Community-Based Adult Services
Provider Type
- Physicians
- Participating Physician Groups (PPG)
- Hospitals
- Ancillary
The Community-Based Adult Services (CBAS) program is a community-based day care program designed to provide a variety of health, therapeutic and social services to eligible Medi-Cal members ages 18 and older. CBAS services are delivered based on need and an established care plan, offering a bundle of services during a service day. The number of days per week that members receive services is based on medical criteria and is incorporated into a Health Net-approved care plan. Services include, but are not limited to:
- skilled nursing care
- social services
- personal care
- physical, occupational and speech therapy
- family and caregiver training and support
- meals
- mental health services
- transportation to and from the CBAS center
Members who may benefit from CBAS are those with multiple complex chronic medical, cognitive or psychological conditions and functional limitations who require regular health monitoring, skilled nursing and therapeutic intervention, and social supports to maintain function in the community and prevent avoidable emergency department or hospital admissions, or short-or long-term nursing facility admission.
CBAS is a Medi-Cal managed care benefit, and covered services are Health Net's financial responsibility. CBAS program eligibility does not affect dual-eligible (Medicare and Medi-Cal) members' Medicare coverage, Social Security benefits or the Medicare physicians they visit outside a CBAS center.
The Health Net Health Services staff and subcontractors are available to coordinate care with the member's primary care physician (PCP), the community-based adult services (CBAS) center and the multidisciplinary team. PCPs continue to provide medically necessary care and must be available to consult with the CBAS center's staff as needed.
Medi-Cal members who have a physical, mental or social impairment occurring after age 18, and who may benefit from community-based adult services (CBAS), may be eligible. Eligible members must meet one of the following criteria:
- Needs are significant enough to meet nursing facility level of care A (NF-A) or above
- A moderate to severe cognitive disability, including moderate to severe Alzheimer's or other dementia
- A developmental disability
- A mild to moderate cognitive disability, including Alzheimer's or dementia and needed assistance or supervision with two of the following:
- bathing
- dressing
- self-feeding
- toileting
- ambulation
- transferring
- medication management
- hygiene
- A chronic mental illness or brain injury and needed assistance or supervision with two of the following:
- bathing
- dressing
- self-feeding
- toileting
- ambulation
- transferring
- medication management, or need assistance or supervision with one needed from the above list and one of the following:
- hygiene
- money management
- accessing resources
- meal preparation
- transportation
- A reasonable expectation that preventive services will maintain or improve the present level of function (for example, in cases of brain injury due to trauma or infection)
- A high potential for further deterioration and probable institutionalization if CBAS is not available (for example, in cases of brain tumors or HIV-related dementia)
If a participating provider disagrees with the community-based adult services (CBAS) center staff's recommendation concerning provision of services, Health Net's public programs administrators can assist with dispute resolution. Refer to the Provider Appeals and Dispute Resolution Overview topic for more information about the provider appeals and dispute resolution process.
Participating providers, case managers, registered nurses, and licensed social workers who believe a member may benefit from the Community-Based Adult Services (CBAS) program must request a face-to-face assessment by submitting the request on the Health Net provider portal. To submit a request for an assessment, go to the enrollee’s profile and select Assessments. Click Fill Out Now! next to CBAS Treatment Request to initiate a face-to-face assessment and arrange for transportation to and from the center for assessment.
Health Net completes an initial face-to-face assessment using the CBAS Eligibility Determination Tool (CEDT) to determine eligibility for CBAS. Once eligibility is validated, Health Net notifies the CBAS center to complete the evaluation of service needs and develop an Individual Plan of Care (IPC). The CBAS center submits the evaluation and IPC, signed by all appropriate team members, to Health Net for authorization or notification of services and number of days per week. Refer to the Eligibility section above for more information about CBAS eligibility.
Prior authorization or notification is required for CBAS. Refer to Prior Authorization Requirements for additional information. For more information on how to submit a prior authorization request or notification, refer to Prior Authorization Requirements.