23-169 New: Emergency Remote Services Added to CBAS Program

Date: 03/07/23

CBAS providers must respond when members experience emergencies

Effective October 1, 2022, Emergency Remote Services (ERS) have been added as one of the required services under the Community Based Adult Services (CBAS) program. ERS is the temporary provision and reimbursement of CBAS in alternative settings other than the CBAS center during specified emergencies. The purpose of ERS is to provide quick response to CBAS members. This service is critical when an emergency restricts or prevents the member from receiving services at their center. There are two types of “unique circumstances” that may result in the need for ERS:

1. Public Emergencies such as state or local disasters such as earthquakes, floods, fires, power outages, epidemic infections/disease outbreaks such as COVID-19, Tuberculosis (TB), Norovirus.
2. Personal Emergencies such as serious illness or injury, crises, and care transitions such as to/from a nursing facility or to/from a hospital to home.

CBAS Emergency Remote Services

CBAS providers are required to provide ERS as a mode of service delivery when members experience emergencies as follow:

1. The member meets the ERS policy criteria established in the Department of Health Care Services (DHCS) All Plan Letter (APL) 22-020 (PDF) and
2. ERS is determined to be the appropriate service for the member and their emergency; and
3. The CBAS provider has obtained approval from the California Department of Aging (CDA) to provide ERS.

Determine Need for ERS

For ERS to be approved, the member must experience a public or personal emergency and need the services and supports CBAS provides under ERS. In determining the initial need for and/or duration of ERS, the following is considered:

• Medical necessity – services and supports are necessary to protect life, address or prevent significant illness or disability, or to alleviate severe pain.
• Hospitalization – whether the member has been hospitalized related to an injury or illness and is returning home but not yet to the CBAS center.
• Restrictions set forth by the member’s primary/personal health care provider due to recent illness or injury
• Member’s overall health condition.
• Extent to which other services or supports meet the member’s needs during the emergency.
• Personal crises such as sudden loss of caregiver or housing that threaten the member’s health, safety, and welfare.

Documentation and reporting requirements

When member meets the criteria for ERS, the CBAS center must complete the CBAS ERS Initiation Form (CEIF) and submit to California Health & Wellness Plan (CHWP) within three days after the start of ERS. The same method used for the Individual Plan of Care (IPC) authorization notification can be used to submit the CEIF form by faxing to the CHWP CBAS Department fax 833-581-5908. Do not attach any other CBAS requests to the CEIF, such as the IPC. All other CBAS requests should be faxed separately.

If ERS extends into a new assessment period, and the member cannot attend in-center for the reassessment, the member is eligible for discharge from CBAS. The CBAS Center is required to fax the discharge summary to CHWP to indicate any unmet needs. The member may re-enroll with CBAS when ready to attend in-center services.

To ensure members’ needs are met, contact the CBAS provider for information or to request updated Individualized Plans of Care.

Additional information

Providers are encouraged to access CHWP’s provider portal for real-time information, including eligibility verification, claims status, prior authorization status, plan summaries, and more.

If you have questions regarding the information contained in this update, contact CHWP at 877-658-0305.

 

This information applies to CBAS Providers.