House Bill H.R. 6476 commonly referred to as the "Medicare Adult
Day Services Act of 2012" was written with significant potential.
Introduced by California Representative Linda Sanchez, it basically does
this:
Allows a person who is entitled to receive home health services by a Medicare certified home health agency, i.e. nursing, physical therapy, occupational therapy, speech therapy, home health aide services, etc. to receive these instead from what the bill refers to as a "certified adult day services center."
Similar requirements to home health care would apply including the 3-day pre-enrollment hospital stay and the order of a physician who states the rehabilitative and other services are medically needed.
The bill died since it never left committee in 2012 and needs to be reintroduced.
Everyone who advocates for adult day care and its value to the community should be writing Representative Sanchez asking her to re-introduce the bill now - not late in the 113th.
Rep. Linda Sanchez:
2423 Rayburn House Office Building
Washington, DC 20515
Fax: (202) 226-1012
Additionally contact should be made with every member of the House Energy and Commerce Committee and House Ways and Means Committees asking for them to give immediate consideration to the bill and get it through. This cannot be handled in 1 or 2 communications, but consistently until action is taken, weekly if necessary.
Financial Impact: It does not require any additional Medicare dollars. It simply means that instead of services being provided by a home health agency in the center, the adult day care can do so itself and bill Medicare directly for reimbursement.
Preparedness Crucial: Of course some adult day care centers are not equipped as medical/clinical model programs. They are not accustomed to maintaining nursing charts or documenting personal care irregularities or even executing and monitoring a physician's directives. Others need charting and participant activity tracking technology.
The time for adult day care providers to become thoroughly familiar with and prepared for your future by studying the traditional home health certification/survey process and to equip your program to function with higher clinical standards is now. Adapting the reimbursement protocol to provide payment to adult day care centers just makes sense and let's face it, its coming!
The advantages are huge. Services end up being rendered in a more professional, structured environment with others cheering the participant on. In addition social isolation that may be associated with someone receiving services at home is eliminated.
No one is doubting the value of home health care. However, when you transfer those services and incorporate them into the routine of an adult day care program, you get a more team-like approach to care and rehabilitation. That is valuable.
Once Medicare reimbursed services are no longer being received for the initial certification period, the patient can remain in the center and continue benefiting from an environment of supervision, medication administration, socialization, personal care rendered as part of general enrollment, nutritional management and more.
Other Impacts: This could also impact the stand some Medicaid waiver agents take before they will contract with an adult day program. Some, including area agencies on aging will insist that the center be operating for at least three, (3) years before they will enter into a direct purchase of service agreement. So a new center is shut-out under the guise that they want you to demonstrate financial stability over a 36-month period before doing business with you, often regardless of community need.
Many in long-term care have long argued that it would be best for the waiver agent to establish a formula for a provider to demonstrate a workable operational plan and proper capitalization before making an arbitrary and blanket determination. Well now, since certified adult day care centers would likely be subjected to a Medicare oriented survey process, their clinical and financial preparedness would be verified thriough the survey process and documented.
This should more than satisfy the concerns of an agent of Medicaid waivers who purchase services from adult day care programs.
Continuity: Continuity of care could also be positively impacted through this process. A patient using an adult day care program could be referred for intake into a Medicaid waiver agent while they are receiving Medicare reimbursed services. Perhaps by the time these services are concluding, their enrollment into a waiver would be completed and their participation in the adult day care program could continue with Medicaid purchasing adult day care services from your program.
How important this would be considering the participant has now become accustomed to this environment and is likely thriving in it.
Changes on the horizon will necessitate more quality programs with ample square footage (Minimum 4,000 in our opinion) and a true clinical initiative.
It all starts with advocacy including ensuring favorable legislation is passed.
So join the LinkedIn group, "Adult Day Care Innovation and Growth" at http://www.linkedin.com in order that together we can ensure the highest quality programs operate in our neighborhoods.
Thanks for allowing me to share.
Allows a person who is entitled to receive home health services by a Medicare certified home health agency, i.e. nursing, physical therapy, occupational therapy, speech therapy, home health aide services, etc. to receive these instead from what the bill refers to as a "certified adult day services center."
Similar requirements to home health care would apply including the 3-day pre-enrollment hospital stay and the order of a physician who states the rehabilitative and other services are medically needed.
The bill died since it never left committee in 2012 and needs to be reintroduced.
Everyone who advocates for adult day care and its value to the community should be writing Representative Sanchez asking her to re-introduce the bill now - not late in the 113th.
Rep. Linda Sanchez:
2423 Rayburn House Office Building
Washington, DC 20515
Fax: (202) 226-1012
Additionally contact should be made with every member of the House Energy and Commerce Committee and House Ways and Means Committees asking for them to give immediate consideration to the bill and get it through. This cannot be handled in 1 or 2 communications, but consistently until action is taken, weekly if necessary.
Financial Impact: It does not require any additional Medicare dollars. It simply means that instead of services being provided by a home health agency in the center, the adult day care can do so itself and bill Medicare directly for reimbursement.
Preparedness Crucial: Of course some adult day care centers are not equipped as medical/clinical model programs. They are not accustomed to maintaining nursing charts or documenting personal care irregularities or even executing and monitoring a physician's directives. Others need charting and participant activity tracking technology.
The time for adult day care providers to become thoroughly familiar with and prepared for your future by studying the traditional home health certification/survey process and to equip your program to function with higher clinical standards is now. Adapting the reimbursement protocol to provide payment to adult day care centers just makes sense and let's face it, its coming!
The advantages are huge. Services end up being rendered in a more professional, structured environment with others cheering the participant on. In addition social isolation that may be associated with someone receiving services at home is eliminated.
No one is doubting the value of home health care. However, when you transfer those services and incorporate them into the routine of an adult day care program, you get a more team-like approach to care and rehabilitation. That is valuable.
Once Medicare reimbursed services are no longer being received for the initial certification period, the patient can remain in the center and continue benefiting from an environment of supervision, medication administration, socialization, personal care rendered as part of general enrollment, nutritional management and more.
Other Impacts: This could also impact the stand some Medicaid waiver agents take before they will contract with an adult day program. Some, including area agencies on aging will insist that the center be operating for at least three, (3) years before they will enter into a direct purchase of service agreement. So a new center is shut-out under the guise that they want you to demonstrate financial stability over a 36-month period before doing business with you, often regardless of community need.
Many in long-term care have long argued that it would be best for the waiver agent to establish a formula for a provider to demonstrate a workable operational plan and proper capitalization before making an arbitrary and blanket determination. Well now, since certified adult day care centers would likely be subjected to a Medicare oriented survey process, their clinical and financial preparedness would be verified thriough the survey process and documented.
This should more than satisfy the concerns of an agent of Medicaid waivers who purchase services from adult day care programs.
Continuity: Continuity of care could also be positively impacted through this process. A patient using an adult day care program could be referred for intake into a Medicaid waiver agent while they are receiving Medicare reimbursed services. Perhaps by the time these services are concluding, their enrollment into a waiver would be completed and their participation in the adult day care program could continue with Medicaid purchasing adult day care services from your program.
How important this would be considering the participant has now become accustomed to this environment and is likely thriving in it.
Changes on the horizon will necessitate more quality programs with ample square footage (Minimum 4,000 in our opinion) and a true clinical initiative.
It all starts with advocacy including ensuring favorable legislation is passed.
So join the LinkedIn group, "Adult Day Care Innovation and Growth" at http://www.linkedin.com in order that together we can ensure the highest quality programs operate in our neighborhoods.
Thanks for allowing me to share.
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