Quick Links. . .
Top-of-Mind . . .
CAADS PRE-CONFERENCE TRAINING -- The Revised IPC for ADHC/CBAS
CAADS FALL CONFERENCE -- The Quality Imperative
CBAS CERTIFICATION FOR NEW ADHC CENTERS
HELP II LOAN PROGRAM -- Affordable Capital
What's New . . . July 29, 2016
Oral Health in California: What About Older Adults?
JUL 27, 2016 | Justice in Aging Health Network Alert
Oral health is a critical aspect of overall health for people of all ages, but especially for older adults. Unfortunately, the oral health needs of older adults, particularly low-income older adults have been neglected.
A new Issue Brief by Justice in Aging, Oral Health in California: What About Older Adults? explores the reasons why the oral health of older adults in the state is suffering and offers recommendations for improvements.
The issue brief launches a new area of advocacy for Justice in Aging in which we seek to improve oral health for low-income older adults in California.
California ranks 30th in dental care for older adults. Older adults with limited income especially face barriers accessing quality dental care through the state’s Denti-Cal program, which provides dental services under the Medi-Cal program. For example, only one in four California dental providers provide services to Denti-Cal enrollees. Five California counties have no Denti-Cal providers and several other counties have Denti-Cal providers, but they are not accepting new patients. As a result of this and other reasons, older adults in California have high rates of dental decay and tooth loss.
Justice in Aging presented a webinar on this topic on Tuesday, July 26. You can access the webinar slides or watch the video here.
This issue brief and its accompanying webinar was funded by a grant from The California Wellness Foundation (Cal Wellness). Created in 1992 as a private independent foundation, Cal Wellness’ mission is to improve the health of the people of California by making grants for health promotion, wellness, education and disease prevention.
New Fact Sheets on How Medicare and Medicaid Work for LBGT People
JUL 21, 2016 | Justice in Aging Health Network Alert
LGBT people need to be aware of recent developments that change how Medicare and Medicaid work for them. First, the Supreme Court’s legalization of same sex marriage in all states changed how Medicare and Medicaid evaluate the eligibility of same sex spouses for both programs. Depending on the program and the individual’s circumstances, the changes can be positive or negative. Additionally, Medicare has begun covering Gender Reassignment Surgery and issued new rules that protect transgender older adults from sex discrimination in healthcare.
Three new fact sheets can help consumers learn how these changes may affect them, whether they are LGBT individuals married to someone of the same sex, or transgender individuals needing to access health care. These fact sheets were produced in partnership with SAGE (Services & Advocacy for Gay, Lesbian, Bisexual, & Transgender Elders), the SHIP National Network (State Health Insurance Assistance Programs), and Administration for Community Living (ACL).
The three fact sheets are:
All are available for download at the National Resource Center for LGBT Aging.
Direct service advocates are encouraged to share these resources widely with the individuals they serve.
Also available from Justice in Aging, Can Legal Services Better Meet the Needs of Low-Income LGBT Seniors?, a special report produced in partnership with Services and Advocacy for Gay, Lesbian, Bisexual, & Transgender Elders (SAGE). This report explains why LGBT older adults have higher rates of poverty, outlines how discrimination and other factors lead to unique legal needs, and provides practical tips for outreach, intakes, and providing culturally competent legal services to LGBT older adults.
Tell CMS What Isn't Working and to Improve Access to Durable Medical Equipment
JUL 19, 2016 | Justice in Aging Health Network Alert
Consumers with both Medicare and Medicaid coverage face recurring problems getting approval for Durable Medical Equipment (DME), getting repairs, and finding reliable suppliers. DME includes many vital items, such as wheelchairs, walkers, hospital beds, home oxygen equipment, and even diabetes test strips used with a glucose monitor. After dialogue with advocates about these problems, the Centers for Medicare and Medicaid Services (CMS) recently issued a Request for Information seeking more information about problems accessing these vital forms of equipment.
This is a very important opportunity to tell CMS what isn’t working and to improve access to DME. Please consider commenting and share this opportunity with others, both advocates and consumers, who can provide input to CMS.
The deadline for comments is August 23.
CMS noted some of the obstacles facing dual eligibles in getting access to DME including:
The agency asked for examples of these problems, as well as suggestions for legislative and administrative measures that could remedy the issue.
The full list of CMS questions is here. It is very open-ended. We hope that policy advocates will talk about trends they see and specific policy changes that would help. We also hope that consumers who can recount first hand problems will respond (but since comments are public - please don’t include personal information such as a Medicare number).
Please take advantage of this chance to help make DME more accessible to dual eligible beneficiaries!
