• Assembly Bill Would Keep Adult Day Program Going | California Healthline, 4/10/13
• Access at Issue in Provider Cut | California Healthline, 3/27/13
• Concern Over Retroactive Medi-Cal Cut | California Healthline, 3/26/13
• CBAS Hearings Nearing an End | California Healthline, 3/12/13
• Oversight Hearing on CBAS Transition Generates Sparks | California Healthline, 3/5/13
• State Delays Adult Day Center Not-for-Profit Requirement | California Healthline, 1/4/13

CARF's Annual Financial Benchmarking Study Extended to ADS Industry

MAY 14, 2013 -- The Commission of Accreditation of Rehabilitation Facilities (CARF) has been analyzing financial ratios as performance indicators for continuing care retirement communities since the early 1990s, and CAADS is pleased their benchmarking study is being extended into the Adult Day Services industry. ADP and ADHC/CBAS poviders are encouraged to participate by the May 31 deadline.

The benefits of participating include:

• Organizations that submit data for the study will receive an individualized report comparing your company data to the benchmarking information.
• Your involvement will help create a valuable financial benchmarking tool that ADS organizations can use to identify strengths, areas for improvement, and industry trends.
• The benchmarking analyses become more relevant when many ADS organizations contribute data, which makes your participation all the more important. There is no cost to participate.

To learn more about how the data will be used and how to participate, click here.

Cal MediConnect Stakeholder Update

On May 6, 2013, the following update was issued to Cal MediConnect Stakeholders:

The Department of Health Care Services (DHCS) is announcing today that Cal MediConnect will begin no earlier than January 2014.

Cal MediConnect represents a historic effort to integrate the medical, social, and mental health services provided to some of the most vulnerable members of society. I'm proud of the work that has been done so far, and I'm grateful for all of the stakeholder participation to move this effort forward. We have come a long way and there is more that needs to be done.

Cal MediConnect is an opportunity to support people who have Medicare and Medicaid with more coordinated care. Doing so requires work on multiple levels between governments, health plans, and communities. This kind of systematic change takes time. We have decided to move the start date to give every issue the full consideration it deserves.

As you know, the state places a high premium on beneficiary protections and is working deliberately to ensure a successful implementation. We will be working toward a January 2014 start date and new timelines will reflect that date. However, we will continue to assess the most appropriate start date as we work to strengthen policy and conduct outreach and education. Over the next few months, we will be determining the final start date based on our ongoing assessment.

We will continue to ask for your thoughts, feedback, and participation during this process. Your input is invaluable as we move forward.

Thank you,

Toby Douglas
Director
Department of Health Care Services

Advocates Notify CMS and DHCS of Concerns about Cal MediConnect

MAY 2, 2013 -- In a sign-on letter to CMS and DHCS, aging and disability advocates expressed concerns with the Memorandum of Understanding (MOU) for Cal MediConnect, and provided the following recommendations:

1. Find additional ways to limit the size of the demonstration;
2. Set a realistic timeframe for implementation of Cal MediConnect and the other elements of the CCI;
3. Start the enrollment process with a voluntary enrollment period in all counties and take steps to simplify the enrollment process;
4. Require that home and community based waiver services be part of the plan benefit package;
5. Strengthen and broaden the continuity of care requirements in the MOU;
6. Develop and execute, before notices are delivered to beneficiaries, a plan for delivering ombuds or consumer assistance services to beneficiaries that will be independent, community-based, and capable of providing individual assistance to CCI enrollees; and
7. Provide data on the assumptions that were made in the development of spending reduction amounts so that stakeholders can evaluate whether these reductions will threaten access and/or quality.

Tracking ACA Implementation in California

APRIL 2013 -- The California HealthCare Foundation (CHCF) has updated its Tracking ACA Implementation in California guide, which details California's progress toward meeting the Affordable Care Act's (ACA) four main objectives — expanding coverage in public programs; streamlining eligibility and enrollment; protecting health insurance consumers; and creating a user-friendly marketplace for consumers to shop for private health insurance. Read more. . .

California's Health Care Safety Net: A Complex Web

APRIL 17, 2013 -- The health care safety net is a complicated web of programs and providers that serve low-income Californians without private health insurance. Changes in the economy, government budgets, and health care policy can influence how the safety-net population obtains medical care. An updated report by the California HealthCare Foundation provides a snapshot of California's safety net at a critical juncture ahead of the full implementation of the federal Affordable Care Act (ACA) in 2014. Stakeholders are preparing for important ACA deadlines, such as the expansion of Medi-Cal, the state's largest safety-net program, while legal and political battles wage on over the future of health care reform. Read more. . .

