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CCL To Make Significant Changes to Inspection Process – 6Beds Calling for Greater Consistency and Transparency

by George Kutnerian
Community Care Licensing (CCL) has announced that it intends to make significant changes to the inspection process in an effort to improve the effectiveness and quality of that process.  6Beds has been invited by CCL to provide feedback on how its new inspection process vision gets implemented in the field.  6Beds is stressing that the new inspection process be more consistent and transparent.

6Beds attended a first meeting with CCL in December, 2017 and will be attending a second meeting with CCL in March, 2018 to further discuss the rollout of the inspection process.  CCL anticipates piloting the new inspection process this spring and 6Beds will provide updates as more information becomes available.

Best Regards,
George K. Kutnerian
Senior Vice President
Public Policy & Legislation
6Beds, Inc.

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IN CASE YOU MISSED IT: DSS ANNOUNCED 2017 SSI/SSP NON-MEDICAL OUT-OF-HOME CARE (NMOHC) PAYMENT STANDARD

by George Kutnerian
The SSI/SSP non-medical out-of-home care (NMOHC) payment that SSI/SSP recipients who live in residential care facilities receive, has increased to $1,158.37 as follows:

Supplemental Security Income (SSI) $   735.00
State Supplementary Payment (SSP) $   423.37
$1,158.37

Of the $1,158.37, the SSI/SSP recipient is entitled to a personal and incidental needs allowance of $132.  This leaves $1,026.37 as the amount payable to the facility for basic services.

Please note that recipients who have income in addition to their SSI/SSP check (for example, a pension, Social Security Retirement, or disability benefits) can be charged the $1,026.37 amount for basic services plus an additional $20.  Because federal rules do not count the first $20 of a recipient’s income against his or her SSI/SSP grant, an SSI/SSP recipient with other income has an extra $20 that people who receive only an SSI/SSP check do not have.  Neither federal nor state law restricts the recipient in how this additional $20 amount is spent.  Therefore, if the recipient agrees in the admission agreement to pay the additional $20 for basic services, the facility may charge the additional amount resulting in a total monthly basic services charge of $1,046.37.

DSS’ Provider Information Notice regarding this topic can be found here (click to download).

Sincerely,

George K. Kutnerian
Senior Vice President of Public Policy & Legislation

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CCL Announces the Launch of Provider Information Notices (PINs)

by George Kutnerian
On October 21, 2016, Community Care Licensing (CCL) announced the launch of Provider Information Notices (PINs), which it will use moving forward to formally communicate to CCL-licensed facilities.

On the homepage for CCL, you will find the link to the Provider Information Notices (PIN) at the top of “Featured Information.”  These notices will also be available by selecting the “Tools/Resources” tab and then “Information Releases.”

PIN 16-01-CCLD is for all Community Care Licensed Providers and it provides an overview of the PIN process.  PIN 16-01-ASC is specifically for Residential Care Facilities for the Elderly (RCFEs) and it releases an updated Medication Guide for RCFEs to use as a resource. PIN 16-02-ASC addresses the protection of residents in RCFEs during flu season.

If you are a licensee and CCL has a contact email for you, you may have already received an email notifying you of the launch of PINs.  However, to ensure that everyone has current information, we will announce individual PINs as we are made aware of them by CCL.

Best Regards,
George Kutnerian
Senior Vice President – Public Policy & Legislation

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Assisted Living Waiver Program – DHCS Announces Increased Provider Rates Effective 2017

by George Kutnerian
In a previous post, we let our readers know that California’s new budget would provide for an increase in funding for the Home and Community Based Services waiver programs, which includes the Assisted Living Waiver Program. At that time, the specific rates to take effect on January 1, 2017 had not yet been announced.

DHCS recently announced the specific provider rates that are to take effect on January 1, 2017.  The new provider rates are as follows:

 

Effective 2017                      Current

Tier 1         $55/day              $52/day

Tier 2         $66/day              $62/day

Tier 3         $75/day              $71/day

Tier 4         $87/day              $82/day

 

This marks the first rate increase the Assisted Living Waiver Program has received since its inception as a pilot program in 2006 when it began serving Los Angeles, Sacramento and San Joaquin counties.