National Study of Long-Term Care Providers: All ADS Centers Invited to Participate
JUL 17, 2016 | National Adult Day Services Association (NADSA)
CARF International is conducting a 2016 study to highlight the concept of “Financial Ratios as Performance Indicators” to the field of Adult Day Services for 2015 financial results. If your organization is an Adult Day Services provider, you are invited to participate in this unique, exciting annual study that began in 2010. MORE
Drop in Percentage of Physicians Participating in Medi-Cal Raises Red Flags
JUL 8, 2016 | Amy Adams, California Health Care Foundation
New 2015 data now available on ACA 411 show the percentage of physicians participating in Medi-Cal has declined since 2013 — during the same period Medi-Cal enrollment skyrocketed by 39%. This raises serious concerns about whether the supply of physicians participating in Medi-Cal can meet the increased demand.
Self-reported data from a voluntary survey of California physicians show physician participation in Medi-Cal declined from 69% in 2013 to 63% in 2015. (Physicians are identified as participating in Medi-Cal if they report any of their patients are covered by Medi-Cal.) The percentage of specialty care physicians participating in Medi-Cal likewise dropped during this time, from 70% to 64%. MORE
Changes to the Medicaid Managed Care Regulations in Effect
JUL 5, 2016 | Justice in Aging
On July 5, the first wave of new Medicaid Managed Care regulation requirements went into effect. The Centers for Medicare and Medicaid Services (CMS) published the final Medicaid managed care rule this spring, introducing sweeping changes to how the federal government will regulate entities that manage long-term services and supports (LTSS).
Justice in Aging discussed some of the most important pieces of the new regulations in a webinar on June 30. Watch the webinar or download the slides here. Read about the changes on our blog.
Cal Duals Update -- JUNE 2016
HHS Issues Guidance on Facility Residents’ Return to Community Living
JUL 5, 2016 | Justice in Aging Health Network Alert
Recent federal guidance instructs nursing facilities on how to better identify and support residents who want to move to community settings. As the guidance notes, unnecessary nursing facility placement may constitute illegal disability-based discrimination.
The guidance concerns how a facility should administer an assessment document called the Minimum Data Set — MDS for short. Since 2010, the MDS has included Section Q, which is designed to determine a resident’s interest in moving from the facility to a community setting. According to the HHS Office of Civil Rights —the author of the guidance — many nursing facilities are administering Section Q improperly, which results in residents being deprived of opportunities to move from facilities into community settings.
One MDS question asks if “active discharge planning” is occurring. The Office of Civil Rights reports that too many facilities are answering “yes” based on the file containing a pro forma “discharge plan” that has no practical effect. Under MDS assessment protocols, this “yes” answer results in the resident not being asked whether he or she wishes to speak to someone about the possibility of moving from the facility into the community.
The guidance also identifies problems in how the facilities ask whether the resident wishes to speak to someone about possibly moving into the community. The guidance instructs facilities to emphasize that the resident does not need to know exactly how or whether a move would take place: the resident just needs to have an interest in the possibility of moving.
Finally, the guidance advises that interested residents be referred to the “Local Contact Agency” designated to assist residents in moves into the community. A facility should not short-circuit the process based on its estimation that the resident would not be able to live in the community, or on the opinions of the resident’s family.
Justice in Aging commends HHS for its attention to these issues, and encourages residents, family members, and care coordinators to actively explore how moves to the community might be facilitated. The federal guidance and contact information for Local Contact Agencies each is available on-line.
For more information from Justice in Aging about rights under the Americans with Disabilities Act (ADA) and Olmstead, see our issue brief, ADA at 25: Aging Advocates Celebrate Partnership and Progress.
CCI COMPREHENSIVE STRATEGY UPDATE
JUL 1, 2016 | Health Care Delivery Systems, Department of Health Care Services
Earlier this year, the Department of Health Care Services (DHCS) shared for stakeholder comment a comprehensive strategy for the Coordinated Care Initiative (CCI). This strategy focused on improving the quality of care and care coordination beneficiaries receive through Cal MediConnect, ensuring that beneficiary satisfaction remains high and increases, and generating sustainability for the program. After considerable feedback from stakeholders, DHCS announced final policy decisions in May. Today, DHCS is sharing an update on these policy decisions, as well as an additional document for stakeholder comment.
Voluntary Enrollment Strategy
DHCS announced its intent to pursue a robust voluntary "opt-in" enrollment effort for the remainder of 2016. Today, DHCS is releasing its DRAFT Cal MediConnect Voluntary Enrollment Strategy for stakeholder comment. It is available here.
This strategy, designed to expand awareness of Cal MediConnect and encourage voluntary enrollment, builds on activities DHCS and its partners are already conducting. This strategy also incorporates many of the lessons learned about how best to reach and educate beneficiaries and providers about the CCI and Cal MediConnect. These strategies include streamlined enrollment and mandatory Medi-Cal plan enrollment for managed long-term services and supports (MLTSS).
DHCS is soliciting feedback from stakeholders on the activities included in this strategy, as well as additional activities Cal MediConnect partners can pursue. Feedback is due Thursday, July 14, 2016.
