CDCAN REPORT #157-2011: Brown Administration releases transition plan for over 34,000 Adult Day Health Care recipients

BROWN ADMINISTRATION RELEASES TRANSITION PLAN FOR OVER 34,000 PERSONS WITH DISABILITIES AND SENIORS IN ADULT DAY HEALTH CARE SCHEDULED FOR ELIMINATION AS A MEDI-CAL BENEFIT EFFECTIVE DECEMBER 1st

• Plan Will Be Discussed At Public Stakeholder Meeting August 9th
• Assembly Aging & Long Term Care Informational Hearing Scheduled for August 16th

SACRAMENTO, CALIF (CDCAN)  [Last updated 08/05/2011 08:30 PM] - The Department of Health Care Services - the state agency that oversees California's federal Medicaid program (called "Medi-Cal) - released late this afternoon the Brown Administration's "comprehensive strategy" outlining the implementation steps for its controversial plan to eliminate Adult Day Health Care as a Medi-Cal benefit for the over 34,000 persons with disabilities (including persons with developmental disabilities) and seniors and transition them to other "appropriate and cost-effective community-based services".  The Brown Administration in the transition plan, believes that the bulk of those receiving Adult Day Health Care services now can be shifted into similar services provided by Medi-Cal managed care plans - a contention along with other points raised in the plan,  that many disability and senior advocates do not agree with or have major concerns about.

Many disability and senior advocates and some lawmakers in the Legislature continue to insist that no "safe and responsible" transition is possible without a new model of Adult Day Health Care - a contention that Governor Brown disagrees with.

The 13 page plan (with 8 additional pages of attachments including charts) contains more details than the 3 page summary that was released in late June by the department.  The transition plan is attached to this CDCAN Report as a pdf file and will be discussed at an August 9th public stakeholder meeting in Sacramento (people can also participate via toll free phone lines).  See below for more information.  The plan will also likely be brought up for review and discussion at a August 16th hearing by the Assembly Aging and Long Term Care Commitee (see below for details).  [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. - Marty Omoto]

The Department of Health Care Services indicated that anyone having any questions about the transition plan can submit their questions (or comments) to the department at: adhc-transition@dhcs.ca.gov

The elimination of Adult Day Health Care as a  Medi-Cal benefit was approved by the Legislature last March as part of a larger package of massive permanent budget cuts to close an enormous State budget deficit, and is scheduled to take effect on December 1, 2011.  The elimination of Adult Day Health Care is considered by many advocates and policymakers as the most sweeping and serious reduction in the health and human services part of the State budget.

Meanwhile, as reported last week, a federal lawsuit that seeks to block - at least temporarily - the elimination of Adult Day Health Care - that was filed by various advocacy and public interest groups including Disability Rights California and AARP on behalf of the thousands of people with disabilities and seniors in the program,  will be heard in federal district court in November.  The hearing for that suit was scheduled originally last week but was postponed until November because the effective date of the elimination was moved back from September 1st to December 1st.

KEY ELEMENTS OF STATE'S TRANSITION PLAN

The plan released today (August 5th) by the Brown Administration indicates it will achieve the transition of the over 34,000 people with disabilities and seniors receiving Adult Day Health Care provided by over 300 community-based organizations and over 7,000 employees by doing the following:

MEDI-CAL MANAGED CARE PLANS

• The Brown Administration in the transition plan says that the "...vast majority of ADHC clients (34,350 of 35,000) live in counties with Medi-Cal Managed Care" and as a result the State's major transition effort will center on "...encouraging and assisting with the enrollment of these clients into managed care plans starting October 1, 2011.
• The transition plan also says that because most Adult Day Health Care recipients are eligible for both Medicare and Medi-Cal (Medicaid), receiving the bulk of their health care services through Medicare.
• Enrollment into Medi-Cal Managed Care, according to the transition plan, "...will allow the participants to receive assessments, care coordination and case management through their Medi-Cal benefit" - services that the State says those recipients generally do not receive under Medicare or the Medi-Cal "fee-for-service" program.
• The transition plan noted that recipients "...whose primary insurance is Medicare may disenroll from a Medi-Cal Managed Care plan at any time" and return to the Medi-Cal "fee-for-service" program.
• The transition plan also indicated briefly that "...some ADHC [Adult Day Health Care] centers may contract with managed care or other social service organizations to continue to provide services such as protective supervision, social day care or respite care as part of a plan a care to avoid institutionalization."

