CDCAN REPORT #156-2011: Adult Day Health Care transition public plan stakeholder meeting August 9th in Sacramento

AUGUST 9th PUBLIC STAKEHOLDER MEETING ANNOUNCED BY DEPT OF HEALTH CARE SERVICES ON ADULT DAY HEALTH CARE TRANSITION FOR OVER 34,000 SENIORS & PEOPLE WITH DISABILITIES

Adult Day Health Care Slated for Elimination As A Medi-Cal Benefit December 1st As Concern and Anxiety Continues to Spread Among Recipients, Over 300 Community Organizations and Over 7,000 Workers Who Face Closure and Elimination of Jobs

SACRAMENTO, CALIF (CDCAN)  [Last updated 07/28/2011 05:45 PM] - The Department of Health Care Services, the state agency that oversees statewide California's Medi-Cal program, announced late this afternoon a public stakeholder meeting regarding the State's controversial plan to transition over 34,000 people with disabilities and seniors currently in the Adult Day Health Care program into other Medi-Cal services when that service is eliminated as a Medi-Cal benefit, effective December 1, 2011.

The public stakeholder meeting is scheduled for:August 9, 2011, Tuesday afternoon from 1:30 to 3:30 PM, at the Department of Health Care Services Auditorium, 1500 Capitol Avenue in Sacramento.  A copy of the 2 page meeting notice released by the Department of Health Care Services is attached to this CDCAN Report, titled "2011-07-28 - August 9th ADHC Stakeholder Meeting Notice.pdf"

[CDCAN Note: The notice released by the department was saved as a pdf document, meaning that persons who are blind or sight impaired should be able to read it using a screen reading device.  The key parts of the notice are also re-produced in this CDCAN Report below - Marty Omoto]

Persons not able to physically attend the Sacramento meeting can also participate via toll free phone line by calling (888) 469-1573 and entering the passcode 393 04 37

The Brown Administration is moving ahead on plans to transition persons receiving Adult Day Health Care as a Medi-Cal benefit - a benefit that the Governor proposed last January for elimination, which the Legislature approved, in March with modifications that it be replaced by a sharply reduced new version of the program. The Obama Administration approved the State's request to eliminate Adullt Day Health Care as a Medi-Cal "optional benefit" on July 1, 2011 effective originally for September 1,  later pushed back at the State's request to December 1, 2011.

It is called a Medi-Cal "optional benefit" because it is a benefit or service that the federal government does not require the states to provide as part of their approved Medicaid program (called "Medi-Cal" in California).

Earlier this week Governor Brown, in a move that angered and dismayed disability and senior advocates and several Democratic legislators including Assemblymember Mariko Yamada (Democrat - Davis), vetoed a budget trailer bill, AB 96 authored by Assemblymember Bob Blumenfield (Democrat - Van Nuys) that would have required the Brown Administration to develop and then submit a proposal to the federal government for a new model of Adult Day Health Care under a new federal Medicaid waiver or through other Medicaid funding.

WHAT THIS NEWS MEANS - AND RELATED DEVELOPMENTS

ELIMINATION EFFECTIVE DATE

The current version of Adult Day Health Care as a Medi-Cal "optional benefit" is scheduled for elimination as of December 1, 2011 (the original date was September 1, 2011, but the Department of Health Care Services requested that the effective date be delayed 90 days from that date to help with transition efforts.  The federal government approved the request last week).

STAKEHOLDER MEETINGS

• The August 9th public stakeholder meeting is one in a series that the Brown Administration has held and intends to continue to hold regarding the elimination of Adult Day Health Care and transition.
• Advocates have said however that the State has not yet addressed or resolved many critical issues and problems related to transition.

GOVERNOR

• Governor Brown vetoed July 25th, AB 96, the budget trailer bill that calls for the creation of a new model of Adult Day Health Care saying the such a new "...look-alike program at this juncture is unnecessary and untimely," in an action that is sure to disappoint and anger tens of thousands of people with disabilities and seniors, their families, hundreds of community-based providers and thousands of workers who provide those services.
• The Governor in his veto message added that the bill, authored by Assemblymember Bob Blumenfield (Democrat - Van Nuys), "...does not address the immediate need to transition ADHC [Adult Day Health Care] beneficiaries to other home and community-based services that can meet their needs, and would cause confusion for both consumers and providers about when an ill-defined" new model of Adult Day Health Care would be available.
• The Governor as expected (also on July 25th), signed a less controversial budget trailer bill also dealing with adult day health centers - SB 91, that would allow those centers to continue to operate as licensed facilities without the requirement of being certified as a Medi-Cal provider.

