Access Issues Behind ADHC Exemptions

The Department of Health Care Services recently exempted 69 adult day health care centers from the 10% reimbursement cut. Because the cutback is retroactive to June 2011, it spared payback of a large amount of retroactive money for those mostly rural ADHCs.

“That is really good news for Contra Costa County,” Debbie Toth — executive director of the Mt. Diablo Center for Adult Day Health Care in Pleasant Hill — said. “We would have had to pay back a lot of money through June. And we’ve already gone through our reserves, so we wouldn’t have been able to do that.”

The 10% cut would’ve put centers in Contra Costa County over the edge, Toth said. “Our direct care staff is required by regulation, so there’s no way … I couldn’t reduce my cost by 10%.”

The rest of the 300 ADHC centers in California won’t get that break. According to Toby Douglas, director of DHCS, the reason these 69 centers were exempted was because closure of them could create a severe access problem for those services.

“We exempted ADHC centers in rural areas due to the low supply of centers there,” Douglas said. When DHCS analyzed the population, the provider network capacity and utilization trends, Douglas said, access to ADHC services in rural areas could be compromised by the 10% cut.

At least eight of the 69 exempted ADHC centers on the list have already closed.

Those closures include centers in Lodi, Sacramento, Sonora, Fortuna, Ukiah, Turlock and two centers in Fresno.

When ADHC is eliminated as a Medi-Cal benefit on Dec. 1, the state expects its transition plan of alternative services to pick up those services.

A lawsuit challenging the efficacy of that transition plan comes to a head on Nov. 15, when a federal judge will decide whether or not the state’s transition program is adequate.

Both parties met twice last week to try to settle the lawsuit, and another settlement conference is scheduled Tuesday.

“I don’t believe ADHC’s going away. It’s a high-need population that needs services, so I think ADHC in some form will continue,” Toth said. “I’m hoping for an injunction or a settlement.”

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