EXPAND CURRENT CARE MANAGEMENT CONTRACT WITH APS, INC.

• In counties that do not currently participate in managed care, or when a Adult Day Health Care recipient chooses not to transition into a Medi-Cal managed care service to replace the services they are receiving now in Adult Day Health Care, the transition plan indicated that the Department of Health Care Services "...is  expanding its contract with a current care management contractor, APS, Inc. to offer and pay for the same services (health risk assessment, care coordination and case management) as those offered by the Plans."
• The transition plan reports that APS, Inc. currently  provides comprehensive case management for persons with chronic health conditions in Butte, Shasta, Contra Costa, Sutter, El Dorado, Tehama, Placer, Yuba, Humboldt, and Sacramento counties.
• The company, according to the transition plan,  also provides services for persons with chronic health conditions and serious mental illness in Kern, Stanislaus, Kings, Tulare, Madera, and San Diego counties.

EXPAND IHSS HOURS WHERE APPROPRIATE

The transition plan also indicated that in addition to the services available through Medi-Cal managed care plans and APS, Inc., the Department of Health Care Services will work with the counties to offer expanded In-Home Supportive Services (IHSS) hours to Adult Day Health Care recipients where appropriate.

EXPAND MSSP PROGRAM

Expand the Multipurpose Senior Services Program (MSSP) to cover Adult Day Health Care recipients.

AMEND EXISTING FEDERAL MEDICAID WAIVERS FOR ADULT DAY HEALTH CENTER PROVIDERS

• The transition plan calls for amending (requiring federal approval) two of the existing federal Medicaid waivers in California - the In-Home Operations (IHO) Waiver to  cover Adult Day Health Care recipients who are at an "long term care institutional placement level" (Nursing Facility B level of care), and allow Adult Day Health Care centers to qualify as providers of In-Home Operations (IHO) services (case management, nursing, and personal care services).
• The transition plan would call for adding Adult Day Health Care centers as a provider type under California's existing Nursing Facility/Acute Hospital federal Medicaid waiver, allowing them to serve former Adult Day Health Care recipients who may choose  to receive some of their waiver services in a center environment instead of in their homes.

TRANSITION FUNDING

• The transition plan noted that the State's 2011-2012 Budget Act provided for an appropriation of $85 million in State general funds for transition services. In  addition to the transition funding in the 2011-2012 State Budget, $85 million in State general funds would be provided in the Department of Health Care Services "budget base" for future State budget years to cover the costs of additional ongoing services needed by former Adult Day Health Care recipients. [CDCAN Note: the appropriation of $85 million - matched by $85 million in federal matching funds would be 50% of the 2010-2011 budget for Adult Day Health Care and was meant to be used not only for transition but to develop and to continue a new model of Adult Day Health Care under a new federal Medicaid waiver or through some other new funding from Medicaid.  However while the $85 million amount remains in the 2011-2012 State Budget,  the specific direction or requirement by the Legislature that the funding would be use to continue a new model of Adult Day Health Care was contained in AB 96 which the Governor vetoed on July 25, 2011.]
• The transition plan notes that the Department of Health Care Services will attempt to draw down "to the extent allowable" federal Medicaid matching funds.
• The transition plan indicated that the $85 million in State general funds could be used for the following:
  • Paying Adult Day Health Care claims through November 30, 2011 [before the December 1st effective date eliminating it as a Medi-Cal benefit].
  • Providing "enhanced capitation payments" to Medi-Cal managed care plans for enrolling former Adult Day Health Care recipients. These enhanced capitation payments [CDCAN Note: rates or payments to Medi-Cal managed care plans are capped]  will cover 8 additional assessment, care planning activities, the availability of Adult Day Health Care-like services, and adjust for the higher levels of acuity of former Adult Day Health Care recipients.
  • Increasing the number of counties served by the APS, Inc. contract to provide comprehensive assessment, linkage to providers, and ongoing care management to persons with severe, chronic medical or mental health issues.
  • Amend the existing In-Home Operations (IHO) Medicaid Waiver to cover 500 former Adult Day Health Care participants who meet the "Nursing Facility-B level of care", and allow Adult Day Health Care centers to be Medicaid home and community-based services (HCBS) providers under that waiver.
  • Amend the existing MSSP (Multipurpose Senior Services Program) Medicaid Waiver to increase caseload to serve eligible former Adult Day Health Care participants. 

