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Adult and Senior Care Update - March 2006
COMMUNITY CARE LICENSING ADULT & SENIOR CARE UPDATE
This is our first Adult and Senior Care Update for 2006. It also marks the beginning of our thirteenth year keeping the residential care community informed about licensing programs and services. The Updates continue to be an important method for sharing information. We appreciate your support in sharing these Updates with members in your organization and others interested in adult and senior care issues.
REGULATION PACKAGES
The following regulation packages for adult care facilities are currently in process or completed. If you have questions about any of the proposed regulations, please contact the Community Care Licensing Division (CCLD), Policy Development Bureau at (916) 324-4312. For copies of proposed regulations or more information about hearing schedules, contact the Office of Regulation Development at (916) 657-2586 or visit their website at www.dss.cahwnet.gov/ord/default.htm . Please note that depending on the version of software that you are currently using, it might be necessary to press your control key to activate the hyperlinks found throughout this document.
Category Consolidation for Adult Day Programs: The applicable General Licensing Requirements, Adult Day Care and Adult Day Support Center Regulations are being consolidated into a single category called Adult Day Programs to comply with Senate Bill 1982, Chapter 773, Statutes of 2002. In reviewing the public comments received, it has been determined that changes are required to these regulations. Upon completion of these changes, the package will go out on a 15-day re-notice this Spring to those individuals who commented during the initial public comment period.
Age and Postural Support Exceptions for Adult Facilities: These regulations eliminated the need for exceptions in Adult Residential Facilities (ARF) when clients reach 60 years of age and exceptions for the use of postural supports in all adult categories. ARF licensees no longer are required to obtain exceptions to retain clients who turn 60, as long as these clients do not exceed 50% of the census in facilities with a capacity of six or less, or 25% of the census in facilities with a capacity of over six. Exceptions are still required to admit new clients over the age of 59 into an ARF regardless of the facility's capacity or census. This regulation package also removed the approval/exception requirements for the use of postural supports in adult facilities if the licensee meets the same conditions currently required to receive an approved exception. These requirements are listed in the regulations which became effective on December 12, 2005.
CHAPTERED LEGISLATION FOR 2005
Several bills that affect adult and senior care facilities were passed by the Legislature and approved by the Governor in 2005. A summary and implementation plan for each of these bills is available on the CCLD website. Unless otherwise noted in the summary and implementation plan, the provisions of each of these bills became effective on January 1, 2006. All licensees are encouraged to review these plans to ensure that their facilities are in compliance with any provisions of these bills that may affect them.
The implementation plans for RCFEs are available at: http://ccl.dss.cahwnet.gov/res/pdf/06apx03.pdf
The plans for Adult Community Care Facilities and Residential Care Facilities for the Chronically Ill are available at: http://ccl.dss.cahwnet.gov/res/pdf/06apx01.pdf
ASSISTED LIVING WAIVER PILOT PROJECT
As reported in the August 2005 Update, Assembly Bill (AB) 499 (Aroner, Statutes of 2000) required the California Department of Health Services (DHS) to test the feasibility of providing assisted living as a Medi-Cal benefit and as an alternative to long-term placement in a nursing home. DHS created the Assisted Living Waiver Pilot Project (ALWPP) for this purpose. Under the ALWPP, Medi-Cal funds may be used to pay for care for eligible persons in a licensed RCFE with care provided by facility staff, or in publicly subsidized housing with care provided by a home health agency. ALWPP participants must be both Medi-Cal eligible and nursing-home eligible.
The ALWPP will be conducted in Sacramento, San Joaquin and Los Angeles counties. It has a capacity of 1,000 participants over its three-year life span. Participating RCFEs must be in good standing with CCLD and must meet the following criteria: 24-hour awake staff; private room occupancy (or shared by choice); private or semi-private full bathroom (to be shared by no more than two residents); kitchenettes; and, as necessary, licensed nursing staff to meet the skilled nursing needs of residents. RCFEs with a licensed capacity of fewer than seven beds do not have to have awake staff at night or provide kitchenettes (as long as residents have access to a common kitchen area at all times).
DHS has approved the initial round of RCFEs that will participate in the ALWPP. These RCFEs had to submit applications to DHS and be evaluated for suitability to participate in the pilot. In January 2006, DHS and its ALWPP contractor, NCB Development Corporation, conducted a training session in each pilot county for local approved RCFE providers. Local licensing field staff also attended each session.
The ALWPP plans to begin enrolling residents March 1, 2006. However, RCFEs can still apply to participate in the ALWPP. For more information, please visit the ALWPP website at www.californiaassistedliving.org . If you have any questions, please contact Mark Mimnaugh of DHS at (916) 552-9379.
ADULT AND ELDER ABUSE RECOGNITION AND REPORTING TRAINING
Abuse of dependent adults and the elderly is a serious issue. It is important for all facility staff to be trained in abuse reporting requirements. AB 1499, Statutes of 1999, and AB 1690, Statutes of 2001, require all adult Community Care Facilities and RCFEs to provide core training to facility staff on recognizing and reporting dependent adult and elder abuse. The law further requires that the training curriculum be provided by the Department of Justice (DOJ). DOJ, in cooperation with the Department of Social Services and DHS, is responsible for the development and distribution of the training materials.
