State Initiates Expedited Hearing Process for Adult Day Services Appeals

When the Department of Health Care Services launched its new Community Based Adult Services plan at the start of October, more than 2,000 people who had been denied services were still waiting for their eligibility appeal hearings.

Now DHCS officials say almost all of what is now a total of 2,500 eligibility appeals will be heard by Department of Social Services’ administrative law judges by the end of November.

That means roughly 2,000 cases will have been heard in just over two months — almost 200 administrative law hearings a week.

According to Norman Williams, director of public affairs for DHCS, it’s an important step for appellants, to have the state expedite the hearing process.

“Most of these hearings are being processed through the accelerated hearings process that began in mid-September and is targeted for completion in November,” Williams said in an email.

After the DSS administrative judges make their ruling, the next step is approval or denial by Toby Douglas, the director of DHCS. Williams could not say when Douglas would finalize the eligibility claims.

“Since the bulk of CBAS fair hearings are currently in process, DHCS is waiting until late November, when these hearings are expected to be finalized, before publicly reporting any summary outcomes,” he said.

Williams did not reveal specifics about the process — such as the number of cases already submitted to Douglas, and the number of cases that have been finalized so far.

For adult day health care centers that serve CBAS enrollees, it’s important to know how many enrollees they’re going to have, said Lydia Missaelides, executive director of the California Association of Adult Day Services. If the final approval process is a long one, and eligibility is unknown into December and January, then centers without enough participants may have to close.

In addition, enrollees will have to go without adult day services for an extended period of time, since the centers can’t afford to keep providing those services for free, the way many of them have been doing, Missaelides said. Receiving payment for approved beneficiaries also has been a challenge for centers, Missaelides said.

“My big concern right now is the inability of centers to get paid,” Missaelides said. “People are still trying to figure out how to submit a claim. Centers have to bill multiple plans, and every plan is doing things differently. They have to learn by mistakes, so we have the payment problem and the beneficiaries leaving. It’s kind of a mess.”

Williams has said the department is working with health plans, providers, beneficiaries and centers to ensure a smooth transition, and is dealing seriously with the high volume of eligibility decisions.

He added that not all hearings have been scheduled yet: “Since new hearing requests can originate at any time,” he said, “some of those newer hearing requests may still be unscheduled at this time.”