October 14 by 5:00pm ET.
This webinar is designed to assist advocates in understanding the proposed changes and in participating in the comment process.
Statement of CA Health and Human Services Secretary Diana S. Dooley on the
Managed Care Organization (MCO) Tax
SEPT 11, 2015 | Source: State of California Health and Human Services Agency
“Since the federal government ruled in July 2014 that our current MCO tax could not continue beyond 2016, we have explored every conceivable option over the past 14 months to avoid losing $1.1 billion in federal matching funds. We have spent countless hours with the health plans, Legislators and those who will be most hurt if we must make up for a $1.1 billion loss. In the past few weeks alone, we agreed to eliminate other taxes paid by the health plans and made additional adjustments that would result in a very small cost to only a few plans. We did everything we could to make this work. It is deeply disappointing that the health plans could not come together to support this proposal and the Republican legislators have refused to consider any tax adjustments at all. Without additional revenue, there will be no alternative to reductions in our health care spending, jeopardizing the significant gains we have made through our implementation of the Affordable Care Act. We put a good plan on the table. With the Special Session still open, it is now up to the plans which refused to endorse this proposal, and the Republicans who refused to consider it, to stop drawing lines and start putting solutions on the table.”
Cal Duals Update
SEPT 11, 2015 | Source: CalDuals.org | View: Update
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
Summary of the Governor's May Revision of the 2015-16 Budget: Impact on California's Older Adults and People with Disabilities
MAY 28, 2015 | Source: The SCAN Foundation | Fact Sheet:
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 | View: 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 | View: 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. 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:
- Intravenous or intramuscular injections and intravenous feeding;
- 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;
- Nasopharyngeal and tracheostomy aspiration;
- Insertion and sterile irrigation and replacement of suprapubic catheters;
- Application of dressings involving prescription medications and aseptic techniques;
- Treatment of extensive decubitus ulcers or other widespread skin disorder;
- 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;
- Initial phases of a regimen involving administration of medical gases; or
- 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.
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.
 42 CFR 409.33(a)
 42 CFR 409.33(b)
 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
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.
CAADS Board of Directors
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
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
CEO, Family Bridges / Hong Fook Centers
Lydia Missaelides, MHA
Executive Director, CAADS
Amanda Sillars, MSW, LCSW
CEO, Total ADHC Solutions, Inc.
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!
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.
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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
Human Kindness--it just flows around here
[Download Real Player]
Honoring Adult Day Services pioneers and those they serve.
Brown Signs $167.7B Budget With Few Line-Item Vetoes
Protest Rises Over Medi-Cal Rates
SCOTUS: Providers Cannot Sue Over Low Medicaid Reimbursements
DHCS Launches Updated Phone System for Medi-Cal Beneficiaries
OCT 6, 2015
Medi-Cal managed care beneficiaries
California Becomes Fifth State To Legalize Physician-Assisted Death
OCT 6, 2015
ABX2-15 | special session on health | individuals with disabilities | limited access to care | end-of-life decisions
The Silver Tsunami
OCT 3, 2015 /
Updated OCT 4, 2015
The Orange County Register
Senior Citizens | OC Council on Aging Ombudsman Program | Acacia Adult Day Services | daycare center for seniors | Proactive Action Care Team (PACT) | Pacific Life
Stakeholders Note Few Changes in Medicaid Managed Care Final Rule
SEPT 28, 2015
CMS | 2016 reimbursement rates for Medicaid managed care plans | long-term care
National Drug Take-Back Day Saturday
SEPT 25, 2015
seniors | public safety
Orange County Rolls Out CA Senior, Disability Care Pilot
SEPT 24, 2015
New America Media
OneCare Connect | Cal MediConnect | low-income seniors and people with disabilities | receive both Medicare and MediCal | CalOptima health plan | adult day health center
Alzheimer's patients reconnect to tunes of their youths
SEPT 24, 2015
Napa Valley Register