All new employees must receive this training within 60 days of their first day of employment. Licensees who have not received these training materials within 60 days of initial licensure or who just need additional copies should contact the Crime Prevention Unit within DOJ at (916) 324-7863 to request this material. Licensees must provide to all staff being trained a written copy of the reporting requirements and written notification of their confidentiality rights. As part of the facility visit, Licensing Program Analysts review the personnel files for documentation that the abuse reporting material has been reviewed by staff. Additionally, each facility staff person must complete the SOC 341A, which is available at www.dss.cahwnet.gov/forms/english/SOC341A.pdf , acknowledging their responsibility and rights regarding abuse reporting.
MEDICARE PART D
On January 1, 2006, Medicare began offering insurance coverage to help people pay for prescription medicines as required by the Medicare Modernization Act. Everyone on Medicare is now eligible for the new Medicare Prescription Drug Plan (Medicare Part D), including those individuals who have Medi-Cal in addition to Medicare. Departments within the California Health and Human Services Agency (HHSA) have been working closely with the Federal Centers for Medicare and Medicaid Services to inform Californians who are dually eligible for both Medicare and Medi-Cal about the benefit changes brought about by Medicare Part D.
In December of 2005, CCLD sent out a letter to all ARF and RCFE licensees to ask for their assistance in helping to educate residents understand the benefits of the new Medicare Prescription Drug Plan. Licensees were asked to let their residents know the importance of becoming informed about this program to ensure that they choose a plan that best meets their prescription drug needs. This letter included: 1) a letter from Jo Frederick, Deputy Director of the CCLD; 2) a letter from Kim Belshé, Secretary of HHSA; 3) a sample newspaper/newsletter article about prescription drug changes; and 4) a Medicare handout, including a list of resources, about recent changes. These documents may also be obtained at http://ccl.dss.cahwnet.gov/res/pdf/MedicarePartD.pdf .
This new program is complicated and there has been some confusion in the early stages of its implementation. State and federal governments have been taking steps to assist residents whose drug coverage has been interrupted by the Medicare Part D changes. Some of the resources listed on the Medicare handout may be of assistance if residents experience problems with Medicare Part D coverage. For current information, licensees and residents are also encouraged to check the websites of DHS at: www.dhs.ca.gov/mcs/mcpd/meb/mma/default.htm and the Department of Aging at: www.aging.ca.gov/programs/medicare_consumers/medicare_consumers.html .
CRIMINAL RECORD EXEMPTION REQUESTS
There have been recent revisions to the exemption request procedures when a licensee chooses not to request an exemption on behalf of a prospective employee who has a criminal record.
AS A REMINDER: If a licensee chooses not to request a criminal record exemption for a prospective employee, the individual has the right to request an exemption on his/her own behalf. Without a criminal record exemption, the individual cannot work in or be associated with any licensed facility.
When an individual has a criminal record, the CCLD Caregiver Background Check Bureau will send an "exemption needed" letter to the licensee of the facility the individual is associated with and a second, similar letter to the individual at his/her home address. Please see the attached sample exemption letters for licensees and prospective employees .
The letter to the licensee asks if the licensee wants to request an exemption on behalf of the individual. The letter lists all of the items that must be submitted to request an exemption. If the licensee chooses to request an exemption on behalf of the individual, the licensee must check the yes box on page two of the letter, sign and return the letter along with the required items within the timeframe specified in the letter. If the licensee does not want to request an exemption on behalf of the individual, he/she must check the no box that applies, sign and return the second page of the letter. In that situation, the individual is disassociated from the facility. Because a similar "exemption needed" letter is sent to the prospective employee's home address, licensees no longer have the responsibility of giving the prospective employee an exemption needed letter .
The letter sent to the prospective employee's home address informs the individual that he/she must obtain an exemption either in coordination with the licensee or on his/her own in order to work in any licensed facility. Like the letter to the licensee, the letter to the individual lists all the items that must be submitted to request an exemption as well as the required timeframes. If the individual requests an exemption on his/her own and it is approved, the exemption may be transferred to any licensee who wishes to hire him/her. The licensee must receive written notice that the exemption transfer has been approved before the individual can work in the facility.
RESIDENTIAL CARE STATISTICS
All of the statistics for licensed Adult and Senior Care facilities are now available online. When you visit the CCLD home page, click on the link on the left side of the page that is titled, " Licensing Overview ". After clicking on "Licensing Overview," click on "Basic Statistics About Licensed Facilities." Then click on the first bullet that says, "Number of State Licensed Facilities, by County." Scroll to the end of the document for the statewide totals. Further breakouts by category and location are still available. Please direct your requests to Sarah Fernandes, Central Operations Branch, at (916) 327-2406. Directories can also be obtained from your local licensing office. Please see the attached lists for phone numbers and locations of Adult and Senior Care Program offices.
SUMMARY
If you have questions about items included in this Update or suggestions for future topics, please contact Barbara Rooney, Chief of the Technical Assistance and Policy Branch at (916) 324-4312. Also, please visit our website at www.ccld.ca.gov to obtain copies of Updates, office locations, provider letters, regulations, or to learn more about licensing services.
Sincerely,
Original Signed by Jo Frederick JO FREDERICK
Deputy Director
Community Care Licensing Division
Enclosures