Assisted Living & CCRCs
LeadingAge California engages in a constant and determined fight to preserve and maintain services to California’s seniors and their providers through policy and advocacy
Assisted Living
The majority of assisted living members are a part of a continuing care retirement community while some are free standing. Assisted living is state regulated. State regulations vary on who can be admitted and reside in assisted living. Assisted living is primarily private pay.
Continuing Care Retirement Communities
CCRCs offer an innovative and independent lifestyle that is different from other housing and care options for older people. Through long-term contracts that provide for housing, services and nursing care, usually in one location, the CCRC meets a resident’s needs for their entire life.
To learn more click on a topic heading below.
- SNF Staffing Survey Form
- Assisted Living
- Continuing Care Contracts
- Legal Issues
- Operation and Regulation
- Resources and Links
SNF Staffing Survey
• SNF Staffing Survey Form
Assisted Living
Assisted Living Waiver
The Assisted Living Waiver provides a Medi-Cal benefit for assisted living residents in certain counties. Visit www.californiaassistedliving.org for more information.
Continuing Care Contract
Advisory Committee Discusses Governance and Fee Language
The state’s Continuing Care Advisory Committee met in Sacramento. The agenda included a lengthy discussion on the proposed statutory language regarding monthly service fee increases. The debate centered on how to adequately define the word “provider” to accurately portray the corporate structure of each CCRC. The committee approved the language as drafted. The Committee also discussed whether or not various quality initiatives like Quality First should be made compulsory. There was no consensus from the committee members to act on this. Download Montly Fee Increase Language.
CCRC Statutes
Continuing Care Retirement Communities (CCRCs) are governed by the Health & Safety Code, commencing with Section 1770. Download the CCRC Statutes
State CCRC Website
The Continuing Care Contracts Branch of the Department of Social Services is responsible for oversight of continuing care contracts. To visit their website, click here.
Legal Issues
Residential Temporary Relocation Fact Sheet for Coninuting Care Retirement Communities
Download the question and answer fact sheet that discusses the details of the temporary relocation law.
Legal Update: RCFE Food Service Not Subject to County Oversight
Joel Goldman, of Hanson, Bridgett, Marcus, Vlahos & Rudy, LLP, provides clarification that RCFEs are not subject to the provisions of the California Uniform Retail Food Facilities Law (CURFFL). Download the Legal Update here.
Return-to-Home Law
In 1998, LeadingAge California sponsored AB 742 (Washington, Chapter 124, Statutes of 1998). This state legislation would guarantee that a resident enrolled in Medicare risk HMO would be allowed to "return home" when that home is equipped to care for them. This legislation was pre-empted by the federal bill, H.R. 5661. Specifically, the Medicare "give backs" portion of the "Medicare, Medicaid and SCHIP Benefits Improvement and Protection Act (BIPA)" which (42 U.S.C. 1395w-22) gives seniors who are enrolled in the Medicare+Choice plan the option to return to their home care facility following hospitalization if the following conditions are met:
• The enrollee elects to return to that facility;
• The home facility must agree to the enrollee's return;
• The home facility must agree to accept the same terms and condition of payment that would apply to an in-network provider under the enrollee's managed care plan.
Should you encounter problems in exercising the resident's rights under these provisions, members are encouraged to contact the plans program manager. Contacts for Kaiser and PacifiCare are listed below:
Sue Herman
Plan Manager
PacifiCare
(415) 744-4908
Anita Kveviel
Plan Manager
Kaiser Permanente
(415) 744-3652
Annual Report Information and Instructions Available Online
The Department of Social Services, Continuing Care Contracts Branch has made its Annual Report Instructions as required by AB 2550 (Steinberg, Chapter 129, Statutes of 2004) available online. To access the site visit http://www.calccrc.ca.gov/reportingrequirements.h tml.
The Department of Social Services, Continuing Care Contracts Branch has made its Annual Report Instructions as required by AB 2550 (Steinberg, Chapter 129, Statutes of 2004) available online. To access the site visit http://www.calccrc.ca.gov/reportingrequirements.h tml.
Draft CCRC Independent Unit LPA Guidance Released for Comment
The Department of Social Services, Continuing Care Contracts Branch has released a draft copy of their protocols when conducting licensing visits of independent units in CCRCs. The Department will be taking comments and will inserrt the final product into the Evaluator's Manual. To access a copy of the draft protocols, click here. To view LeadingAge of California's comments, click here.
The Department of Social Services, Continuing Care Contracts Branch has released a draft copy of their protocols when conducting licensing visits of independent units in CCRCs. The Department will be taking comments and will inserrt the final product into the Evaluator's Manual. To access a copy of the draft protocols, click here. To view LeadingAge of California's comments, click here.
SB 244 Compliance Materials Available
Effective January 1, 2006, the provisions of SB 244 will take effect. As a result, some CCRCs may be required to modify their policies and procedures in the areas of billing, level of care transfers, posting of certain information, and how to handle level of care transfer appeals, etc. CAHSA has developed several resources to aid members in complying with the new law. Click here for:
• updated provider statutes with the modifications made by SB 244,
• a compliance checklist, and
• a sample residents' rights poster.
DSS Issues Memo Clarifying Use of "Point Systems"
A memo issued on July 29, 2005 from DSS’ Policy Development Bureau seeks to clarify statutory requirements for admission agreements and the use of “point systems.” Specifically, the memo is meant to provide Licensing Program Analysts (LPAs) with consistent criteria for evaluating these two areas. The issues addressed in the memo include: 1) clarity of language used in admission agreement, 2) explanation of terms such as “occasional, frequent, routine, extensive, repeated, many, numerous, recurrent, etc.”, 3) consistency of the treatment of documented points across all facility staff, 4) clearly defining activity descriptions, such as “wake-up assistance”, 5) clearly delineating the resident’s right to decline services (and thus not accruing points), 6) ensuring the points do not conflict with residents’ rights, 7) clearly identifying point maximums, 8) identifying appropriate staff to determine behavioral related point assessments, 9) disclosing frequency of totaling points, 10) disclosing whether or not points will be re-evaluated, and 11) ensuring a tracking system auditable and in place.
