California centers that offer adult day services are having trouble getting reimbursed for services provided to Medi-Cal beneficiaries under the state’s new Community Based Adult Day Services program launched on Oct. 1.
“We are not getting paid. And I don’t know when we will get paid. I’m not expecting anything at this point,” said Manooch Pouransari, who runs the Grace Adult Day Health Care center in Santa Clara.
“My experience is similar to many other centers,” he said. “We haven’t been told who to bill, where to bill, how to bill. And we found the same thing on their side, the MCOs (managed care organizations), they don’t know any of that, either.”
It may be a little early to pass judgment, since the CBAS program really just started, said Norman Williams, director of public affairs for the Department of Health Care Services.
“Because this system has been in effect only since Oct. 1, DHCS does not have sufficient claims data to assess the scope of the problem,” Williams said. “DHCS is committed to ensure access to services that help these vulnerable individuals remain independent and in their communities.”
He said part of the CBAS effort is to monitor just this kind of thing, and the department has already checked in with the health plans setting up the billing systems.
“Each plan is conducting extensive outreach with the providers in its service areas to help explain the process to be followed,” Williams said. “We have contacted the plans and providers to ascertain the nature of the problem, and we will work to help both sides determine an appropriate solution.”Â
Pouransari said he has spent many days just trying to track down someone at the health plans who knows what to do about the CBAS program. Pouransari said he believes the state wasn’t fully ready for the Oct. 1 launch of CBAS.
“The problem in a nutshell is there is not enough time,” Pouransari said. “If you talk to any IT person, these things take time. You need to find out all the problems and issues and then go live. This way, without even having the information from the MCOs, it’s so difficult. Most of them haven’t even heard from CBAS, let alone putting in sophisticated systems [to create billing and payment programs for it].”
A similar sentiment was echoed by Kathryn Holt, who runs the Poway Adult Day Health Care Center in San Diego.
“It’s the end of October and we havenât received a single payment as of now, and we’ve been billing since the start of the month, every week,” Holt said. “The plans are doing the best they can under the circumstances, but the speed at which this transition has been made is just a nightmare.”
Williams said DHCS is paying close attention to access issues throughout this transition.
“The department and the California Department of Aging are closely monitoring access to services,” Williams said, “and will move swiftly to ensure that participants continue to receive their services with minimal interruption should a center close.”
That might happen soon, according to Pouransari. “We’re hoping to get some payments by sometime in November, or we can’t stay open,” he said. “We’ve been under the gun since the start of this year. We can only stay open if we get reimbursed. And that is not happening.”
Pouransari said he can make payroll this week, but after that, he’s just not sure. “We’re really any day now,” he said.