Poll: Aging US in denial about long-term care need

APRIL 2013 -- According to a new poll, Americans underestimate their chances of needing long-term care as they get older - and are taking few steps to get ready. Conducted by the Associated Press-NORC Center for Public Affairs Research, funded by The SCAN Foundation, the poll examined how people 40 and over are preparing for this difficult and often pricey reality of aging. View LONG-TERM CARE: Perceptions, and Attitudes among Americans 40 or Older.

SCAN Foundation Fact Sheet: Cal MediConnect Program

APR 2013 -- Cal MediConnect: A Summary of the Memorandum of Understanding Between California and the Centers for Medicare and Medicaid Services is a 13 page fact sheet issued by the SCAN Foundation. The fact sheet provides background information and summarizes key points of the MOU that formalized a federal-state partnership to implement the Dual Eligibles Integration Demonstration known as "Cal MediConnect."

SCAN Foundation Issues LTSS Program Compendium

APR 13, 2013 -- The SCAN Foundation has issued a compendium of federal and state agencies and departments supporting Long-Term Services and Supports Systems (LTSS), including:

• U.S. Department of Health and Human Services (DHHS)
• Centers for Medicare and Medicaid Services (CMS)
• Administration on Aging (AoA)
• California Health and Human Services Agency Program Initiatives
• California Department of Health Care Services (DHCS) Programs/Services
• California Department of Aging (CDA) Programs/Services
• California Department of Rehabilitation (DOR) LTC Programs/Services
• California Department of Social Services (CDSS) Programs/Services
• California Department of Public Health (CDPH) LTC Programs/Services
• California Department of Developmental Services (DSS) Programs/Services

CA Dept of Aging Issues Corrected Notice of IHSS Class Action Settlements

APR 10, 2013 | ACL #13-08 -- Corrected versions of the following notices which were transmitted to CBAS Providers on April 8, 2013, have been issued:

(1) Notice of IHSS Class Action Settlements (4 page notice);
(2) Notice About In-Home Supportive Services (IHSS): Settlement of IHSS Lawsuits (1 page flyer)

These notices and the full IHSS Settlement Agreement will be posted on both the DHCS and CDSS websites. Translations of the Notice and Flyer can also be found on both websites:

     DHCS - http://www.dhcs.ca.gov/Pages/IHSSSettleAgreeInfo.aspx
     CDSS - http://www.cdss.ca.gov/agedblinddisabled/PG3192.htm

Genworth 2013 Cost of Care Survey

Home Care Providers, Adult Day Health Care Facilities,
Assisted Living Facilities and Nursing Homes

For the 10th consecutive year, Genworth has examined the cost of long term care across the U.S. to help Americans plan for these expenses. The most comprehensive study of its kind, Genworth’s 2013 Cost of Care Survey (conducted by CareScout®) covers nearly 15,000 long term care providers across all 50 states and the District of Columbia, in 437 regions nationwide. This unique level of detail can help consumers plan for long term care costs in their preferred location and care setting. View Genworth 2013 Cost of Care Survey findings. (3/22/13, 96 pages)

Transitioning the SPD Population to Medi-Cal Managed Care:
Examining the Experiences of Beneficiaries

The video and slides from the March 28, 2013 California HealthCare Foundation briefing may be viewed on the State Health Policy page of the CHCF website.

Cal MediConnect Stakeholder Update

The following links have been posted on the CalDuals website:

• Cal MediConnect health plan readiness review tool jointly developed by the Centers for Medicare & Medicaid Services (CMS) and Department of Health Care Services (DHCS).

• A recording of the 90-minute call DHCS hosted Thursday, March 28, 2013 to answer technical questions related to the CMS-DHCS demonstration Memorandum of Understanding (MOU).

LTC Commission Should Right Imbalance In How Medicaid Pays for LTSS

MAR 2013 NSCLC Policy Issue Brief -- President Obama recently appointed the final members of the Commission on Long Term Care. Over the next six months the Commission must accomplish one objective: develop a plan for the establishment, implementation and financing of a comprehensive, coordinated, and high-quality system that ensures the availability of long-term services and supports (LTSS) for individuals who need LTSS. Read The HCBS Opportunity: Recommendations for the Commission on Long-Term Care

CCI Readiness Report Submitted to Legislature

As required by SB 1008, the Department of Health Care Services (DHCS) recently submitted to the Legislature a report on the status of readiness for implementation of the Coordinated Care Initiative (CCI) pursuant to Welfare and Institutions (W&I) Code §14182.17. As of the date of this report, the Duals Demonstration in eight counties is scheduled to begin enrollment no sooner than September 1, 2013. Statewide expansion of Medi-Cal Managed Care into new counties is underway now. View Report.

