Medi-Cal Update Community – Based Adult Services (formerly Adult Day Health Care Centers)

 March 2013 | Bulletin 462

 

1. Community-Based Adult Services: Recipient Eligibility Determination

Effective for services on or after April 1, 2013, Community-Based Adult Services (CBAS) providers must follow the process described below to determine recipient eligibility for CBAS services. This process is specific to the fee-for-service Medi-Cal program, but the process for CBAS centers requesting recipient eligibility determinations and authorization for services also applies to Managed Care Plans (MCP). CBAS providers should check with their MCP(s) for specifics that apply to the individual MCP.

The CBAS Eligibility Determination Tool (CEDT) version 2.0 will be used by DHCS onsite reviewers beginning April 1, 2013 for all CBAS recipient eligibility determinations.

Note: The CEDT is not a provider form; CBAS providers are not required to complete this form.

  1. The CBAS center is responsible for ensuring that recipients seeking CBAS are Medi-Cal eligible. CBAS providers that have recipients requesting CBAS as of April 1, 2013, will be required to follow this process for determining eligibility.
  2. Providers fax a CBAS eligibility inquiry request to the Los Angeles Medi-Cal Field Office (LAMFO) at (213) 897-1740. Although there is no specific or designated form, the CBAS eligibility inquiry fax must contain at least the following:
    • Center’s name
    • Center’s National Provider Identifier (NPI)
    • Name of person to contact at the center
    • Contact’s telephone number
    • Center’s fax number
    • Recipient’s name
    • Recipient’s Medi-Cal ID number (CIN)
    • Recipient’s birth date
  3. When the fax is received, the LAMFO checks recipient eligibility and determines if the recipient is required to enroll in managed care or is exempt from managed care enrollment.A field office Nurse Evaluator (NE) completes the CEDT during the face-to-face assessment visit. While in the field conducting the assessment, the NE does not share preliminary determination information with the CBAS center. 
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  • LAAAC is managed by St. Barnabas Senior Services; Funded, in part, by Archstone Foundation.
  • St. Barnabas Senior Services

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