Seeking To Save Money, Calif. Ending Adult Day Health Care Program
The California Department of Health Care Services recently sent a letter to most Medi-Cal beneficiaries participating in the adult day health care program, informing them that their coverage for ADHC will end Dec. 1. Medi-Cal is California's Medicaid program.
In Sacramento, legislators are holding hearings on how to help 36,000 elderly and disabled residents continue to receive ADHC-type services in other programs. A lawsuit pending in federal court challenges whether the state can adequately supply replacement services for this population. ADHC providers have accused the department of bad planning for rushing elimination of the services.
All of this turmoil is predicated on one basic outcome: saving money for the state.
In previous budget cutbacks, adult dental services were eliminated as an optional Medi-Cal benefit along with speech therapy, vision services, chiropractic and podiatric care. Now it's ADHC's turn.
The ADHC transition is a kind of pilot project for California, which aims to transition many more individuals who are eligible for both Medicare and Medi-Cal into managed care. But advocates say that the ADHC population should be treated more carefully and more slowly, arguing that a rapid transition threatens the well-being of at-risk elderly and disabled residents.
"This is a human experiment on a scale we haven't seen in California, that's what we're embarking on," Lydia Missaelides of the California Association of Adult Day Services said. "There is no road map, because this has never been done before."
According to DHCS Director Toby Douglas, the ADHC transition is required by law and is a challenge the department can accomplish.
"The majority of these people will be served by our managed care plans," Douglas said. "We have deliberately slowed down the process, so we make sure we do it right. We want these people to be able to remain in the community.
Medicare Inpatient Psychiatric Facility Prospective Payment - News
On July 29, 2011, the Centers for Medicare & Medicaid Services (CMS) issued a Final Rule regarding payment and policy changes for Inpatient Rehabilitation Facilities (IRFs). The rule will be published in the Federal Register on August 5, 2011.
In 2003, after the cap expired, psychiatric hospital services were supposed to join other medical care providers in the Prospective Payment System (“PPS”), but the Secretary did not begin to implement the PPS until 2006. In their Complaint, Plaintiffs
Another 2000 have mental disabilities, 17000 have a psychiatric diagnosis, 14000 are incontinent and almost 19000 need restorative physical therapy. Almost 29000 beneficiaries require skilled nursing services. To account for ADHC beneficiaries with
Like many other Medicare providers, inpatient rehabilitation facilities (IRFs) will soon be subject to quality reporting requirements. In addition to the usual annual updates of the IRF rates addressed in the final rule for Federal
Quality Reporting – The rule requires hospitals that are paid under the Medicare inpatient prospective payment system (“IPPS”) to report on seven outpatient quality mea- sures for services furnished in the hospital outpatient department in 2008 in
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Overview Inpatient Psychiatric Facility PPS
This is an overview of the inpatient psychiatric facilities prospective payment system.
Further Information Related to Inpatient Psychiatric Facility ...
Further Information Related to Inpatient Psychiatric Facility (IPF) Prospective ... Payment to Hospitals and Units excluded from the acute Inpatient Prospective Payment ...
Federal Register, Volume 76 Issue 88 (Friday, May 6, 2011)
... the prospective payment rates for Medicare inpatient hospital ... implemented the inpatient psychiatric facilities (IPF) prospective payment system (PPS) in a final rule that ...
The revised Inpatient Psychiatric Facility Prospective ...
Update-Inpatient Psychiatric Facilities Prospective Payment System (IPF ... Medicare Administrative Contractors (A/B MACs) for inpatient psychiatric services ...
Inpatient Psychiatric Facility (IPF) | Putting Medicare Data ...
Claims priced in accordance with the Inpatient Psychiatric Facility Prospective Payment System (IPF PPS) Built in DRG grouper for CMS DRGs and MS DRGs ...