There is no doubt adult day care/health centers have changed the world. They keep families together, assist in managing medication and nutritional considerations for the frail elderly and younger disabled and help protect the employment of family caregivers. They also help reduce abuse of the elderly, disabled and homebound.
Most are reimbursed via private funds and Medicaid waiver contracts. Others contract with the Department of Veterans Affairs or are reimbursed via long-term care insurance policies. Others make a crucial mistake. What is that?
They seek CMS (Centers for Medicaid & Medicaid Services) under the Part B social work designation and use this to bill for participation in activities programs. On the surface it seems simple and legal enough, however, this approach is fraught with problems.
For one it is not comprehensive and could potentially ignore other important needs the program enrollee may have. For this reason we have long recommended that the center explore operating as Comprehensive Outpatient Rehabilitative Facility, (CORF). In this way services are provided via a physician authored/approved Treatment Plan that speaks to not only which services are being ordered but why. Treatment Goals are established and an enrollee can be served in a truly person-centered way.
Often the enrollee/patient receives treatment benefits from both physical and cognitive rehabilitation services and their entire household benefits. Why is this not happening instead of what we discussed earlier? Its simple. Providers:
Refuse to embrace a truly clinically competent approach.
Are too lazy to operate a real workhorse, even though it could benefit those they serve tremendously.
Do not want to invest into contracting with a nurse, physician, rehabilitative therapist or psychosocial professional because their insight is simply too short and they cannot perceive the long-term benefits.
So, they short-cut it any way they can and many are no longer around. For some, this is because they could not survive a CMS audit and may be now be indebted to the federal government. We hear stories of services being billed under the premise that one, (1) social work professional was serving up to fifty, (50) persons and logistically alone this is simply not sustainable if not fraudulent. Others are going intro group homes and managing activity sessions with a non-clinical bend to them, and billing under social work while defying the very definition of the proposed service.
It is also not a competent approach to individualized therapy.
Click Here to read more about CMS reimbursed therapy services.
Click Here for a CORF Fact Sheet
The approach top developing and operating a truly rehabilitative initiative must be a serious one; not some money grab from a one-sided program approach.
Having developed hundreds of programs and made friends in the adult day care community the world over, we implore you to get it right. If you are an existing or prospective adult day care provider, and would like to discuss legitimately enhancing the clinical value of your adult day program, please send an email to firstname.lastname@example.org.
Another Blog Post from the minds of Direct Care Training & Resource Center, Inc.
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