LEGISLATURE

• August 16th Legislative Informational Hearing - Assemblymember Mariko Yamada (Democrat - Davis), chair of the Assembly Aging and Long Term Care Committee, sharply criticized the Governor's July 25th veto of AB 96, saying it was "... both disappointing and incomprehensible; especially from someone who is himself a member of the senior community.  AB 96 would have provided partial relief to some of California’s most vulnerable adults.  Instead, this ill-advised action will ultimately result in higher costs to the State, and more tragically, exact an immeasurable toll on 37,000 frail elders, their families, and those who care for them.  The administration has promised that they will protect these citizens with a plan to transition them into other services."
• Yamada indicated she will hold an informational hearing on the issues surrounding the elimination of Adult Day Health Care on August 16th (see separate CDCAN Report for details) "...to discuss the status of this plan and the consequences it may have on other services in the state.
• The Legislature is in summer recess from July 15th to August 15th,  Monday, when both houses will reconvene.

LAWSUIT

Action on an existing federal lawsuit that seeks to block the elimination,  filed on behalf of the Adult Day Health Care recipients by several disability and senior advocacy groups including Disability Rights California (DRC) was scheduled to be heard on July 26 but that hearing was postponed by the federal district court in Oakland - where the suit is being heard - until November (because the effective date of the elimination of Adult Day Health Care was delayed until December 1, 2011).

WHO THIS IMPACTS

• Over 34, 000 seniors and people with disabilities - including thousands of persons with developmental disabilities, who are in the Adult Day Health Care program either through Medi-Cal or referred there through one of the 21 non-profit regional centers under the State's Lanterman Developmental Disabilities Services Act  (the nation's only civil rights act for persons with developmental disabilities).
• It is not clear how the elimination  and any transition plan of the Medi-Cal optional benefit impacts those persons since they were placed in those programs through regional centers - not through the Medi-Cal program.
• Over 7,000 people who work in the over 300 community-based organizations that provide Adult Day Health Care services - probably nearly all facing either outright closure and elimination of thousands of jobs in a matter of months, the time frame is not clear.
• Other agencies and community organizations, including the 21 non-profit regional centers, county health and human services agencies, including those involved with Medi-Cal, In-Home Supportive Services, housing and other supports and services.

SUMMARY OF AUGUST 9TH PUBLIC STAKEHOLDER MEETING

WHAT: Adult Day Health Care (ADHC) Transition Plan Stakeholder Meeting
PURPOSE: The Brown Administration's plans to transition Medi-Cal Adult Day Health Care (ADHC) participants to other services when ADHC is no longer a benefit under the Medi-Cal program.
WHEN:  August 9, 2011 (Tuesday)
TIME: 1:30 to 3:30 PM
WHERE: California Department of Health Care Services Auditorium, 1500 Capitol Avenue (across the street from Capitol Park and two blocks from the east steps of the State Capitol), Sacramento CA 95814
Site Map of Meeting Location:  http://www.cdph.ca.gov/certlic/occupations/Documents/REHS/WalkingTour.pdf

TOLL-FREE PHONE LINE

(888) 469-1573
Passcode: 393 04 37
Note: persons should call in just before 1:30 PM

REGISTRATION

• The Department of Health Care Services is asking that any person who plans on attending the public meeting in person or by teleconference, to please register. by Friday, August 5 by telephone at (877) 246-3343 or by e-mail at:
• adhc-transition@dhcs.ca.gov.
• Please indicate if you are attending in person or by teleconference and provide your full name, e-mail address, and the organization you are representing if applicable.
• The department indicates that with advanced registration, a person's check in time with building security will be reduced and you may bypass the on-site registration process.
• Should advance registration reach the auditorium capacity, persons will still have the opportunity to attend by teleconference.

MEETING AGENDA

The agenda has not yet been released yet but will include a discussion of the ADHC Transition Plan. T
he ADHC Transition Plan is available online at: http://DHCS.ca.gov/ADHCtransition. That 3 page plan also attached to this CDCAN Report and reproduced in full below]

REASONABLE ACCOMMODATIONS

• If special or reasonable accommodations are needed for a person's attendance, please contact the Department of Health Care Services by telephone at (877) 246-3343 or by email at adhc-transition@dhcs.ca.gov.
• Special or reasonable accommodation requests should be made as soon as possible or by Friday, August 5 to allow sufficient time to coordinate services, according to the department.