A memo issued on July 29, 2005 from DSS’ Policy Development Bureau seeks to clarify statutory requirements for admission agreements and the use of “point systems.” Specifically, the memo is meant to provide Licensing Program Analysts (LPAs) with consistent criteria for evaluating these two areas. The issues addressed in the memo include: 1) clarity of language used in admission agreement, 2) explanation of terms such as “occasional, frequent, routine, extensive, repeated, many, numerous, recurrent, etc.”, 3) consistency of the treatment of documented points across all facility staff, 4) clearly defining activity descriptions, such as “wake-up assistance”, 5) clearly delineating the resident’s right to decline services (and thus not accruing points), 6) ensuring the points do not conflict with residents’ rights, 7) clearly identifying point maximums, 8) identifying appropriate staff to determine behavioral related point assessments, 9) disclosing frequency of totaling points, 10) disclosing whether or not points will be re-evaluated, and 11) ensuring a tracking system auditable and in place.
LeadingAge California will be meeting with the Department on this issue and will advise members of any changes if they occur. It should be noted that CCRCs are exempt from Article 9 of Chapter 3.2 of the RCFE statutes. Therefore, much of the content of the memo does not apply. Download the memo here.
Recent Title 22 Regulation Manual Updates
The most recent manual updates are listed below. A complete set is available on CCLD's website (scroll down to Residential Care Facilities for the Elderly).
The most recent manual updates are listed below. A complete set is available on CCLD's website (scroll down to Residential Care Facilities for the Elderly).
Navigating the Fingerprinting & Background Check Process
According to the Department of Justice and the Community Care Licensing Division, 96% of fingerprint clearances should be available within 3-5 days when using Live Scan. Staff with client contact and volunteers must be cleared prior to their presence in the facility. Common issues that cause delays include missing court information, applicant born prior to 1945 requiring a manual file search, and missing or incorrect data submitted with the fingerprints. The following information is provided to assist you in checking on status of your applicants:
According to the Department of Justice and the Community Care Licensing Division, 96% of fingerprint clearances should be available within 3-5 days when using Live Scan. Staff with client contact and volunteers must be cleared prior to their presence in the facility. Common issues that cause delays include missing court information, applicant born prior to 1945 requiring a manual file search, and missing or incorrect data submitted with the fingerprints. The following information is provided to assist you in checking on status of your applicants:
Checking on Status of Fingerprint Submission
You should allow a minimum of seven days before making a status inquiry. Applicants should check first with the DSS-Care Giver Background Check Bureau since the Department of Justice sends results directly to the applicant agency.
24-hour Automated Telephone Service Available: 916-227-4557. If DSS does not have results yet and digital Live Scan fingerprints were submitted, you can use the automated telephone system to check on your submission. You will need the following information: (1) your date of birth; and (2) the 10-digit Automated Transaction Identifier (ATI) number that appears at the bottom of the Department of Justice form requesting Live Scan fingerprint background checks. The ATI number always appears in the following sequence: 1 LETTER; 3 NUMBERS; 3 LETTERS and 3 NUMBERS.
There is no automated system for checking on paper fingerprint card submissions. To check on card submissions or if you have specific applicant submission problems, contact the state Department of Justice's Applicant Processing Program at (916) 227-3823. Because of the volume of calls received and time needed to research each request, there may be delays in responding to your inquiry.
Additional Information:
• The Background Check Requirement Overview, click here.
• Livescan Locations, click here.
• CCLD Frequently Asked Questions (FAQs), click here.
• Checking the Status of Fingerprint Submission guidelines (DOJ), click here.
• Applicant Fingerprint Transaction Follow-up Request, click here.
• The Background Check Requirement Overview, click here.
• Livescan Locations, click here.
• CCLD Frequently Asked Questions (FAQs), click here.
• Checking the Status of Fingerprint Submission guidelines (DOJ), click here.
• Applicant Fingerprint Transaction Follow-up Request, click here.
Resources and Links
DSS Legislation Online Research Tool
Each year, the Community Care Licensing Division of the Department of Social Services updates the Evaluator Manual to reflect recently chaptered legislation. This information serves as guidance for Licensing Policy Analysts for the period after the new statutes take effect and before regulations are adopted. In addition, this information provides policy guidance in areas where regulations are not necessary.
The Evaluator Manual updates from 1998 through 2004 have been compiled and posted on Aging Services' website. The information is available for browsing by topic, year, or author. The site will be updated annually to reflect recently chaptered legislation. To access the Research Tool, click here.
Technical Support Documents
DSS' Technical Support Program has several self-assessment guides available. To download, click on the name of the document below:
• Administrative Assessment
• Compatible Needs
• Hospice Guide
• Incidental Medical Services
• Preadmission Questionnaire
• Resident Records
• Staff Records
HIPAA: An Introduction
Allan Jergesen, Esq. of Hanson, Bridgett, Marcus, Vlahos & Rudy, LLP provides members a general introduction to HIPAA including background of the HIPAA legislation, and several components that make up HIPAA. Click here to access the complete text in PDF.
Links
• Map and listing of all LeadingAge California member CCRCs and MLRCs in California
• Department of Social Services:
• Adult & Senior Care Updates
• Community Care Licensing Division
• Administrator Certification Program
• Online Evaluator Manual
• Continuing Care Contracts Branch
• Office of Regulation Development
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