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State Veterans Homes VA A088 Overview

Learn about the updated federal regulations for State Veterans Homes, including per diem payments and implementation plans. Find out about key points, purpose, and communication strategies for education and survey updates.

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State Veterans Homes VA A088 Overview

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  1. State Veterans Homes VA A088 Overview JoAnne Parker Valarie Delanko Office of Geriatrics & Extended Care (10NC4) Winter Conference 2019

  2. Discussion Topics • Background of Federal Regulation – A088 • Implementation Plan • Communication/Education Plan • Recognition Survey Update • Other regulation changes

  3. Background Federal Regulation 38 CFR Parts 17, 51 & 52 – RIN 2900-A088: • Title: Per Diem Paid to States for Care of Eligible Veterans in State Homes • VA published the proposed rule in the Federal Register on June 17, 2015.  • The public comment period closed August 17, 2015.  • VA received comments from 23 commenters, comprising national State Veterans homes organizations and private citizens.  • The final rule making was published in the Federal Register November 28, 2018 • Effective Date – December 28, 2018

  4. Background Federal Regulation The key points to this new rule making are: • This final rulemaking reorganizes, updates, and clarifies State Veterans Homes regulations currently in parts 17, 51, 52. • This final rulemaking supports a major change whereby states can provide both medically-based and socially-based adult day health care programs, encouraging states to increase the number of these programs. • The rulemaking will constitute VA's first comprehensive regulations on State Veterans Homes domiciliary care programs.

  5. Background • PURPOSE: This rulemaking reorganizes, updates, and clarifies VA's State Veterans Homes (SVH) regulations.  These regulations govern VA's payments of per diem to SVHs that provide nursing home, domiciliary, and adult day health care to eligible Veterans. • In order for the National SVH Program Office to implement the new regulations the following will need to be completed by priority:

  6. Implementation Plan - High Priority • Create Blank survey forms for the NH, DOM and ADHC • Update the SVH Survey Software utilized to create a legal survey report and collect aggregate data • Update Quick Reference Guides for NH, DOM and ADHC – used to assign regulations to members of the survey team • Phased-in Training to: • Designated VA SVH VISN & VAMC Representatives • States, State Veterans Homes, NASVH • Contractor Survey Vendor • Complete Interpretative Guidelines for the NH, DOM and ADHC

  7. Implementation Plan - High Priority • Updates to define Corrective Action Plan in 51. • Changes to the SVH Appeals Process in 51. • Changes to the Recognition survey in 51. • Changes to subparts

  8. Implementation Plan - Medium Priority • Revise VHA Directives • 1145.01: Survey Procedures • Revise SVH Orientation Guides • VA SVH VISN Liaisons • VA SVH Medical Facility Representative • VA SVH Fiscal Representatives • Revise Team Leaders Guide • Annual Survey • Recognition Survey

  9. Implementation Plan - Low Priority • Revise VHA Directives • 2011-035: Medications • Revise Software Power Points • Revise FAQs • Review and revise VHA memo’s and Office of General Counsel Opinions.

  10. Communication/Education Plan NASVH • Overview education to General Assembly - today • Monthly Town Hall sessions to begin in March 2019 • Collaborate on establishing a Start Date CONTRACTOR • Full Day Training to all reviewers • Continuous training/meeting with Program Manager/reviewers • As needed training VA SVH REPRESENTATIVES • Conduction education in phases, “need to know” • Train those with upcoming surveys in 1 to 6 months • Utilize Monthly National Calls for training • Utilize training in phases to gauge feedback and make continuous improvements

  11. State Veterans Homes VA A088 Overview Recognition Surveys

  12. Recognition Survey Updates • New in AO88** • No recognition surveys needed to reduce bed numbers within the same level of care • Subpart B - §51.30 (c) – Certification of a State Home: “Decreasing capacity for a program of care. The State must report any decreases in the capacity for a particular program of care to the Office of Geriatrics and Extended Care in …….., no later than 30 calendar days after such decrease, and must provide an explanation for the decrease.”

