State, Stakeholders Work To Renew Community-Based Adult Services

by David Gorn

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California health officials and stakeholders yesterday gathered in Sacramento to lay out a path to renew the Community-Based Adult Services program, which must be renewed by May 2014 or it will expire in August 2014.

The wide-ranging meeting touched on dozens of facets of care for the frail population but also managed to skip over one of the central issues of the waiver renewal -- the state requirement that all CBAS centers shift to not-for-profit status.

"That's one of the standards of participation, and will be included in the next meeting," said Denise Peach, chief of the CBAS branch of the state Department of Aging. The next stakeholder meeting is scheduled Jan. 9 in Sacramento.

The CBAS workgroup yesterday covered the program's successes, weaknesses and areas of opportunity for improvement.

"We know CBAS has gone through a lot of evolution this year," said Lora Connelly, director of the Department of Aging. "We have an ambitious agenda. We need some closure, in terms of renewal of this 1115 waiver."

"This is the beginning of the next phase of the life cycle of CBAS," said Bobbie Wunsch, a health care consultant who helped facilitate the meeting. "We want to know what's working in managed care and what needs to be improved."

The Department of Health Care Services will talk to CMS in February 2014, according to Peach, to broach the amendment of the 1115 waiver to include the CBAS program. That waiver has to be submitted to CMS in May, three months before the CBAS waiver is due to expire in August. 

"So we have a very tight timeline," Peach said.

The list of what works well was a long one, including a can-do spirit by the state and health plans, stakeholders said. The positive attitude helps CBAS function smoothly for its beneficiaries, stakeholders said.

"There were a lot of bumps, especially early in the transition [a year ago], but that has gotten a lot better," said Lydia Missaelides, executive director of the California Association of Adult Day Services. "Health plans have acted quickly to fix any problems, and it's clear that people have wanted to do right by the beneficiaries in this transition."

Areas for improvement included fragmentation of hospitalization data, less-than-stellar lines of communication, health plans' lack of experience in handling dementia patients and reported delays -- sometimes up to 30 or 40 days -- in getting access to CBAS care.

"I think we need to turn the plan of care into a more clinical plan of care instead of what it is now," Missaelides said. "We call it the Winchester Mystery House, where it's been added on and added on, and it's not that clear."

The workgroup resolved to look at revising individual plans of care and to investigate ways health plans can educate clients and the provider community about CBAS availability.

Flexibility of funding was also an issue.

"I think there should be a CBAS center in every neighborhood," said Bill Henning, chief medical officer for the Inland Health Plan in Southern California. "But that can't be done the way the funding works now."

The half-day workgroup meeting was marked by civility and cooperation between the centers, health plans and Department of Aging officials.

"I think what we've seen here is a clear picture of what's possible," Peach said at the end of the meeting. "And I think it may be surprising that that vision is shared by so many people here."


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