Adult Day Health Care Benefit Transitions to Managed Care


It’s
 been
 15
 months
 since
 a
 court‐mediated
 settlement
 preserved
 Medi‐Cal
 coverage
 for
 Adult
 Day
 Health
 Care
 and
 created
 a
 new
 ADHC
 benefit
 called
 Community‐Based
 Adult
 Services
 (CBAS).
 
Since
 then,
 the
 Adult
 Day
 Services
 Network
 of
 Alameda
 County
 (ADSNAC)
 has
 been
 working
 with
 its
 members
 (six
 organizations
 that
 run
 thirteen
 adult
 day
 programs
 throughout
 Alameda
 County)
 and
 with 
the 
county’s
 two 
Medi‐Cal
 Managed
 Care
 Plans 
to
 transition 
programs
 and 
patients
 into
 Medi‐Cal
 managed 
care.


Having 
experienced
 the 
transition 
of 
a
 Medi‐Cal covered 
LTSS 
into 
managed
 care,
 Anne
 Warner‐Reitz,
 ADSNAC
 Executive
 Director,
 provided
 an
 informed
 template
 for
 the
 coming 
Coordinated 
Care
 Initiative.

Ms.
 Warner‐Reitz
 acknowledged
 the
 CBAS
 implementation
 was
 complicated
 by
 the
 state’s
 flawed
 eligibility
 process.
 
 About
 35%
 of
 the
 people
 who
 had
 been
 receiving
 ADHC
 services
 in
 Alameda
 County
 were
 initially
 found
 ineligible
 for
 the
 new
 CBAS
 coverage.
 It
 took
 a
 year
 in
 a
 laborious
 and
 difficult
 fair‐hearing
 process
 to
 reinstate
 eligibility
 for 
most 
of
 those
 participants.
 During 
that 
time,
 two
 ADHC 
centers 
closed 
and
 other
 providers
 were
 severely
 stressed
 as
 they
 worked
 to
 provide
 services
 under
 the
 double 
burden
 of
 rate 
cuts
 and
 delayed
 reimbursement.

One
 of
 the
 assets
 that
 eased
 transition
 difficulties
 was
 the
 goodwill
 and
 shared
 communications
 that
 occurred
 between
 the
 plans,
 agencies
 and
 providers.
 Early,
 the
 ADHC
 centers
 invited
 medical
 directors
 and
 other
 managed
 care
 plan
 staff
 to
 the
 centers.
 The
 plans
 and
 centers
 executed
 data‐sharing
 agreements,
 then
 shared
 assessment
 and
 outcome 
information
on 
patients 
they 
had 
in 
common, 
discovering 
that
 ADHCs
 knew
 significantly
 more
 about
 patients’
 health
 and
 had
 played
 a
 clear
 role
 in
 stabilizing
 patient’s
 with
 complex
 medical
 conditions.
 These
 conversations
 allowed
 the
 plans
 to
 recognize
 ADHC’s
 value
 and
 its
 role
 in
 a
 patient’s
 care
 plan,
 and
 built
 relationships,
 good
 will
 and
 common
 understanding
 that
 proved
 helpful
 as
 they
 developed
 the
 business 
relationships,
 protocols 
and
 procedures 
to
 implement
 CBAS.

Now,
 with
 a
 few
 exceptions,
 Medi‐Cal
 CBAS
 coverage
 is
 available
 only
 through
 a
 Medi‐ Cal
 Managed
 Care
 Plan.
 There
 is
 an
 expedited
 enrollment
 process
 so
 that
 people
 who
 need
 ADHC
 services 
can 
be 
enrolled 
in 
a 
plan
 quickly.

 ADSNAC
 has
developed 
a
 guide 
to
 help
 navigate
 the
 eligibility
 and
 enrollment
 process,
 available
 at
 http://www.adsnac.org/cbas.htm.
 

To return to the Changing Landscape page, click here.

For a report on the entire January 31st SSC Panel Discussion, click here.

 

 

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