Standardized LTSS HRA Questions & Data Measures
DHCS announced that it would strengthen LTSS referrals and improve care coordination by standardizing the Health Risk Assessment (HRA) referral questions for LTSS to reflect the best practices developed over the early years of the program and expanding data collection and reporting. MORE
STOP THE THREAT TO SHIP PROGRAM FUNDING
State Health Insurance Assistance programs provide local help for people with Medicare
JUN 21, 2016 | Justice in Aging Health Network Alert
The Senate Appropriations Committee shocked advocates last week by approving a bill that would entirely eliminate funding for State Health Insurance Programs (SHIPs). The Senate bill now goes to the House Appropriations Committee.
SHIPs in every state provide vital one-on-one benefit counseling to people with Medicare, helping them choose Medicare plans and navigate denials. They assist low income Medicare beneficiaries in accessing programs that lower their costs, such as Medicare Savings Programs and the Low Income Subsidy, and in using those programs effectively. For example, in 2015, SHIPs served over 1 million beneficiaries with one-on-one assistance during the Medicare Open Enrollment Period. Losing SHIPs would be a major blow to the people we all serve.
Now is a good time for your Senators and Representatives to hear from you. Use our Action Alert to contact members of the House of Representatives and urge them to reject the Senate proposal and invest in SHIPs. For more information, this Kaiser Health News article explains the potential consequences of a loss in funding, and The National Council on Aging (NCOA) also prepared an issue brief on SHIP funding.
Make your voice heard and let the House know how important SHIPs are for Medicare beneficiaries.
New Report: Moving Medi-Cal Forward on the Path to Delivery System Transformation
JUN 21, 2016 | California Health Care Foundation
Today the California Health Care Foundation (CHCF) released Moving Medi-Cal Forward on the Path to Delivery System Transformation. The report, commissioned by CHCF and written by Manatt Health, explores the reforms that are needed to ensure that Medi-Cal consistently delivers excellent access, quality, and patient experience while using resources efficiently.
Manatt conducted a landscape review and in-depth interviews with a diverse array of over 50 Medi-Cal stakeholders and thought leaders. The report assesses key challenges and opportunities in Medi-Cal, establishes a vision for delivery system reform, and articulates a path forward. Topics discussed include capitation rates, behavioral health, workforce shortages, access to providers, and more. See the report.
In the latest CHCF blog, Chris Perrone, director of Improving Access at CHCF, shares his key takeaways from the paper. Read the blog.
CHCF will hold a briefing in Sacramento on Wednesday, July 13 to discuss the report's findings. Register for the briefing.
LawHelpCA.org News Features Advance Planning, Scam Alerts
JUN 3, 2016 | LawHelpCA.org
LawHelpCA is a statewide resource for legal information and referrals. This issue of LawHelpCA.org News features:
Mental Health Access for Persons with Dementia
As this paper, Mental Health Services for Californians with Alzheimer's Disease, proposes, California has a number of timely opportunities to improve access to mental health services for people with dementia, beginning at the point of diagnosis. An urgent need exists to pursue such opportunities immediately to prevent the types of crises presented here, enable families to stay together, improve quality of life, and reduce the cost of care.
Human Kindness--it just flows around here[Download Real Player]
6/20/16 California Healthline
4/12/16 California Healthline
Adult day centers provide care for older adults, respite for caregivers
UnitedHealth, Aetna to join major Medi-Cal markets
El Monte center pays former employee $9,187 in unpaid wages, penalties
Savvy Senior: How to Choose an Adult Day Care Service
Jerry Brown signs $167 billion California budget, makes no cuts
Fighting the Swell of Latino Dementia
California Budget: Small Health Gains, Advocates Look To Nov. Ballot For Big-Ticket Items
California dual-eligibles happy with their healthcare
California Budget Includes Limit on Medi-Cal Estate Recovery
Experts: CMS observation notice needs work
When Aging Parents Need Help With Financial Tasks
Medicaid managed care sees surge in enrollment, revenue
Hike in Minimum Wage Will Push Some Workers Out Of Medi-Cal
Medi-Cal Cards Getting A Facelift
Caregivers find support at monthly meeting
Medi-Cal's Positive Impact Must Not Be Overlooked
Feds Approve California’s Health Plan Tax Swap
Fix For VA Health Snarls Veterans And Doctors In New Bureaucracy
Dignity Health dips into the red as Medicaid volume grows
Alzheimer's OC to take over adult day care service in Laguna Woods
Aging population caused by lower fertility, longer lives
California Governor Signs Bill Giving Time For ADA Fixes
State Makes Changes to Managed Care Program For Elderly, Disabled
Anthem Blue Cross Fined For Poor Handling Of Consumer Grievances
San Ysidro Health Center, Inc.
Your Money, Your Life
Marin Adult Day Health Care