The primary goal of the Assisted Living Waiver Program is to enable low-income, Medi-Cal eligible seniors and persons with disabilities, who would otherwise require nursing facility services, to remain in or relocate to the community.  The program was approved by the Centers for Medicaid and Medicare and is currently in the midst of its second five-year waiver that will run into 2019.  The Assisted Living Waiver Program currently operates in 14 counties throughout the State.

6-bed RCFEs play an important role in the Assisted Living Waiver Program.  The Assisted Living Waiver Program provider rate increase is yet another signal of the effectiveness of 6Beds’ advocacy in Sacramento, where 6Beds has persistently been advocating for provider rate increases for programs that impact 6-bed facilities as well as new funding sources for 6-bed facilities to cope with the rising costs of doing business in California.

Best Regards,

George Kutnerian, M.S., MBA
Senior Vice President – Public Policy & Legislation

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First Increase in a Decade to State SSP Portion of the SSI/SSP Grant

by George Kutnerian
Effective January 1, 2017, the state SSP portion of the SSI/SSP grant will receive a cost-of-living increase equivalent to the increase in the California Necessities Index, which is 2.76 percent.  This increase would mark the first State SSP increase in more than a decade.

California, home to almost 20% of the nation’s SSI population, has long relied on 6-bed residential care facilities to provide housing and care for SSI/SSP recipients, among which are primarily the elderly and adults with disabilities, including those with developmental disabilities and mental illnesses.

The disparity between the capped SSI/SSP rate and the median market rate has grown to become a gaping chasm over the years, with the SSI/SSP board and care rate failing to keep up with the rapidly rising housing and operating costs that California’s small 6-bed residential care facilities face.

The 2.76% increase to the State SSP portion of the SSI/SSP grant, the first such increase in more than a decade, has been long overdue and is a step, albeit a very modest one, in the right direction.  6Beds recognizes that much more will have to be done to sustain the small 6-bed residential care facilities that care for SSI/SSP recipients and will continue to advocate on their behalf.

Best Regards,

George Kutnerian, M.S., MBA
Senior Vice President of Public Policy & Legislation

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First Ever Rate Increase for Assisted Living Waiver Program

by George Kutnerian
California’s new budget will provide for an increase in funding for the Home and Community Based Services waiver programs, which includes the Assisted Living Waiver Program.

The budget will provide for an estimated $7.1 million from the State’s General Fund and an estimated $5.1 million in federal funds, reflecting increased costs in Home and Community Based Services waiver programs and long-term care facilities rate add-ons.

The specific provider rate increase for the Assisted Living Waiver Program has not yet been determined, but increased rates should take effect on January 1, 2017 and we expect the new rates to be announced sometime in the 4th quarter of this year.

The much needed and long overdue provider rate increase would be the first rate increase the Assisted Living Waiver Program has received since its inception as a pilot program in 2006 when it began serving Los Angeles, Sacramento and San Joaquin counties.

The primary goal of the Assisted Living Waiver Program is to enable low-income, Medi-Cal eligible seniors and persons with disabilities, who would otherwise require nursing facility services, to remain in or relocate to the community.  The program was approved by the Centers for Medicaid and Medicare and is currently in the midst of its second five-year waiver that will run until February 28, 2019, by which time we expect that another five year waiver renewal will be approved.  The Assisted Living Waiver Program currently operates in 14 counties throughout the State.

6-bed RCFEs and ARFs play an important role in the Assisted Living Waiver Program and 6Beds will continue to keep its members and followers apprised of new information pertaining to the provider rate increase.

Best Regards,

George Kutnerian, M.S., MBA
Senior Vice President of Public Policy & Legislation

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Urgent: ARF DD Must Return DDS Surveys in Order to Receive Rate Adjustment

Attention ARF DD:

DDS sent out 1800 surveys and they only received 800 back. They are missing a significant sample of small facilities. They have indicated that unless DDS receives another 400 surveys back, they will NOT increase the rates this coming July 1.

6Beds ARF members (and non-members), please fill out the survey ASAP (if you received one) and return it to DDS.

Sincerely,

Gina Wasdyke
Founder & Legislative Director
6Beds, Inc.

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6Beds Lobby Day: Dozens and Dozens of 6Beds Members Flood the State Capitol for Testimony in Opposition to the Civil Penalties Bill (AB 2231)

Dozens and dozens of 6Beds members and supporters flooded the State Capitol on April 12, 2016 for 6Beds’ Lobby Day with 6Beds’ testimony before the Assembly Human Services Committee in opposition to the civil penalties bill, AB 2231, one of the focal points of the day.

