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Adult Day Health Care: An Unbelievable Cost Containment Resource that Is Underfunded and Underutilized
For those who think Adult Day Health Care (ADHC) is just day care…think again! Read Russell D. Foster's featured article in MAZARS USA HEALTHCARE TRENDS,Sept 2017.
The Effect of Adult Day Program Attendance on Emergency Room Registrations, Hospital Admission and Days in Hospital: A Propensity-Matching Study
Research by Ronald Kelly, PhD finds a decreased reliance on costly health care services by seniors who attend adult day programs. Read Abstract and Full Article | JUN 2017 | The Gerontologist, Volume 57, Issue 3, Pages 552–562.
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 . . . FEBRUARY 16, 2018
Justice in Aging Statement on Proposed 2019 Budget
FEB 14, 2018 | Justice in Aging
President Trump’s proposed FY 2019 Budget is yet another attack on the health and economic security of older adults and people with disabilities. After using the latest tax bill to give away trillions of dollars in tax cuts to America’s wealthiest, the Administration is attempting to pay for those tax cuts by slashing critical programs that keep older adults in their homes, allow them to visit their doctors, and ensure they can meet their basic needs.
This budget would take us backwards by increasing poverty and making it harder for people to get the health care they need. It goes against what Congress wants and what the public wants. In its 2018 budget, Congress recently increased spending for important and popular programs. Those gains would disappear in 2019 under this budget.
The American people do not want cuts to Medicaid or the repeal of the ACA, yet this budget renews calls for slashing Medicaid by more than $1.4 trillion over the next decade through block grants and per capita caps, as well as repealing and replacing the Affordable Care Act (ACA). As we have explained, such cuts would be devastating to low-income older adults who rely on Medicaid to support their health care needs and ability to stay in their homes, leave millions without coverage, and weaken consumer protections.
The President promised the American people he wouldn’t touch Medicare, yet his proposed budget for the next ten years calls for over $490 billion in cuts to a program that every American will need.
The budget also would make it harder for older adults to pay rent, put food on the table, and meet their basic needs. The budget proposes significant cuts of over $83 billion to Social Security, primarily through cuts to Social Disability Insurance (SSDI) and the Supplemental Security Income (SSI) programs. These programs are there for people who have no or little income and are the difference between home and a life on the streets for many.
Additionally, the budget proposes dramatic cuts to nutrition assistance, eliminates funding for home heating and cooling assistance for about 6 million low-income households, and calls for the complete elimination of the Legal Services Corporation, which provides vital legal help for low-income older adults and their families.
This budget is a true window into the misplaced priorities of this President and his Administration. On the heels of a massive tax cut that will increase income inequality, this budget proposes to make life even more difficult for America’s poor older adults and people with disabilities.
By joining together we have fought back successfully against previous attempts to cut the programs older adults and their families rely on, and we will continue to fight for justice for us all as we age.
California Gubernatorial Forum on Long Term Care
FEB 8, 2018 | Facebook Live hosted by SEIU 2015
Panel of experts discuss the challenges facing our long term care system. Then at minute 54:45 the candidates for Governor outline their plans for our state's aging population.
Teresa Favuzzi, aka "Fearless Favu," Transitions
FEB 7, 2018 | California Foundation for Independent Living Centers (CFILC)
To friends and colleagues in the national Disability Rights movement, Teresa M. S. Favuzzi, aka "Fearless Favu," was an intrepid leader who made the fight for justice, equality and inclusion her life's focus. On Monday morning, February 5, Teresa passed away quietly at home with her beloved wife, Carol Bradley, by her side. She was 56.
Click to visit the CFILC website to read Teresa's complete obituary.
Services have not yet been scheduled. CFILC will host a Celebration of Life in Sacramento, CA in June. Additional details to follow. In lieu of flowers, contributions can be made online to the Teresa Favuzzi Mobilization Fund, or via mail, checks made to the address of CFILC in memory of Teresa Favuzzi, 1000 G Street, Suite 100 Sacramento, CA 95814.