  13. Recognition Survey Updates • What requires a recognition survey: §51.20(d)(2) – After a State home is recognized, any new annex, new branch, or other expansion in the size or capacity of a home or any relocation of the home to a new facility must be separately recognized; examples: • New Addition to existing SVH • New Location for an existing SVH • Increase in bed numbers for an existing SVH • Change in level or care that increases the recognized bed numbers

  14. Recognition Surveys Update • New in AO88** • VA will not conduct a recognition survey unless the following minimum requirements are met - Subpart B - §51.31 (b) • (1)–For NH and DOM – need 20 residents or 50% of the resident capacity of the SVH • (2) – For ADHC – need 10 participates or 50% of the participant capacity of the SVH

  15. State Veterans Homes VA A088 Overview Other Regulation Changes

  16. Other Regulation Changes • Deleted provisions to any State Home Hospitals, there are none. • Moved to Part 51 other provisions that apply and included the Domiciliary Program. • Revised Part 51 subparts A, B, C to eliminate redundancy governing payment by combining similar regulations from Part 17 and Part 52. • Subpart D remains for nursing home, but subpart E and F added for Domiciliary and Adult Day Health Care. • Subpart A is Purpose, Subpart B is Definitions and Subpart C is payment.

  17. Other Regulation Changes • Subpart A: • Changed “rules” to “requirements” • Domiciliary – Defined what constitutes “necessary medical services” in Subpart E • Treatment plan, care plan, plan of care all equate to “Comprehensive Care Plan.” • Subpart B: • Use of “capacity” versus beds or participants • Subpart C is included on all surveys, contains requirements on eligibility, payment rates and payment procedures.

  18. Other Regulation Changes • Subpart B: • Qualify time in “Calendar days” • 3 exceptions that will qualify in “working days”: • 51.30(d)(1)(iii) corrective action plan • 51.320(a)(4) DOM to report a sentinel event • 51.430(a)(3) ADHC to report a sentinel event • Provisional certification means: • Can continue to receive per diem payment while correcting deficiencies; • None of the deficiencies are an immediate danger; • SVH submits a CAP in 20 working days; • Plan is reasonable and Medical Center Director accepts

  19. Other Regulation Changes • Subpart D is Nursing Home Care: • §§17.190 – 17.194 is removed • §§17.196 – 17.200 is removed • “Chief Consultant of Geriatrics & Extended Care (114)” to “Office of Geriatrics & Extended Care VACO” • American Dietetic Association is now the Academy of Nutrition and Dietetics • No change in eligibility

  20. Other Regulation Changes • Subpart E is Domiciliary Care: • Follows several categories and regulations from Subpart D which is 51, with many exceptions and edits. • 51.300 - Resident rights, practices and quality of life • 51.310 - Admission, assessment, care plan, discharge • 51.320 - Quality of care • 51.330 - Nursing • 51.340 - Physician and other provider services • 51.350 - Specialized services and environment • 51.390 - Administration • Follows 51.210 regarding Administration in providing domiciliary care.

  21. Other Regulation Changes • Subpart E is Domiciliary Care: • Regulations VA will require for Domiciliary are those determined as essential to the health, safety and well-being of residents that will enable the State homes to continue providing services that foster Veterans independence. • VA will apply some provisions of §51.70, 51.80, 51.90 and 51.100 but excluded some. • No change in eligibility • No MDS Assessment • State homes do not provide either surgical or comprehensive mental health services but to provide basic mental health screening and assist residents with obtaining those services.

  22. Other Regulation Changes • Subpart F is Adult Day Health Care: • Removes Part 52, consisting of 52.1 through 52.220. • Follows several categories and regulations from Part 52, with revisions to allow medical and social models. • Follows 52.210 regarding Administration except for Medical Director, Laboratory, Radiology, Other Diagnostic Services and the Quality Assurance Committee if program does not offer medical supervision. • No MDS assessment

  23. Contacts • Valarie Delanko, RDN, LDN, CPHQ National Program Manager SVH Quality & Survey Oversight 814-860-2201 • Jo Anne Parker, MHA National Program Manager SVH Survey Process 202-623-8328

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