AB 2231 addresses violations, including repeat violations and serious/zero tolerance violations, as well as the civil penalties associated with these types of violations.  6Beds’ official comment letter on the bill can also be found here as well as the Assembly Human Services Committee’s bill analysis, which incorporated 6Beds’ comments.  Similar to the complainant appeal process that was proposed in 2015, 6Beds was once again the only provider organization to formally take an opposition position.

Although AB 2231 did not propose to change the highest civil penalty amounts of $15,000 and $10,000, which took effect with the passage of AB 2236 two years ago, 6Beds advocated that AB 2231 be amended to include the scaling down of these penalty amounts for RCFEs and ARFs serving six or fewer persons given the disproportionate economic impact and risk of closure these penalties expose small facilities to.  6Beds also advocated for an amendment that would tighten up the definition of a repeat violation to prevent situations where violations with different facts and circumstances could unfairly be labeled as repeat violations, subjecting licensees to costly civil penalties.  Finally, in light of Community Care Licensing’s (CCL) move towards collecting civil penalties upfront even if the deficiency is under appeal, 6Beds advocated for an amendment that would codify historic practice of having to pay a civil penalty only after the conclusion of an unsuccessful appeal.  It is fundamentally unfair for licensees to be asked to pay civil penalties while their appeals are pending.

The audience in the room that held the Assembly Human Services Committee hearing resembled a sea of blue, dominated by a large number of 6Beds members wearing blue 6Beds shirts. 6Beds’ testimony and the dozens of 6Beds members that formed a long line to individually express their opposition following the testimony made a powerful statement to both legislators and CCL that licensees of small residential care facilities are not to be ignored.  In response to 6Beds’ message and presence, the Chair of the Assembly Human Services Committee, Susan Bonilla (D – Concord), and the author of AB 2231, Ian Calderon (D – Whittier) both recognized the treatment of licensees with respect to sometimes inconsistent and subjective enforcement by CCL.  In the longer term, 6Beds believes that this recognition may help pave the way for future reforms of the Community Care Licensing system with the aim of improving the treatment and rights of licensees.  In the immediate term, 6Beds’ advocacy has caused Mr. Calderon to commit to working with 6Beds, particularly on amendments related to the definition of a repeat violation as well as the timing of civil penalty payments.

6Beds’ leadership would like to convey a heartfelt thank you to all of its members and supporters for their participation on April 12, 2016.  Everyone did a tremendous job of representing 6Beds, which has only increased 6Beds’ efficacy and will help 6Beds build upon the following positive changes relative to previous proposals for the bill that were already made prior to April 12, 2016:

Civil Penalty Amounts

The bill proposes to increase civil penalty amounts for serious/zero tolerance violations (e.g. fire clearance violations, overcapacity, ambulatory status, inoperable smoke alarms, absence of supervision, accessible bodies of water, accessible firearms/ammunition, refused entry to a facility, etc.).  Currently, the civil penalty amount for these types of violations is $150.  Prior to the introduction of AB 2231, it was proposed that the civil penalty amount for serious/zero tolerance violations be $1,000.  6Beds’ advocacy helped reduce this amount to the $500 that is currently proposed in AB 2231.

AB 2231 also proposes to increase civil penalty amounts for repeat violations of serious/zero tolerance violations, as well as other violation types.  Prior to AB 2231, it was proposed that the civil penalty amount for repeat violations of serious/zero tolerance violations be $2,000 plus $1,500 for each day the violation is not corrected.  6Beds’ advocacy helped reduce this amount to the current $1,000 plus $100 for each day the violation is not corrected that is proposed in AB 2231.

Prior to AB 2231, it was proposed that the civil penalty amount for repeat violations that were not of the serious/zero tolerance type be $500 plus $100 for each day the violation is not corrected.  6Beds’ advocacy helped reduce this amount to the current $250 plus $100 for each day the violation is not corrected that is proposed in AB 2231.

Imposition of Separate Civil Penalty for Underlying Violations

Prior to AB 2231, it was proposed that there could be imposed a separate civil penalty for an underlying violation that resulted in the imposition of a larger civil penalty.  For example, if absence of supervision resulted in the death of a resident, the previous proposal would have allowed for the imposition of a civil penalty for the death of the resident as well as a civil penalty for absence of supervision.  As a result of 6Beds’ advocacy, AB 2231 would only allow for the imposition of the higher civil penalty amount.  No double dipping.

