Who, What, Why, Where, When, and How of Adult Day Health Care

Why were we visited? 

The visit can be triggered by many factors which include:

• Complaint(s) about your service(s) by a participant or his/her family member/caregiver.
• Report by a participant, participant family member/caregiver, staff member, volunteer, and/or visitor that may range from observations of minor noncompliant practices to major violations of  regulations.
• Repeated citations of noncompliance, i.e. "deficiencies", observed by state regulatory surveyors.
• Red flags!  Eligibility?  Services delivered/documented parallel the IPC?  Liaison with the Primary Care Physician?  Contact with and knowledge of the the individual or simply "boiler plate", "rubber stamp" approach?
• Your facility's turn at a visit thanks to a random draw.

1. Attend the all-day training session provided by the GA Dept. of Human Resources -- Division of Aging Services -- Community Care Services Program.  (Numerous documents are required prior to approval of attendance.)
2. Attend an orientation session by the Area Agency on Aging.
3. Prepare the application as per the instruction session #1 above.  (Yes, yes, we know that the Policies and Procedures Manual is hairy!  Wait until you get to the Forms needed for the Appendix!)
4. Prepare your site according to regulatory standards.  Suggestion:  prepare a more detailed checklist than the state regulators give you.  Remember, you are applying to be a licensed health care provider.
5. Attend the pre-licensed provider training.
6. Prepare your site for the site survey date that your designated state analyst gives you.  Pass it!
7. Upon passing, i.e. meeting the state's ADH regulatory standards, your state analyst will give approval of your site, your staff, and your operations system you put into place.  The approval letter will grant your license (!), and notify the state Medicaid agency to grant  you a provider number.

1. Have a transactional attorney review the sales contract.  
2. Have an accountant verify claimed revenues and expenses. 
3. Then, follow these additional, basic steps, specific to ADHCs. 
1. Verify that the ADHC may be bought.  Sounds too basic yet too true!  Starting about early 2006, several ADHCs -- facing suspension of license, withhold of reimbursements, inability to bill electronically, etc. -- were "sold" to a "cooperating" party.  In effect, wiping the proverbial slate clean of regulatory complaints -- ranging from  non-compliant operations to out and out fraud.  Hence, in January 2008, regulators, smelling this dodge-the-bullet practice, alerted the ADHC community that only ADHCs that were significantly in compliance with the regulations (i.e., operating under acceptable standards) could be sold/bought.  There is a new (as of June 2008), preliminary form for this transaction.
2. Verify the operating status of the ADHC.   Check its record of deficiencies versus plans of correction with the California Departments of  1) Public Health - Licensing and Certification Division, and 2) Aging - ADHC Branch.  Important:  These records are public documents and are provided to you readily and at no cost.
3. Compare/cross-check data.  Have an ADHC consultant compare data submitted to your attorney and accountant with various operating documents:  various files required in day-to-day operations, reports submitted to the state, and many other "insider ops" data.

Is the ADHC program only in California?

No - but each state's program is in some way unique.  The 8 states that have the most similar regulatory definition -- a separate Medicaid benefit -- but different implementation are:   California, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Texas and Washington.

Georgia -- effective July 1, 2008 -- offers Adult Day Health (ADH) as a program within the state's Department of Human Resources (DHR) - Division of Aging Services (DAS) - Community Care Services Program (CCSP).

Who pays for this service?

Current sources of "reimbursement" are: 

• The state's Medicaid agency.
• Managed care groups (formerly known as HMOs).
• Private insurance.
• Private pay.  Private pay may be offered on a sliding scale.  (Contact us and we will send you a basic sliding scale formula -- remember to submit it to your regulatory agency for approval.)

There is a study* on how the benefit may also be covered by Medicare, which would increase the participant-eligible base.

1. August 2008 Update:  We have no advance to offer on this study at this time.
   
2. July 2009 Update:  As there is increasing talk of health care budget crunches, shortfall and cuts, there is also increasing interest in "folding in" ADHC services to the Medicare  population's benefits.  

What is the difference between "Adult Day Care" and "Adult Day Health Care"?

Adult Day Care is a social model; it is generally licensed by the same state agency that licenses child care centers.

Adult Day Health Care is a medical model; it is licensed by the state's Department of Health Services, the same agency that licenses hospitals, skilled nursing facilities such as nursing homes and convalescent centers.

The social model is a lower level of licensure; the process is less demanding and may be obtained in a shorter time.  The medical model is a higher level of licensure; the process is more strict, generally involves other regulatory agencies, and requires a longer application period.

How many beds are there in a center?

No beds except for:

1. Quiet rest during the day.
   
2. Isolation should a participant become ill and waits to be picked up by a family member, caregiver or medical care provider. 

Are there overnight stays?

No overnight stay  -- it is a non-residential (i.e. "day") program.  That is why an ADHC works cooperatively and well with  senior housing programs -- such as  retirement complex ("Senior Apartments"), board-and-care home,  and assisted living facility.

Is ADHC only for the elderly?

No. Although almost 80% of program participants are 65 and over, the program is available to anyone over 18 years of age (i.e. "adult") who meets eligibility "criteria of need" guidelines.

E-mail/Mail us your questions!

While in the interest of time and space not all questions can be answered, the most in demand issues will be addressed, briefly here and in greater detail in our quarterly "Care Giver".

• Our responses are generalized.  Some issues may require more specific answers; for example, questions on a specific state, may require a perspective on the state's budget provisions and regulations.
    
• Our responses may later be invalidated by governmental decisions -- legislative, administrative, etc. -- which are beyond Choice Professionals' control.  We will always strive to provide you with an update.

Here's what I can pledge:

• When we don't know, we will say so. 
• If we know a higher authority, we will share it with you.
• If we have contradictory opinions within our team, we will give you all of them.

Rica Burton
Founder / CEO
ADHC Team Leader
ricaburton@choicepros.com