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.
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