Alzheimer's Association Issues A Guide to Quality Care from the Perspectives of People Living With Dementia
FEB 2018 | Alzheimer's Association
With more than 5 million Americans living with Alzheimer's disease, direct care workers — such as nurse's aides, home health aides, personal and home care aides — provide most of the paid long-term care to older adults living at home or in residential settings. From the perspective of individuals lising with dementia, quality care includes person-centered care techniques that address their unique experiences and needs, which is contract to a "one-size-fits-all" approach.
In this guide, survey data and interviews from individuals living in the early stage of Alzheimer's or with other dementias are used to describe quality dementia care, explore topic areas relative to the dementia experience and share approaches for care providers. As Alzheimer's progresses, individuals living in the early stage will depend on care providers to help preserve their sense of identity, autonomy and quality of life with dementia. This guide provides valuable guidance for people living with the disease, their caregivers, other family members and anyone concerned about providing high quality dementia care.
Cal Duals CCI Monthly Update
PDF | Word
600,000 Medi-Cal Beneficiaries Must Transfer to New Medical Group
JAN 19, 2018 | Justice in Aging
Advocates should be aware that California’s Department of Managed Health Care (DMHC) has ordered nine health plans across the state to move 600,000 Medi-Cal beneficiaries from Employee Health Systems (EHS) to new medical groups by early February.
According to a DMHC order, health plans contracted with EHS are required to terminate their contracts by early February and transfer all beneficiaries to different medical groups or provider associations. This DMHC order is in response to an investigation into SynerMed. The investigation found that SynerMed secretly and systemically blocked patients and providers from accessing in-network specialists who were deemed too costly. Since EHS subcontracted with SynerMed to carry out most of its medical and administration functions, DMHC found that EHS, acting through SynerMed, improperly denied access to care to Medi-Cal beneficiaries in order to reduce costs.
The affected health plans include Adventist Health Plan, Aetna Health, Blue Cross, Care1st, CalViva Health, Cigna, Health Net, LA Care, and Molina. This order may impact dual eligibles enrolled in Cal MediConnect as a number of Cal MediConnect plans also contracted with EHS. The EHS network includes more than 6,500 providers in nine California counties. State regulators are requiring that plans must send notices to impacted beneficiaries and conduct outbound telephone calls to educate beneficiaries.
If your client is one of those affected and needs help, please contact the Health Consumer Alliance at 1-888-804-3536 for free legal assistance.
Given the DMHC timeline, many health plans have already sent notices to affected beneficiaries. Beneficiaries may find these notices confusing and be unaware that a change in provider groups may affect their relationships with their pre-existing providers. Furthermore, in light of the charges against EHS, advocates should work to ensure their clients have their medical needs – including access to specialty care – met after the transition.
Read the DMHC order.
Introducing Aetna Better Health® of California
JAN 11, 2018 | Business Wire
SAN DIEGO--(BUSINESS WIRE)--Aetna (NYSE: AET) has announced the California Department of Health Care Services has approved Aetna’s participation in Medi-Cal, the State’s Medicaid managed care program.
Effective immediately, Medicaid beneficiaries who are eligible for Medi-Cal now have the opportunity to sign up with Aetna Better Health in Sacramento and San Diego Counties.
“Aetna Better Health is committed to California’s Medicaid population,” said Chet Uma, CEO of Aetna Better Health of California. “We look forward to working with the State of California, provider communities, and local organizations to improve health outcomes for the members we serve.”
Aetna Better Health of California provides members full medical benefits, including vision coverage, some mental health and substance use services, and pre-natal and postpartum care. In addition, members may access their information 24 hours a day, seven days a week through the Aetna Better Health of California website and mobile app. Members can also receive assistance at any time, including weekends and after hours, through Aetna Better Health of California’s Member Services department at 855-772-9076, TTY 711 and the 24-hour nurse help line; interpreter services are available upon request.
For more information about Aetna Better Health of California, visit https://www.aetnabetterhealth.com/california/.
Collabria Care and Partnership HealthPlan Team Up to Provide Medi-Cal Palliative Care Benefit
JAN 1, 2018 | Partnership HealthPlan of California
In the months near the end of life, what most people want is a last chance to be themselves, in their homes, with the people they love.
Palliative care is patient- and family-centered care that anticipates, prevents, and treats suffering during end of life. And beginning January 1, 2018, palliative care becomes a covered benefit for all eligible Medi-Cal beneficiaries. The benefit gives individuals, during the period before hospice care is necessary, an alternative to spending time in hospitals and emergency rooms.