The 2013-14 Budget: Coordinated Care Initiative Update

The Legislative Analyst's Office has issued the following report: The 2013-14 Budget: Coordinated Care Initiative Update. In 2012, the Legislature authorized the Coordinated Care Initiative (CCI) as an eight-county pilot to demonstrate the integration of Medi-Cal and Medicare benefits for "dual eligibles"—beneficiaries eligible for both benefits. The CCI will also integrate long-term services and supports (LTSS) under Medi-Cal managed care in the eight counties for dual eligibles and seniors and persons with disabilities covered only by Medi-Cal. The Governor's budget delays the start date of CCI implementation to September 1, 2013, resulting in lower 2013-14 savings than initially anticipated.

Joint federal-state decisions regarding key financing and operational aspects of CCI are pending, creating uncertainty regarding the timely and successful implementation of CCI. The Legislative Analyst's Office recommends that the Legislature clarify the legal status of CCI to go forward and consider authorizing CCI to test greater integration of In-Home Supportive Services—a particular LTSS—under managed care.

FEB 20: CDA CBAS Branch Main Telephone Line Temporarily Out of Order

The CDA CBAS Branch main telephone line -- (916) 419-7545 -- is temporarily out of order. Until service is restored, please telephone the CBAS receptionist at (916) 419-7546 or call your CDA Branch analyst directly. You may also contact the CDA CBAS Branch by Email at: CBAScda@aging.ca.gov.

Ninth Circuit Court of Appeals Reverses Injunctions Against Reimbursement Cuts to Providers in Medi-Cal Program

The Ninth Circuit Court of Appeals on December 13, 2012, reversed the District Court's earlier decision in CMA et al. vs Douglas, which had approved injunctions against reimbursement cuts to providers in California's Medicaid (Medi-Cal) program. Earlier this year, the federal district court blocked California from implementing 10 percent rate cuts for physicians, pharmacists, hospitals, dentists and medical suppliers. Read the decision here.

Duals Demonstration Stakeholder Update

On November 29, 2012, Jane Ogle, Deputy Director, Health Care Delivery Systems, California Department of Health Care Services (DHCS), announced the release of several new reports that use a comprehensive set of 2010 data to provide descriptive statistics and insights into the populations eligible for participation in California's proposed demonstration to coordinate Medicare and Medi-Cal services for dually eligible beneficiaries.

Created by DHCS' Research and Analytic Studies Branch (RASB), the reports and pivot tables are part of the department's efforts to inform all stakeholders, ensure a smooth transition, and help contracting health plans prepare their operations for the demonstration.

To view and download the reports and tables, click here.

The reports highlight the high burden that California Medicare and Medicaid beneficiaries face from chronic diseases. The data reinforce the need for effective care coordination -- the cornerstone of the proposed demonstration.

Pending federal approval, this demonstration would give beneficiaries the opportunity to combine their Medi-Cal and Medicare benefits into one health plan and receive more coordinated and accountable care than available in today's fragmented health care delivery system.

The reports and data explore questions about the eligible population, such as:

• How many eligible beneficiaries reside in the eight demonstration counties?

• What is the chronic disease burden among those eligible?

• What are their utilization patterns and cost differences?

• What are the demographic characteristics and differences between the eligible populations across the eight counties?

Some key facts about the population eligible for California's duals demonstration are highlighted below. You are encouraged to visit the DHCS website and read the full reports.

• The demonstration population is smaller than originally estimated. California has about 1.2 million dual eligible beneficiaries, but less than half of those people (about 526,900) are eligible to participate in the demonstration. This lower estimate reflects all the populations excluded, such as beneficiaries with developmental disabilities or without full Medicare benefits. (Medi-Cal's CCI Population, pages 4, 65)

• Many eligible participants already use managed care. About one-third of the population is already enrolled in some form of managed care, either Medicare Advantage, Medi-Cal managed care, or both. (Medi-Cal's CCI Population, page 67)

• Concurrent chronic conditions are common. Among beneficiaries currently not enrolled in managed care, 44 percent were treated for three or more conditions. The complexity and cost of caring for people with multiple conditions is significant, with costs increasing by 50 percent from a person with one condition to someone with two conditions. County-specific disease burden information is provided and can be helpful guidance to health plans and community-based organizations. (Profiles of Eight Counties, page 3)

• Use of long-term services and supports (LTSS) varies. About 57 percent of the eligible participants currently in fee-for-service used no LTSS in 2010. About 36 percent used home-and community-based LTSS, and 5 percent were residents in a skilled nursing facility. (Medi-Cal's CCI Population, pages 111-112, 161)

