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CBAS CERTIFICATION FOR NEW CENTERS
HELP II LOAN PROGRAM -- AFFORDABLE CAPITAL
CAADS SPRING CONFERENCE -- THE QUALITY IMPERATIVE
MAY 11 - 13, 2016
SAVE THE DATES!
Crowne Plaza Hotel | San Francisco Airport
Join us at the Crown Plaza Hotel, SFO for this information-packed conference featuring exciting new initiatives, state department presentations, education sessions filled with best practices, and great opportunities to network with colleagues! Watch for details coming soon. . .
What's New . . . February 3, 2016
Good News: CMS Issues Final Rule Prohibiting “Homebound” Requirement for Medicaid Home Health Services
JAN 29, 2016
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:
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.
Cal Duals Update
HCBS Settings Rule: National Organizations Release Toolkit to Help Stakeholders Advocate for Strong Implementation in Their States
JAN 26, 2016
Justice in Aging, together with other disability and aging advocacy groups, issued a toolkit to help advocates push for strong implementation of the new Home and Community Based Services (HCBS) Settings Rules in their states. The new HCBS Settings Rules require all settings funded by Medicaid HCBS programs to, among other things, provide opportunities for participants to be integrated in and engage in community life, have access to the community, control their personal resources, and seek employment and work in competitive settings. States have until March 2019 to transition their HCBS programs into full compliance with the new settings requirements.
The extent to which these new rules are a catalyst for positive change in states’ service systems will depend on the strength of each state’s transition plan, as well as the ability of stakeholders and advocates to influence the plan and monitor its implementation. All states have already submitted to CMS their initial transition plans, and CMS has provided feedback to states about needed improvements and next steps for amending and implementing their transition plans. The next several months are an important time to become involved because this is when important decisions at the state level will be made and the parameters of state plans will be set. CMS has indicated that they are looking closely at public comments — advocates’ voices matter!
This new toolkit provides advocates with detailed information about the HCBS Settings Rule and provides action steps for advocates to impact implementation of the new rules in their states. The toolkit contains three documents:
Justice in Aging is pleased to partner with a coalition of disability and aging advocates to develop this toolkit and work together for strong implementation of the HCBS Settings Rule –the American Network of Community Options and Resources, Association of People Supporting Employment First, Association of University Centers on Disabilities, Autistic Self Advocacy Network, Bazelon Center for Mental Health Law, Coalition to Promote Self-Determination, Human Services Research Institute, National Association of Councils on Developmental Disabilities, National Consumer Voice for Quality Long Term Care, National Council on Independent Living, National Disability Rights Network, National Down Syndrome Congress, National Health Law Program, TASH, and The Arc of the United States.
See Justice in Aging’s complete list of resources on HCBS.
To learn more about the HCBS rules, see www.HCBSadvocacy.org, a website with up-to-date information about the rules and states’ implementation maintained by several member organizations in the coalition.
Fact Sheet: Social Security’s Representative Payee Program Basics
More than ten million older adults rely exclusively on Social Security benefits as their primary source of income. As the population ages and the prevalence of Alzheimer’s disease and other cognitive impairments increases, more older adults will need to rely on others to manage their finances.
The Social Security Administration (SSA) has authority granted by Congress to appoint third parties, known as representative payees, to receive and manage payments when a beneficiary is unable to do so. To protect seniors from financial exploitation or interruptions in benefits, it’s important for advocates and caregivers to understand key issues relating to the program.
Justice in Aging, with the support of a Borchard Center Foundation on Law and Aging fellowship grant, will be producing a series of informational publications about the Representative Payee Program. Download and read the first in the series.
CMS Releases First Reports Evaluating the Dual Eligible Demonstrations
JAN 22, 2016
The Centers for Medicare and Medicaid Services (CMS) released the first ever evaluations of the federal Financial Alignment Initiatives, known as the dual eligible demonstrations. The reports provide unprecedented detail on the early challenges, success, and impact of the demonstrations. CMS contracted with RTI International to conduct interviews, focus groups, and collect qualitative and quantitative data for the reports, the first in a series to be released the course of the demonstrations.