PARTICIPATE VIA TEXT TELEPHONE RELAY

• Persons who use TTY (text telephone) machine, and wish to participate in this meeting via the California Relay Service (CRS), should dial the CRS line at 711.
• Tell the CRS Operator that you wish to participate in a conference call. Then give the operator the toll free number (888) 469-1573 and passcode 393 04 37.
• From that point onward, the conference call operator will provide further instructions.

COMMENTS and QUESTIONS BY E-MAIL

Persons who are not able to attend the August 9th public stakeholder meeting, can also e-mail comments and questions to: adhc-transition@dhcs.ca.gov

Please type: "Stakeholder Meeting Comments" on the e-mail subject line.

DEPARTMENT OF HEALTH CARE SERVICES ADULT DAY HEALTH CARE TRANSITION PLAN

The following text is from 3 page document was released on June 20, 2011 by the Department of Health Care Services outlining the initial steps toward transition of the over 34,000 people with disabilities and seniors currently in the Adult Day Health Care program.  The document was saved as a pdf document, so it can be read by persons who are blind or sight impaired using a screen reading device and is attached to this CDCAN Report titled "20110620 - Dept of Health Care Services ADHC Transition Plan (June 2011).pdf" .  To help those who may have difficulty in downloading or opening pdf files, the complete text of the 3 page document is reproduced below and also can be accessed by going to the department's website on Adult Day Health Care transition at:
http://www.dhcs.ca.gov/services/medi-cal/Document/ADHC%20Transition%20Plan%20June%202011%20Final.pdf:

Adult Day Health Care (ADHC) Transitiom

The ADHC transition process is designed to facilitate Medi-Cal ADHC participants with accessing available community based services that address their needs, keep them in the community, and minimize the risk of institutionalization, in accordance with Welfare Institutions Code sections 14589 and 14590.

Following the Centers for Medicare and Medicaid Services’ (CMS) approval of the State Plan Amendment eliminating the ADHC Program as an optional Medi-Cal benefit, the State will issue communications both to affected participants and to the ADHC program administrators.

• Department of Health Care Services (DHCS) plans to send a notice to ADHC participants informing them that the benefit will be eliminated effective September 1, 2011 (if CMS approves the SPA [State Plan Amendment] on or before June 30). The notice will also include a phone number for participants to call if there are questions.  This notice will be sent by late July. [CDCAN Note: the effective date is now December 1, 2011 and so the notice dates indicated here will also be delayed]
• CDA [California Department of Aging] plans to send a follow-up letter to the ADHC centers reminding them of their ongoing discharge planning responsibilities for ADHC participants and the process to be followed for discharging participants from the ADHC center. The letter will also include a link to a centralized website for more information. The letter will be sent by late July and a phone number will be provided for ADHC providers to call. On May 6, 2011, the California Department of Aging (CDA) faxed a letter to ADHC centers notifying them of the pending elimination of ADHC as a Medi-Cal benefit and encouraging them to begin updating discharge plans to ensure a smooth transition to other services.

The actual transition will be grounded in individualized discharge planning and begin with the ADHC centers completing the discharge planning process for all Medi-Cal ADHC participants in advance of the elimination of the benefit. This process includes assessing the individual needs of the participants, identifying alternative services and taking steps to coordinate participant access to those services. Discharge planning is a required component of the ADHC program (Title 22, California Code of Regulations, Sections 54213 and 78345).

DHCS and CDA staffs have been reviewing the Individual Plans of Care (IPCs) for ADHC participants who receive four or five days of ADHC services per week.  Approximately 6,600 IPCs of 7,900 identified at this level of service have been reviewed to date. Since ADHC centers provide bundled services, this review is revealing the most commonly recorded diagnoses which have led to the range of services currently being provided. ADHC participants may have many co-occurring diagnoses. Understanding  the most prevalent diagnoses will help DHCS to identify the community resources that may be able to provide an alternative to ADHC services for participants with these diagnoses. The results of these reviews are being communicated to appropriate state and local agencies for follow up. A large proportion of IPCs reviewed thus far indicate the necessity for medication management as part of the plan of care. IHSS provides medication management as a service, and individuals may be eligible for additional IHSS services. DHCS will request that the ADHC centers notify the state if there are participants for whom they cannot secure access to services. DHCS and CDA will also continue the IPC review process for ADHC participants authorized for fewer days of service and provide this information to state and local agencies and the ADHC centers.