Napa Valley Hospice and Adult Day Services | Alzheimer's or dementia | Music and Memory | NVHADS | Intergenerational program
Bill will boost early diagnosis of Alzheimer’s
Many patients and family members aren’t told promptly by doctors of the disease
SEPT 22, 2015
Susan Disney Lord
Senate Bill 613 | physician guidelines for Alzheimer's disease management | chronic disease management | Alzheimer's Association
Good News: Volunteer program helps comfort Alzheimer's patients
SEPT 19, 2015
NorthBay Adult Day Center | Alice's Embrace program | Alzheimer's disease | NorthBay Healthcare
Advocates Say Balance Billing of Medi-Cal Patients on the Rise
SEPT 18, 2015
Medi-Cal | balance billing | Medicare | dually eligible
Orange County Seniors Opting Out of State's Duals Demonstration Project
SEPT 17, 2015
duals | Cal Medi-Connect | dually eligible for Medi-Cal and Medicare | opt-out rate | health plans | managed care | CalOptima | Coordinated Care Initiative | CCI
Bill Passed To Undo 'Step Therapy' Rule
SEPT 17, 2015
AB 374 | health plan
Bill for CMS Waiver Extension Quietly Heads to Governor for Signature
SEPT 16, 2015
CMS waiver | SB 36 | duals demonstration project | dually eligible for Medicare and Medi-Cal | "Bridge to Reform" 1115 federal waiver
Growth of L.A. Aging Population To Pose Health Care Challenges
SEPT 15, 2015
aging population | barriers to care | accessing care | shortage of providers | patient-centered medical homes
Poll: Californians Divided Over Undocumented Health Care
SEPT 15, 2015
low- or no-cost health insurance | Medi-Cal
[Poll: Key Findings]
California Advocates Welcome Federal Plan To Deal With Disparities in Medicare
SEPT 15, 2015
CMS | health disparities | Medicare
Dept. of Labor To Delay Enforcement of Home Care Worker Pay Rule
SEPT 14, 2015
home care workers | elderly and disabled consumers | pursuing providers for noncompliance
Calif. Legislature Acts on Three Health Care Bills Ahead of Deadline
SEPT 11, 2015
multi-lingual prescription drug labels | limit deductibles | out-of-network bills
CMS Tackles Disparities for Low-Income, Minority Medicare Enrollees
SEPT 9, 2015
Medicare | Medicaid | disparities in minority heatlh | vulnerable populations | health care facilities
California Association of Health Plans Opposes Two Tax Bills
SEPT 8, 2015
Medi-Cal | California Association of Health Plans
California, Other States Will Not Fully Transition to ICD-10 in October
SEPT 8, 2015
Medi-Cal | ICD-10 code | Medicaid fee-for-service programs
Why the State's Seizure of a Local Health Plan May Have Rescued It
SEPT 3, 2015
local health plan | Alameda Alliance for Health | Family Bridges | access to quality care | Medi-Cal expansion
State Begins To Collect Back Payments From Pharmacies Over Medi-Cal Cuts
SEPT 3, 2015
"clawback" money from pharmacies | 10% rate reduction | Medi-Cal provider rates | "recoupment" | skilled nursing facilities
Protesters call for funding for developmental disability programs
SEPT 1, 2015
Los Angeles Daily News
developmental disabled | 10 percent increase | adult day programs | Regional Centers | Laternman Developmental Disabilities Services Act | Medi-Cal
Special Session Bills Keep On Coming
SEPT 1, 2015
California Legislature's special session on health | managed care organization tax | 7% hike in In-Home Supportive Services hours | provider rate increases
Calif. Lawmakers Work To Save $1B in Federal Medi-Cal Funds
AUG 31, 2015
Medi-Cal | Legislature's special session on health care financing | tax all health plans equally or implement a tiered tax system
Seniors thrive in adult day programs
AUG 28, 2015
"The OTHER Side of 50"
Andrea Gallagher, CSA, President of Senior Concerns
Adult day care centers | Social model day care centers | Medical model day care centers | adult day healthcare | Medicare | ONE Generation | Oxnard Family Circle | Senior Concerns | Camarillo Health Care District
Report: Demographic Disparities in California Greatly Affect Health
AUG 28, 2015
disparities | physical and mental health | health outcomes | poverty
Rural Northern Counties Set To Launch Pilot Palliative Health Care Initiative
AUG 26, 2015
Partnership HealthPlan of California | Medi-Cal managed care | Napa Valley Hospice and Adult Day Services
Federal Court Sides With Home Workers
AUG 24, 2015
home health workers | overtime pay and minimum wage rates | In-Home Supportive Services workers
Easter Seals Supports Employment of Veterans
PSA Video Series
What to Wear
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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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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
The Falling Monologues
Lydia Missaelides, MHA
Education & Events Manager
Membership & Communications Director
Please Direct Questions and Comments to