The “Report on Early Implementation of Demonstrations Under the Financial Alignment Initiative,” provides a summary of experiences in the first six months of implementation of the dual eligible demonstrations in seven states: California, Illinois, Massachusetts, Minnesota, Ohio, Virginia, and Washington. Information for the report was gathered from site visit interviews and state-submitted data and documents. The report focuses on five key components of the duals demonstrations: 1. Integrated delivery systems; 2. Enrollment; 3. Care coordination models; 4. Beneficiary safeguards; and 5. Stakeholder involvement.
The second report, “Measurement, Monitoring, and Evaluation of the Financial Alignment Initiative for Medicare-Medicaid Enrollees,” focuses specifically on the managed fee-for-service model implemented in Washington. The report concludes that in the first six quarters of implementation, there have been significant reductions in Medicare costs for beneficiaries enrolled in the demonstration. The report, however, states that further evaluation is needed to determine if these savings have been achieved while also maintaining or improving quality of care.
Justice in Aging will provide a more detailed review of these reports in the coming weeks.
Other Recently Released Reports
GAO released a report examining care coordination in the dual eligible demonstrations. The report, "Medicare and Medicaid: Additional Oversight Needed of CMS's Demonstration to Coordinate the Care of Dual-Eligible Beneficiaries," recommends that CMS strengthen care coordination reporting requirements in the dual eligible demonstrations.
New GAO Report Recommends CMS Strengthen Care Coordination Reporting Requirements in Dual Eligible Demos
The Government Accountability Office (GAO) recently released a new report on the federal Financial Alignment Initiative (FAI), known as the dual eligible demonstrations. The report examines care coordination in five demonstration states from June 2013-December 2015, looking specifically at how care coordination is implemented, challenges to care coordination, and CMS oversight. Based on its review, GAO recommends CMS develop new care coordination measures and align existing measures so they are comparable across states.
Interviews Conducted to Determine the Extent of Care Coordination:
Report Finds Common Challenges among States:
Throughout the report, the GAO stressed the need for comparable care coordination measures in order to make useful cross-state comparisons possible. The GAO found that states each had their own measures to explore care coordination, but without consistency among states, CMS does not know whether it has achieved its goal of providing coordinated care to dual eligible individuals.
Justice in Aging has submitted comments on CMS and state care coordination models and measure development, and analyzed person-centered care planning. More information on the dual eligible demonstrations is available here.
NADSA Conference Call for Proposals Due February 22
Call for Proposals to Present Education Sessions for this year’s National Adult Day Services Conference are due Monday, February 22, 2016, and in keeping with the conference theme, INNOVATION IN ADULT DAY SERVICES, we are seeking forward thinking education session proposals that present innovations with demonstrated outcomes within adult day services. We encourage presenters to tell their stories of, and experiences with, innovation and creative approaches so we can learn from one another and help move the field of ADS forward. We are specifically looking for proposals that will provide attendees with replicable models, practical ideas and fresh tools that they can take back and implement in their own centers.
The Conference is September 21-23, 2016, at the Crowne Plaza Downtown, Indianapolis, IN. It is the largest gathering of adult day services providers and influencers in the country. Plan on joining us in Indianapolis, not only as an attendee, but also as an education session presenter!
Nine to Ninety -- Documentary on End of Life Caregiving Decisions airs on 70 PBS stations beginning in January
Nine to Ninety is the love story of Phyllis and Joe Sabatini, who at age 89 and 90 live in the home of their daughter and her husband, relishing time with their young granddaughter Jacqueline. But as their health problems escalate, Phyllis becomes determined to free her daughter from the burden of caring for everyone from nine to ninety. When Phyllis makes a difficult decision to move 3,000 miles away to live with their other daughter, she faces parting from Joe after 62 years. Phyllis’ choice ignites bigger conversations about when the best way to say “I love you” is to say “goodbye.”
