Out With ADHC, In With CBAS

by David Gorn

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The CBAS era has officially begun.

Late Friday night, CMS approved implementation of the Community Based Adult Services program. That means the state has successfully eliminated adult day health care as a Medi-Cal benefit, and is replacing it with CBAS, starting today.

According to officials from the Department of Health Care Services, almost 32,000 of the nearly 40,000 ADHC beneficiaries have been deemed eligible for CBAS. That's more than 80% of the ADHC population.

The remaining 7,800 beneficiaries will receive enhanced case management and can still appeal ineligibility status for CBAS, DHCS spokesperson Norman Williams said.

"We have completed the assessments, we have sent all of the [eligibility status] letters," Williams said. "The vast majority of them are eligible for CBAS."

What the program needed next, Williams said, was the federal announcement of waiver approval:

"CMS has approved California's request to move Adult Day Health Care (ADHC) services into the state's Bridge to Reform Demonstration as Community Based Adult Services (CBAS)," according to an email received from CMS officials. "We are pleased that this amendment will enable the state to provide a range of important services to a vulnerable population.  This policy will provide benefits that are consistent with California’s legal settlements regarding this program."

The CBAS program itself evolved from settlement of a lawsuit that challenged the state's transition out of ADHC services. That settlement is back in court after Disability Rights California, which filed the original suit and agreed to the settlement, filed a contempt of court motion against DHCS. DRC officials contend the department violated the terms of the settlement by, among other things, reversing approval of eligibility status for some beneficiaries.

The contempt hearing, originally scheduled last week, has been delayed. Both parties are trying to come to a new agreement by the end of this week.

Cindy Mann, a deputy director at CMS, referred to the settlement in the letter granting approval of CBAS implementation:

"It is our understanding and intent that the CBAS program contained in this amendment provides benefits that are consistent with a settlement agreement related to California's termination of Adult Day Health Care services as an optional benefit under its state plan effective March 31, 2012," the letter said. "In the settlement agreement, California agreed to request an amendment to its 1115 demonstration to provide CBAS benefits that would be similar to those previously provided under the ADHC benefit."

When CBAS was first announced, DHCS Director Toby Douglas estimated that about 50% of ADHC recipients would be eligible for the new CBAS program. Williams said the actual percentage -- so far, before any appeals are heard -- is more like 80% of the ADHC beneficiaries.

"About 32,000 are eligible," Williams said. "It's the number that's the result of our assessments. The goal was to get it right, there was never any intent to reach a target."

The contempt motion could still change DHCS direction a little, but now that federal officials have given approval, the department is pretty happy to launch the CBAS program today, Williams said.

"It is good news," Williams said. "We're ready to move forward with the CBAS program."


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