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CAADS WEBINAR RECORDING NOW AVAILABLE
Keeping Your Center Cyber Secure: Internet and Email Safety
CAADS Member: No Charge -- See Quick Links: EVENT HANDOUTS on Members Only page
Non-member: $99 -- Order Form Fill-in :: Write-on
NOV 6-8 CAADS Fall Conference & Annual Membership Meeting in Anaheim
Information available on Meetings page.
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. Abstract and Full Article | JUN 2017 | The Gerontologist, Volume 57, Issue 3, Pgs 552–562.
What's New . . . AUGUST 21, 2018
More Than Three-Quarters of Low-Income Older Californian Tenants Are Rent Burdened
AUG 21, 2018 | UCLA Center for Health Policy Research | Health Policy Fact Sheet
In 2016, more that three-quarters of low-income older Californians whose head of household is age 65 or over are "rent burdened," and more than half are "severely rent burdened." The shortage of affordable housing is a pressing issue in California.
For most older adult renters who are retired and on fixed incomes, rising rents create a particular challenge. These tenants have often lived in the same unit for many years, have established ties with their health care providers and community services, and have support networks of friends nearby. If rents rise too high, they can be forced to leave their support networks for distant but less expensive housing. MORE
Medicare Summary Notices Help Protect Against Improper Billing
AUG 15, 2018 | Justice in Aging
As of July 2018, Medicare beneficiaries who are Qualified Medicare Beneficiaries (QMBs) have begun seeing changes in the Medicare Summary Notices (MSNs) they receive every three months. The notices now show that the beneficiary has no financial liability for co-insurance for each Medicare-covered service listed on the MSN. The Remittance Advice (RA) that Medicare sends to providers shows the same information. By spelling out protections on a service-by-service basis, the MSNs provide clarity for both the QMB beneficiary and the provider.
Advocates should educate their clients on these changes and use the MSNs as a tool to address improper billing when it occurs.
- The “Your Deductible Status” box on the first page can be ignored as long as the beneficiary remains a QMB. QMBs are protected from paying Medicare deductibles. The box keeps track of deductible payments in case the individual loses QMB status during the year.
- Service dates on or after July 2, 2018 are affected. MSNs issued in the first three months of the change may include earlier service dates that won’t show QMB payment levels. Nevertheless, QMB protections still apply.
The MSN changes apply to Original (fee-for-service) Medicare. Medicare Advantage plans send Explanations of Benefits (EOBs) instead of MSNs. CMS issued guidance to Medicare Advantage plans encouraging them to incorporate QMB information in their EOB notices and in RAs to network providers. We urge advocates to talk with plans in your area about steps that they are taking to implement the CMS guidance.
Resources for Advocates:
- Justice in Aging updated its Improper Billing Toolkit to incorporate references to the MSNs in its model letters. Resources on the site provide additional information on the details of improper billing protections and avenues to file complaints. A chart of state statutes that may offer state protections in addition to federal law also is available.
- In educating providers who have improperly billed, advocates can use a recently-updated Medicare Learning Network article and a helpful Q&A that explains many practical aspects of provider compliance.
DHCS Allows Brokers to Market Cal MediConnect Plans
JUL 31, 2018 | California Health Advocates
Despite strong opposition from California Health Advocates and other advocates statewide, California’s Department of Heath Care Services (DHCS) recently approved a new pilot that will allow brokers to market Cal MediConnect plans to dual eligibles as of January 1, 2019. This new pilot overturns a longtime ban on brokers which prevented them from marketing Cal Mediconnect plans for fear of exposing consumers to potentially harmful broker misconduct and disruptions in care. While DHCS has noted that existing marketing guidelines from the Centers for Medicare and Medicaid Services will apply, how that will play out specifically is not yet known. This new policy to introduce brokers is inconsistent with consumer experience on the ground, and the whole stakeholder engagement process during the proposal review was woefully inadequate. MORE
DHCS Seeks Public Comment on Data-Sharing Proposal
JUL 30, 2018 | CA Department of Health Care Services
The Department of Health Care Services (DHCS) released a set of recommendations on how Cal MediConnect (CMC) plans can share data to promote continuity of care when members transfer between CMC plans. Public comment on these recommendations is requested by 5 pm, August 10, 2018, and can be emailed to email@example.com.
The Cal MediConnect program was developed to provide better coordinated and integrated care to dual eligible beneficiaries in the participating counties. As a part of ongoing efforts to strengthen the program, the recent revision of the three-way contract between the participating Cal MediConnect plan, DHCS and the Centers for Medicare & Medicaid Services (CMS) created a new requirement to improve continuity of care as members transition between CMC plans.