Justice in Aging Responds to California Governor’s Proposed Budget
Rates of senior poverty in California are high and rising, with more than one million seniors in one of country’s wealthiest states struggling to pay rent, buy food, and cover health care costs. California Governor Jerry Brown released a proposed budget for fiscal year 2016-2017 that provided some relief, but more action and bolder policies are needed.
Federal Government Approves Medi-Cal 1115 Waiver Renewal
The Department of Health Care Services (DHCS) is pleased to announce that today the federal government approved California’s 1115 waiver renewal, which includes $6.2 billion of initial federal funding to support the state’s Medi-Cal program and its health care coverage of more than 12.8 million individuals. This approval extends the waiver from January 1, 2016 through December 31, 2020.
The waiver renewal, called Medi-Cal 2020, builds on the successes of the state’s Bridge to Reform waiver in 2010, a critical piece of the state’s implementation of the Affordable Care Act. More than 4 million of the state’s current Medi-Cal members have enrolled since California implemented the ACA in January 2014.
The Medi-Cal 2020 waiver opens the door to innovative changes in the way Medi-Cal provides services to its members, all with the goals of improving efficiency, access and quality of care.
This final Medi-Cal 2020 renewal reflects the overall construct announced at the end of October. It includes initial federal funding over the five years of $6.2 billion, with the potential for additional federal funding in the Global Payment Program (GPP) after the initial year of the waiver. M O R E
CAADS Submits Final Comments to DHCS on Design of New Health Home Model
CAADS has submitted comments to DHCS Director Jennifer Kent regarding the Department's Health Homes for Patients with Complex Needs Concept Paper Version 3.0 -- the state's vision for launching a health home program in California. Based on CAADS close work with the Alliance for Leadership and Education's three-year Community Based Health Home (CBHH) pilot project, CAADS comments on the state's concept paper focused on eligibility criteria, acuity, care coordination, referral to community and social supports, community based care management entity responsibilities, and payment methodologies.
CAADS Testifies at Hearing on Workplace Violence
DEC 17, 2015
CAADS only recently became aware of new California Occupational Safety and Health Standards Board (OSHSB) regulations that address workplace violence prevention in health care settings and determined that the intent was to include ADHC within the scope of the rule. In addition to CAADS testimony, the California Hospital Association submitted a 13-page analysis and Disability Rights California provided brief comments. CAADS Members may view today's Members Only ALERT on the Members Only page.
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.
The CAADS Members Only page features information and technical assistance specific to Adult Day Services, as highlighted below. For membership information, click here.
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:
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]
1/4/16 California Healthline
Surprise! Here’s Another Bill For That ‘Paramedic Response’
Integrating Social Service and Healthcare Delivery in San Francisco
UCI doctor discusses challenges in Alzheimer's research
CMS explains how it arrives at its hospital star ratings
What Does the Future Hold for Medi-Cal?
Kent Confirmed as DHCS Director
Why Los Angeles’ leading Alzheimer’s nonprofit chooses to stand on its own: Susan Disney Lord
Orange County Alzheimer's group breaks with national organization
Legislature Eyeing $2 Billion Surplus
4.7M Calif. Medical Records Affected by Data Breaches Last Year
Options are limited for California caregivers shouldering burden of growing Alzheimer's crisis
Senior advocates address affordable housing, health care
UC initiative to spur Alzheimer's disease research
Aging Plan Gets Downscaled, Approved
Drug Pricing Bill Can't Pass Committee
Many Faces of the MCO Tax
California Lawmakers To Revive Rx Drug Cost Transparency Bill
Let the Budget Plan Pushback Begin
Brown's $170.7B Budget Includes Several Health Care Proposals
Dual-Eligible Coordinated Care Program Gets Vote of Confidence in Gov.'s Budget
MCO Tax a Looming Question in Governor's Upcoming Budget Proposal
Nursing Programs Across California Reporting Long Wait Times for Admittance
California Lawmakers To Address $1B Medi-Cal Budget Hole in 2016
Expensive Drugs in 2016 Crosshairs
Feds OK California's $6.2 Billion Waiver
San Ysidro Health Center, Inc.
Your Money, Your Life
Marin Adult Day Health Care