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Alliance for Leadership & Education (ALE)
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:
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. Medicare regulations also list nine specific services that are defined as skilled and covered by Medicare. 
The nine services, which apply to both skilled nursing facilities and to home health care, are:
The Center recently received a denial of Medicare coverage for skilled nursing services for intramuscular injections of vitamin B-12 for an approved diagnosis in a home health case. This patient was homebound and met all the criteria for Medicare coverage of home care. So far, at each level of appeal, the Medicare Contractor or judge has inappropriately denied Medicare coverage. The latest reason for denial is that the “Vitamin B-12 injection products are often purchased without a prescription and self-injected by individuals without medical training.” This reason for denying a skilled nursing service is improper, and we will pursue the case.
Most often the nine skilled services are automatically covered by Medicare, however, denials seem to be occurring more frequently for services that Medicare recognizes as “per se” skilled. We are seeing denials most often for tube feedings, wound care and intramuscular injections, but any of the nine per se skilled services may be improperly denied.
We encourage people to appeal improper denials of skilled care, particularly of per se skilled care. We want to monitor instances of these denials, whether in traditional Medicare or with Medicare Advantage companies. Please let us know by emailing firstname.lastname@example.org.
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
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
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
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
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
A new report by the federal Centers for Medicare and Medicaid Services (CMS) verifies a troubling trend for poor seniors: across the country, health care providers are illegally billing low-income Medicare beneficiaries.
The practice, known as “balance billing,” occurs when health care providers are billing low-income Medicare beneficiaries for portions of their medical bills. Qualified Medicare Beneficiaries (QMB) are protected against balance billing. However, as the report demonstrates, QMBs are frequently illegally balance billed. For years, Justice in Aging has provided guidance to attorneys and advocates assisting clients with stories like this:
Justice in Aging applauds CMS for highlighting the stories of beneficiaries who are illegally balance billed and for providing detailed data and research to explain this problem. As CMS, Justice in Aging, and advocates across the country work to end balance billing, the information in this report is an invaluable tool for understanding the problem and its many complexities.
Unfortunately, as the report demonstrates, balance billing happens everywhere. Advocates are encouraged to review Justice in Aging’s balance billing materials and tell us about problems you are seeing. We covered the report on our blog and you can access all of our Balance Billing resources for advocates below:
California Adult Day Services State Advocacy Fund
URGENT HELP NEEDED TO REACH OUR FUNDRAISING GOAL OF $45,000 BY AUG 31
What's Trending . . .
California State Budget
ASSEMBLYMEMBER LEVINE PROPOSES FUNDING FIXES FOR VITAL HEALTH CARE SERVICES
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---
CAADS Submits Comments on DHCS' Health Homes for Patients with Complex Needs Concept Paper Version 2.0
California Association for Adult Day Services, a 501 (c) 6 non-profit grassroots-driven organization, advocates for the growth and development of adult day services in California and nationally. CAADS was the first state association formed in the United States for the purpose of advancing adult day services. Centers in membership with CAADS provide innovative day programs that support individuals with physical or mental disabilities and older adults with Alzheimer's disease and their families.
A nationally recognized leader in the field of aging, the Association is governed by the CAADS Board of Directors and provides timely information, analysis, advocacy, technical assistance, education, and networking opportunities for its members. CAADS members agree to abide by the Association's Bylaws, Code of Ethics, and Anti-trust Policy.
The CAADS Members Only page features information and technical assistance specific to Adult Day Services:
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
NATIONAL ADULT DAY SERVICES ASSOCIATION (NADSA)
CAADS is a proud member of the National Adult Day Services Association.
Three representatives from California currently serve on the NADSA Board of Directors:
CARING FOR A VETERAN?
For help, call the VA Caregiver Support Line (toll-free):
Mon - Fri 8 AM - 11 PM (EST) || Sat 10:30 AM - 6 PM (EST)
TO REPORT FRAUD AND ABUSE
Call DHCS Medi-Cal Fraud Hotline:
The call is free and you can remain anonymous.
California Association for Adult Day Services
Human Kindness--it just flows around here[Download Real Player]
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Highlighted Media Coverage
Brown Signs $167.7B Budget With Few Line-Item Vetoes
Protest Rises Over Medi-Cal Rates
SCOTUS: Providers Cannot Sue Over Low Medicaid Reimbursements
Special Session Bills Keep On Coming
Calif. Lawmakers Work To Save $1B in Federal Medi-Cal Funds
Seniors thrive in adult day programs
Report: Demographic Disparities in California Greatly Affect Health
Rural Northern Counties Set To Launch Pilot Palliative Health Care Initiative
Federal Court Sides With Home Workers
Republicans Balk at Revised MCO Tax
Governor Signs Bill Allowing Mid-Level Practitioners To OK Resuscitative Edicts
Feds OK State's Drug Medi-Cal Waiver
Effort Ramps Up To Establish MCO Flat Tax as Legislature Reconvenes
CMS extends two-midnight rule enforcement delay
Advocates, CMS Warn Providers About Continuing Medicare 'Balance Billing'
Duals Allowed To Designate an Assistant
Medicaid Recipients Continue to Use ED for Dental Work, Even With Coverage
California Home Health Agencies Get Medicare’s Star Treatment
The silver tsunami
Your Money, Your Life
Marin Adult Day Health Care
Lydia Missaelides, MHA