EXISTING ADULT DAY HEALTH CENTERS

• Most of the plan does not address the  specific issues regarding the over 300 community-based organizations and over 7,000 persons employed by those organizations who provide Adult Day Health Care services.  Advocates say an overwhelming number of those providers face imminent closure and thousands employees face loss of jobs once State and federal funding for the program ceases December 1st.
• However the transition plan, in addition to mentioning changes proposed for some existing federal Medicaid waivers,  does briefly mention at the end of the document that various health and human services agency departments - including the Department of Health Care Services and the California Department of Aging, to work together to implement budget related legislation (contained in SB 91 that Governor signed) so that existing Adult Day Health Care centers can remain as state licensed facilities without the requirement that they also had to be a certified Medi-Cal provider.
• The Department of Health Care Services indicated in the transition document that on August 2 the California Department of Aging sent an instruction letter to all of the over 300 Adult Day Health Care centers providing them with information regarding that process.
• The transition plan as mentioned earlier, also briefly mentions that the Department of Health Care Services would seek to amend (change) a current federal Medicaid waiver - "In Home Operations" (IHO) -  to allow Adult Day health Care centers to qualify as providers of IHO services which includes case management, nursing, and personal care services, as directed in those Medi-Cal recipients' "Individual Plan of Care".
• Also as mentioned earlier, the Department of Health Care Services will also add Adult Day Health Care centers as a provider type under the Nursing Facility/Acute Hospital waiver, allowing them to serve those Medicaid waiver participants who were not previously Adult Day Health Care participants but who choose to receive some of their Medicaid waiver services in a center environment instead of in their homes.

Governor Proposed Elimination As Part of His January State Budget Proposal

• The Governor proposed last January as part of a huge package of spending cuts to help close the enormous State budget deficit, the elimination of Adult Day Health Care as a Medi-Cal "optional benefit".  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).
• The Legislature approved the proposal in March but with modifications that it be replaced by a sharply reduced new version of the program. A budget related bill (AB 96) that would have required the Brown Administration to develop and submit a proposal for a new model of Adult Day Health Care to the federal government to be matched by new Medicaid funding,  was later sent to the Governor, which he vetoed on July 25th.  That veto angered and dismayed disability and senior advocates and several Democratic legislators including Assemblymember Mariko Yamada (Democrat - Davis).
• 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.
• The Obama Administration approved the State's request to eliminate Adult 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.

Who Is Impacted By Elimination of Adult Day Health Care

• 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 federal and state and local government 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, Area Agencies on Aging (AAA), APS, Inc. (private contractor) and other agencies.

Public Stakeholder Meeting Set for August 9, Tuesday 1:30 to 3:30 PM on Transition

• As previously reported last week, the Department of Health Care Services has scheduled a public stakeholder meeting 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 "20110728 - 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 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.

Assembly Aging and Long Term Committee Schedules August 16th Hearing on Adult Day Health Care

• As previously reported by CDCAN last week, the Assembly Aging and Long Term Care Committee, chaired by Assemblymember Mariko Yamada (Democrat - Davis), will hold an informational hearing on August 16, Tuesday afternoon at 2:00 PM, at the State Capitol, in Room 127,  on the issues surrounding the elimination of Adult Day Health Care as a Medi-Cal benefit and its impact on thousands of people across the State.
• The informational hearing, titled the "Costs and Consequences: Eliminating Adult Day Health Care" will include updates and comments from Brown Administration officials including from the Department of Health Care Services and advocates.   There will be time for public comments.
• As reported last week, Yamada sharply criticized the Governor's action vetoing what advocates and Legislative Democrats believed was a key component of transition - AB 96, saying the veto 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."
• The Legislature is in summer recess from July 15th to August 15th,  Monday, when both houses will reconvene.

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 2 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. The ADHC Transition Plan is available online at: http://DHCS.ca.gov/ADHCtransition. and is 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.

File Attachments: 

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

2011-08-05 - Department of Health Care Services - ADHC Transition Plan (August 5, 2011).pdf (206.89 KB)