Under this new requirement, CMC plans with members transferring to a new CMC plan will be required to share data for those members. The contract called for a workgroup of plan, DHCS, and CMS representatives to determine what data should be shared and how. That workgroup developed the recommendations included in the memo being released for public comment and include:
- Data elements to be shared between Cal MediConnect plans
- Cal MediConnect members eligible for the data-sharing process
- Data sharing process
- Implementation timeline and considerations
Download the Workgroup's Draft Recommendations.
Cal Duals Coordinated Care Initiative
Monthly Update: July 2018
JUL 19, 2018 | Cal Duals
The Cal Duals Coordinated Care Initiative Monthly Update: July 2018 is now available.
Millions of seniors pushed into poverty
JUN 28, 2018 | Capitol Weekly | Shelley Lyford and Bruce A. Chernof | Article
It is no secret that Californians are living longer, but not necessarily better.
By 2030, the state’s senior population will increase by 4 million people, yet the state is woefully unprepared to care for this growing and financially unstable demographic. The lack of any strategy or organized master plan has pushed millions of seniors into poverty, unable to access high-quality, affordable healthcare, dental care, housing and supportive services.
Our lawmakers and next governor need to set aside partisan differences and collaborate on the creation of a state master plan for aging that recognizes three important pillars: the ability to age with independence; a healthcare system that responds to the individual not an institution; and affordable housing. MORE
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.
TO FILE A COMPLAINT AGAINST A HEALTH CARE FACILITY LICENSED BY THE CALIFORNIA DEPARTMENT OF PUBLIC HEALTH
Use the California Department of Public Health's Cal Health Find website
call, write, fax the Center for Health Care Quality,
Licensing and Certification District Office nearest you.
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
CAADS Stands With Seniors
Join the campaign!
Videos / Podcasts
Human Kindness--it just flows around here
[Download Real Player]
Honoring Adult Day Services pioneers and those they serve.
Seniors and Children Find Inspiration Together at a Day Care With a Heartwarming New Approach
FEB 2, 2018
What is an Adult Day Health Care Center? One of San Diego's Best Kept Secrets...
APR 18, 2017
Featuring Kathryn Holt, Owner, Poway Adult Day Health Care Center, and her mother Lois Knowlton, the Center's Administrator
MORE Videos / Podcasts
This is What Life Without Retirement Savings Looks Like
Alana Semuels | FEB 2018
Why a patient paid a $285 copay for a $40 drug
AUG 19, 2018
KVIE / PBS News Hour
Anthem Medicare plan | Express Scripts | CVS | Caremark | OptumRX | GoodRx | WellRx
Blood pressure guidelines changed, and that wasn't good for my elderly mother
AUG 19, 2018
The Washington Post
geriatrician | rehabilitation facility | nursing homes | age and quality of life | Journal of the American Geriatrics Society | betterhealthwhileaging.net | geriatric nurse practitioner
A Black Eye For Blue Shield: Consumers Lash Out Over Coverage Lapses
AUG 20, 2018
Blue Shield of California | Covered California exchange | Affordable Care Act | HealthPlan Services | health care | California Department of Managed Health Care
Thousands of Medi-Cal Patients Report Poor Treatment by Doctors, Staff
AUG 16, 2018
California Health Report
Caitlin Yoshiko Kandil
Medi-Cal | accessing health care | California Department of Health Care Services | older folks | Gold Coast Health Plan | low reimbursement rate | low-income Californians | federally qualified health centers
Industry Voices—Chronically ill patients deserve a better care model
AUG 16, 2018
Mahesh Krishnan, MD
multiple chronic conditions | medically complex patients | multidisciplinary care teams | care coordination | Medicare beneficiaries
With Scarce Access To Interpreters, Immigrants Struggle To Understand Doctors' Orders
AUG 15, 2018
Sheila Mulrooney Eldred
"meaningful access" | Affordable Care Act | Medicaid and Medicare managed care plans | health care | Department of Health and Human Services' Office for Civil Rights
‘Too Little Too Late’: Bankruptcy Booms Among Older Americans
AUG 5, 2018
New York Times
Tara Siegel Bernard
older Americans | social safety net | Social Security | health care | costs of aging | aging of the baby boom generation | adult day care center | unmanageable medical expenses | Medicare
VA nursing home woes will be explored at congressional hearing in Camarillo
JUL 22, 2018
Ventura County Star
Register here for the July 30 hearing or call 805-379-1779
VA long-term care | adult day care for veterans | Oxnard Family Circle for adult day health care | quality of care
MORE Media Coverage
Lydia Missaelides, MHA
Membership & Communications Director
Education & Events Manager