Partnership HealthPlan of California (PHC), the Medi-Cal managed care plan for 14 Northern California counties, is pleased that its community-based palliative care pilot program, which launched in September 2015, is becoming a full-fledged benefit. READ MORE
Legitimate CMS Communications to Beneficiaries
JAN 2, 2018 | California Health Advocates, Senior Medicare Patrol
The Senior Medicare Patrol is sharing two very important announcements regarding CMS legitimate communication:
- Medicare is sending emails about new Medicare cards coming:
It was brought to our attention by our Stanislaus SMP liaison, that Medicare is sending emails to beneficiaries with a MyMedicare.gov subscription informing them about New Medicare cards coming in 2018 and asking everyone to update their address with Social Security. We have confirmed with our CMS contacts that these emails are legitimate. The email is from Medicare (email@example.com) with Subject: New Medicare cards coming in 2018 and Subject: Update your information. Per CMS, they are trying to ramp up their Medicare email efforts in advance of the card mailings. This listserve currently has 300+K on it, and folks will be able to sign up from the Medicare.gov homepage after December 20th.
- CMS is sending mail containing a survey:
It was brought to our attention by the Alameda HICAP, about a letter being sent to beneficiaries informing them about a "Medicare Provider Experience Survey" they will be receiving in the mail. According to the letter, a beneficiary's response is voluntary; whether or not he/she take the survey has no effect on his/her Medicare benefits. The survey itself is being sent by nrc Health. For more information, you may visit https://search.cms.gov/search?utf8=%E2%9C%93&affiliate=cms-new&dc=&query=nrc+health+survey
NADSA SIGNS-ON TO SPREAD THE MESSAGE. . .
Congress: Protect Americans who need the most care.
DEC 11, 2017 | AARP
The National Adult Day Services Association (NADSA) was asked and agreed to be a signatory urging the House-Senate tax conference committee to retain the Medical Expense Deduction in any final tax restructuring bill. The ad appeared in Politico on Thursday of the past week and was sponsored by AARP on behalf of the signatories.
Politico is a daily publication “with a focus upon Congress and issues that make Washington tick.” It is delivered free to all Capitol offices and available to the public at several other locations in DC.
CMS Temporarily Suspends Improvements in QMB Notices
DEC 8, 2017 | Justice in Aging | Fact Sheet
On October 2, 2017, the Centers for Medicare and Medicaid Services (CMS) initiated changes in the Provider Remittance Advice and the Medicare Summary Notice (MSN) to show more clearly that Qualified Medicare Beneficiaries (QMBs) may not be charged for Medicare deductibles and co-insurance. Unfortunately, CMS will be temporarily suspending these system changes as of December 8 because of significant unforeseen issues affecting provider payments. CMS is working to address the problem and reinstate the new systems sometime in 2018.
The temporary suspension of the system improvements does not affect the rights of QMBs. QMBs do not owe deductibles and co-insurance for any Medicare Part A or Part B services.
The suspension also does not affect another change, instituted in November, that enables providers to confirm QMB eligibility before serving individuals, using the same systems through which they check other insurance coverage.
To learn more about these developments, read our fact sheet.
For more information on QMB protections, see the CMS QMB Program webpage. For tools that advocates can use to assist QMB clients who have been improperly billed, go to Justice in Aging’s Improper Billing page.
Your Donations Help!
Three (3) great opportunities to further support Adult Day Services:
- CAADS STATE ADVOCACY FUND
- CAADS MANAGED CARE CONSULTING FUND
- ALE NINA M. NOLCOX SCHOLARSHIP FUND
Learn more and DONATE today -- 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. 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.
Learn more about CAADS
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.
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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.
FREE FRAUD PREVENTION EDUCATION
The California Senior Medicare Patrol offers free fraud prevention education throughout the state.
To schedule a presentation, call 855-613-7080
See the SMP/Medicare fraud section at www.cahealthadvocates.org, for more information on ways to protect yourself from healthcare fraud and how to detect it.
If you come across any suspicious activity,
PLEASE REPORT IT AT
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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