Thanks again to everyone for their support and stay tuned for more updates on this bill as 6Beds works diligently to improve upon the bill.

Regards,

George Kutnerian

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Newly Sworn in Assembly Speaker Anthony Rendon Announces Assembly Floor Leadership Team

New Assembly Speaker Anthony Rendon (D-Paramount) announced his floor leadership team effective March 10, 2016.

The Assembly Democratic leadership appointments are as follows:

 

Speaker pro Tempore – Assemblymember Kevin Mullin (D-South San Francisco)

Assistant Speaker pro Tempore – Assemblymember Autumn R. Burke (D-Inglewood)

Majority Floor Leader – Assemblymember Ian C. Calderon (D-Whittier)

Assistant Majority Floor Leader – Assemblymember Jim Cooper (D-Elk Grove)

Majority Whip – Assemblymember Miguel Santiago (D-Los Angeles)

Democratic Whip – Assemblymember Nora Campos (D-San Jose)

Assistant Majority Whip – Assemblymember Evan Low (D-Silicon Valley)

Democratic Caucus Chair – Assemblymember Mike A. Gipson (D-Carson)

 

6Beds will continue to provide updates on new developments as it pertains to legislative leadership in Sacramento.

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CCL Announces that Complaint Investigation Reports Being Posted to Transparency Website – 6Beds Meets with CCL Regarding Concerns

Community Care Licensing (CCL) announced on February 26, 2016 that on Tuesday, March 1, 2016 it would begin online posting of Complaint Investigation Reports (LIC 9099s), making them available for public online consumption for the first time via its Transparency Website.

Given that 6Beds has become aware of a number of inconsistencies in practice, it has not been entirely clear as to what CCL’s policies are regarding whether a Complaint Investigation Report is classified as either “Public” or “Confidential”  based on either the completion status of the investigation or the actual investigation findings.  For example, for Complaint Investigation Reports that are not yet completed and where the reports identify that further investigation is required, 6Beds is aware of some of these reports being labeled as “Confidential”, some of them being labeled as “Public”, and some of them not being labeled at all.  However, all complaint investigations that are not yet completed should be marked “Confidential” until a resolution is reached.

In general, 6Beds is not opposed to the idea of information being available for public consumption.  However, the public should be entitled only to information that is legitimately and legally “Public” and the availability of information should not come at the expense of accuracy, consistency, and fairness.  Earlier this week, 6Beds formally registered its concerns regarding this issue with CCL and has sought clarification regarding its policies.

On Wednesday, March 2, 2016, CCL Deputy Director Pam Dickfoss and Statewide Adult and Senior Care Program Administrator Ley Arquisola were kind enough to meet with me to discuss 6Beds’ concerns and to provide clarification.  In this meeting, CCL was able to confirm the following:

  • Complaint Investigation Reports that indicate that further investigation is required should be marked “Confidential” and not posted to the Transparency Website until a resolution is reached.
  • For RCFEs, all Complaint Investigation Reports with approved complaint findings, even if the findings are “Inconclusive” or “Unfounded”, are to be marked “Public”. This is an area that has been a source of confusion for RCFE licensees as many RCFE licensees have been under the impression that “Unfounded” complaint findings are to be labeled “Confidential,” which would make sense.  However, CCL has clarified that based on statute all approved complaint findings for RCFEs are “Public”.
  • For ARF licensees, however, “Unfounded” complaint findings are “Confidential”. “Inconclusive” and “Substantiated” complaint findings are “Public”.
  • Only Complaint Investigation Reports with complaint findings approved after January 1, 2016 will be posted to the Transparency Website. This is positive news because the inconsistencies that 6Beds is aware of are from before January 1, 2016 and 6Beds, therefore, was concerned that Complaint Investigation Reports with complaint findings issued prior to January 1, 2016 would be posted to the Transparency Website.

CCL has also committed to producing a document explaining these policies, which I will distribute once it’s made available.  6Beds is also working internally and with CCL on a process whereby licensees can report to 6Beds any inconsistencies or inaccuracies related to confidential Complaint Investigation Reports inappropriately being labeled “Public” and posted to the Transparency Website.  The inquiries from licensees would then be vetted by 6Beds and forwarded directly to CCL headquarters for review and follow-up.

Stay tuned for updates on this issue as they become available.