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  • 2021 Lay Advocacy Training

    …from the MA plan should be considered requests for an organization  There are different time frames for service and claim payment requests. Claim payment requests must be reviewed in 60 days. Service requests must be reviewed in 14 calendar days. All of the following situations should be treated as an organization determination that is a denial: The planhas denied the level of care requested, but approved another level of care. For example, the request for skilled nursing care was not authorized, but home health services were approved; Theplan has denied the request for service or has not approved the amount of service requested; Theplan has reduced or discontinued services; Theplan has failed to approve, provide or arrange the requested health care services in the time frame required; Theplan has denied payment of the claim submitted or only partially paid the  If the organization determination is a denial, it must be in writing and must provide the following information: Thereason for the denial; and Informationon how to appeal the denial and on the expedited appeal  Reconsideration– If the organization determination results in a partial or total denial, or the MA plan fails to issue a written determination within the specified time frames, the member may request  The reconsideration review is performed by the MA plan. The member must file the reconsideration request with the MA plan within…

  • Caregiver Companion Guide (2016)

    …Paying for Home Care Services or why it refused to pay for a service. The MA plan must also explain in writing how to appeal the decision. In either case,…

  • Nursing Home Companion (2011)

    …Unfortunately, no scientific formula exists to determine the “best” facility for any individual. Although internet sites can provide helpful information about nursing homes, that information is only a starting point for a search. To the extent possible, set your sights high, and do not be shy about seeking competent, personalized care. RESOURCES For more information on topics in this chapter, consult the following agencies, print and online resources, and the legal citations on which the information is based. Agencies BetTzedek Legal Services: bettzedek.org, (323) 939-0506 CaliforniaDepartment of Public Health, Licensing and Certification Division: cdph.ca.gov/programs/LnC, (800) 236-9747. (For phone numbers of local District Offices, see Appendix C, pages 118–120.) CaliforniaDepartment of Social Services, Community Care Licensing Division: ccld.ca.gov, (916) 651-8848 CaliforniaLong-Term Care Ombudsman Program: aging.ca.gov/programs (search: “ombudsman”), CRISISline (800) 231-4024. (For phone numbers of local Ombudsman Programs, see Appendix B, pages 115–117.) Print BetTzedek Legal Services, Assisted Living Companion (print and download versions): bettzedek.org/resources, (323) 549-5897 BetTzedek Legal Services, The Caregiver Companion (print and download versions): bettzedek.org/resources, (323) 549-5897 Eric Carlson and Katherine Bau Hsiao, The Baby Boomer’s Guide to Nursing Home Care, Chapters 1 and 2, ©2006, Taylor Trade Publishing Online CaliforniaAdvocates for Nursing Home Reform: nursinghomeguide.org, (800) 474-1116 CaliforniaCulture Change Coalition: calculturechange.org…

  • Assisted Living Companion (2013)

    …for one limited program called the Assisted Living Waiver. Medi- Cal will pay for licensed healthcare professionals to provide medical services in an assisted living facility. Generally these services are…

  • Advisory Guide to Regional Center Services (2016)

    …Regional Center adopts a Purchase of Service Policy which can factor into the services available at your designated Regional Center. Healthcare Service Criteria Duration Counseling or Therapy Services: Short term counseling and/or therapy services necessary to improve the consumer’s status or preferred living situation…

  • IHSS Companion Guide – English (2017)

    …see the “In-Home Supportive Services Protective Supervision” publication from Disability Rights California, www.disabilityrightsca.org/pubs/549301.pdf. WHAT ARE PARAMEDICAL SERVICES? Paramedical services are services that a medical professional usually performs. When your medical provider requests your IHSS provider to perform the service, it is called a paramedical service. Some examples of paramedical services include checking blood sugar levels, giving injections, wound care, checking blood pressure and catheter care. IHSS requires your doctor to complete a paramedical services form, called the “Request for Order and Consent—Paramedical Services” before these hours are approved….

  • Limited Conservatorship Guide (2016)

    …(IHSS) pays for in-home care for low-income people who are blind, disabled or over 65. JewishFamily Services Chaverim Program for Adults jfsla.org/chaverim (213) 482-7242 Hamercaz Program for Children and Teens www.hamercaz.org (866) 287-8030 Jewish Family Services (JFS) provides services for adults, children and teens with I/DD. They also provide counseling, shelter, and food. JFS is open to all faiths. 23) Jewish Vocational Service www.jvsla.org (323) 761-8888 Jewish Vocational Services (JVS) provides job training, education and expert career guidance. JVS is open to all faiths. LA Goallagoal.org (310) 838-5274 LA Goal’s services include educational, vocational, and recreational programs. 25) Legal Assistance lawhelp.org LifeServices,  www.lifeservicesinc.org (818) 547-0585 Life Services, Inc. provides fee-for-service fiduciary management services including conservatorships, trust management, representative payee, estate administration, daily money management, etc. 28) Los Angeles Superior Court…

  • The Worker’s Guide: Your Rights During COVID-19 – A know your rights guide for workers affected by COVID-19

    …for unemployment benefits online, by fax, by mail, or by phone. Online: https://www.edd.ca.gov/Unemployment/UI_Online.htm Phone: English 1-800-300-5616 Spanish 1-800-326-8937 By Mail or Fax: You can find the forms online here: https://www.edd.ca.gov/Unemployment/Forms_and_Publications.htm#FillInForms…

  • The Full Benefit Too – English – A User-Friendly Guide to Understanding SSI for Adults with Intellectual and/or Developmental Disabilities

    …you to sign some authorization forms so they can contact your doctors, other service providers or teachers who interact with you or help with your disability. The Disability Determination Service

  • COVID-19 Emergency Guide for Tenants in LA County – Housing guide for tenants in LA County affected by COVID-19

    …□ Regular Mail □ Email □ Personal Delivery I am writing regarding my tenancy at (address)———————————————————–. I am writing to notify you that I am unable to pay the rent…

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