• Behavioral health conditions are highly prevalent and a major cost driver, with greater frequency for beneficiaries age 21-65. The data on schizophrenia, mood disorders, depression and drug and alcohol dependency indicate a strong need to ensure that behavioral health care is properly integrated with a beneficiary's overall care. (Medi-Cal's CCI Population, pages 114-121 and 128-130)

• The demonstration population is diverse. English is the primary language for less than half of people eligible for the demonstration. Spanish, Vietnamese, Armenian and Cantonese are the most common languages spoken other than English. About 60 percent of eligible beneficiaries are women, 40 percent are disabled, 75 percent are age 65 or older, and 40 percent are age 75 or older. (Medi-Cal's CCI Population, pages 85 - 87)

When reading the report, please keep in mind that the report focuses on findings for the entire population eligible for the demonstration in some sections and in others draws on data only from the population currently not in managed care. This is noted in the reports. The fee-for-service population available for analysis in Orange and San Mateo counties was small due to their existing models of mandatory managed care.

These reports and data will inform the department's ongoing planning to improve the delivery system for some of California's most vulnerable populations. As we move closer to implementation of the demonstration, the data will help us focus our efforts. We encourage you to read and analyze the data to inform your local efforts, as well.

CAADS Submits Comments on Standards for Care Coordination and LTSS Readiness

>> Care Coordination Standards - CAADS Comments 12/10/12
>> Long Term Services and Supports Readiness Standards - CAADS Comments 12/10/12

DEC 31, 2012 -- CBAS Non-Profit Provider Requirement Postponed

The California Department of Health Care Services (DHCS) is postponing implementation of the CBAS non-profit requirement from July 1, 2012 to no sooner than January 1, 2014.
>> Read Notice to CBAS Providers

MAR 13, 2012 -- CAADS Releases Issue Paper Critical of State's New Policy Requiring Non-Profit Status for CBAS Providers

CAADS has published an analysis of the state’s new policy requiring CBAS providers to become non-profit entities, outlining the legal and logistical challenges that make implementation of this policy a maze of bureaucratic dead ends. CAADS recommends that the state take a different approach to avoid problems with reducing access to care and creating unnecessary state cost. The burdensome oversight of the exception process that the state proposes as a remedy to maintain access merely adds to the uncertainty as the programs move into managed care. Penalizing two-thirds of existing providers based on their tax structure does not make sense when the vast majority of ADHC participants are found eligible for CBAS and require uninterrupted access to those very same for-profit centers. A better solution is one that relies on assuring compliance with the new Standards of Participation in the 1115 Waiver.

• CAADS Issue Paper: New CDHCS Policy Requiring Current CBAS Providers to be Non-Profit Entities (3/13/2012, 9 pages)

Legal Help for ADHC Providers Seeking Nonprofit Status

With the recent announcement by the California Department of Health Care Services that CBAS sites must be nonprofit organizations, many of the state's for-profit ADHC centers are facing significant financial implications and a tight timeframe to complete the process for obtaining nonprofit status. In response, CAADS has prepared a Preferred Attorney List which includes legal firms in membership with CAADS which have experience with establishing a nonprofit organization and have expressed interest in working with ADHC providers on this complex process.

For more information on ADHC Transition to CBAS, click here.

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. CAADS member-centers 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 advocacy, timely information, analysis, technical assistance, education, and networking opportunities for member organizations. CAADS members agree to abide by the Association's Bylaws and Code of Ethics. For more information on CAADS Membership click here!

The 2010 CAADS Annual Report highlights the Associations efforts to build state relationships, pursue legislation, and provide education, training and public awareness.

CAADS Members-Only Online Benefits

Available to CAADS members on the Members-Only page:

• State Budget Analysis
• CBAS / Medi-Cal Managed Care Plans Information
• Medi-Cal Updates
• Licensing Updates
• Laws & Regulations for ADHC/CBAS and ADP Facilities
• Advocacy & Legislative Alerts
• Funding Sources
• Technical Assistance
• Education / Training Materials
• Member Roster
  
  

The Alliance for Leadership and Education (A.L.E.) is a non-profit 501(c)(3) public benefit arm of CAADS. The A.L.E. 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. The organization is governed by the 7-member A.L.E. Board of Directors.

The 2010 A.L.E. Annual Report summarizes the year's grant activities and initiatives focused on Quality of Care, Public Education and Information.

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THE STAFF

Lydia Missaelides, MHA
Executive Director

Pamela Amundsen
Education & Events Manager

Kathryn Atkinson
Membership & Communications Director

Coni Segretto-Ricci
Office Assistant