DHCS has convened ongoing meetings regarding the ADHC transition process with several of its partner departments, including CDA, the Department of Developmental Services (DDS), Department of Mental Health (DMH), Department of Social Services (DSS), and the Department of Rehabilitation (DOR). Staff from these Departments are reaching out to their local partners (e.g. Area Agencies on Aging, county In Home Supportive Services (IHSS) offices, Independent Living Centers, California Mental Health Directors Association, etc.) to inform them of the pending benefit elimination so that they can begin to prepare for possible referrals or requests for assistance from ADHC centers or participants. Some of these local organizations have met to help coordinate efforts.

State-Level Assistance

Efforts are being made by both state and local entities to coordinate transition options at the local level. CDA has provided the other departments with a contact list of the thirty-three Area Agencies on Aging (AAA) and a map identifying each catchment area.  County-level community resource sheets identifying the key local agencies and their contact information (e.g., AAA, ILC, In-Home Supportive Services, Medi-Cal, etc.) are being developed for ADHC centers’ reference in transition planning. Some AAAs, including those in the Los Angeles area, have begun partnering with other local resource providers in anticipation of the transition. This partnering is an attempt to identify service options for local participants. A draft Community Services Resource Guide for Los Angeles City is attached as an example, and a similar one is being developed for other catchment areas.

DHCS is exploring Targeted Case Management (TCM) options. TCM consists of case management services that assist Med-Cal eligible individuals within a specified target population to gain access to needed medical, social, educational, and other services. TCM is available in many county jurisdictions for specific target populations. DHCS is reviewing the availability of this service for the transition process and is reaching out to the TCM Consortium to obtain local contacts.

DHCS provides care coordination, personal care services, and Medi-Cal home and community based waiver and State Plan services for this population. In addition, services and supports available through Older American Act programs such as home delivered and congregate meals and local non-governmental supports can be essential to on-going community living and will be part of the transition process to the extent they are available.  DHCS is working with DDS, which in turn is working with the Regional Centers, to facilitate transition to appropriate services for ADHC participants with developmental disabilities. Funding was included in the budget to ensure that DDS consumers receive other available services to avoid institutionalization.

As part of their contract for providing services to Medi-Cal beneficiaries, Medi-Cal managed care plans must provide care coordination and care management to plan beneficiaries. When the ADHC benefit is eliminated, Medi-Cal managed care plans that had beneficiaries enrolled in ADHC will need to re-evaluate these beneficiaries to determine what other available Medi-Cal services may be necessary. ADHC beneficiaries not currently enrolled in Medi-Cal managed care, Senior Care Action Network (SCAN), or Program of All-Inclusive Care for the Elderly (PACE) may enroll in one of these programs, if qualified, to receive care coordination services.  These services may include a comprehensive care assessment, care management, and other services to facilitate their ability to remain in the community. In its communication with ADHC participants, DHCS will provide them with these managed care options and assist with voluntary enrollment if they should so choose.

Short-Term Transitional Program

If an ADHC participant cannot be transitioned timely to another program or service, the participant may receive services in a short-term transitional program. The provision of any additional ongoing services after the transition must consider other existing home and community based services; ensuring that the services provided complement those of other programs; that no duplication of services occurs; and that the state is taking a coordinated and integrated approach to providing services that reduce Medi-Cal beneficiaries’ risk of institutionalization. The 2011-12 Budget Act provides $85 million General Fund for this purpose.

The transitional program may include seeking federal waiver services or developing alternative funding arrangements. As one example DHCS is exploring the option of amending the In-Home Operations (IHO) waiver to cover the former ADHC participants receiving a high level of service to minimize the risk of institutionalization. The goal in amending the IHO waiver would be to maximize the use of federal financial participation to provide short-term services to the former ADHC participants most at risk of institutionalization who may ultimately receive other Medi-Cal services.

Critical to the success of this transition will be stakeholder participation in the refinement of the process. DHCS will engage stakeholders, including the Legislature, to involve them and develop an ongoing dialogue about the needs of the former ADHC participants so that together we can attain a smooth transition for these Medi-Cal beneficiaries.

Transition Updates

DHCS will provide updated information about the ADHC transition to stakeholders and the Legislature as it is available.

File Attachments: 

2011-06-20 - Dept of Health Care Services - ADHC Transition Plan (June 2011).pdf (22.03 KB)

2011-07-28 - Dept of Health Care Services - August 9th ADHC Stakeholder Meeting Notice.pdf (91.51 KB)