Cyndi Kindred, Acting Deputy, Chief Business Office for Purchased Care

1. National Association of State Veterans Home State Home Per Diem Program Update Cyndi Kindred, Acting Deputy, Chief Business Office for Purchased Care February 2013

2. Agenda • State Home Per Diem Program Overview • Public Law 112-154, Section 105 • Implementation Plan • VA Consults with State Homes • January 2013 Milestones • February 2013 Milestones • FY 2012 State Home Expenditures • FY 2013 Distribution of Facilities • FY 2013 Budget Projections • Accomplishments • State Home Per Diem Program Future State • State Home Per Diem Program Contacts • Questions for State Homes

3. State Home Per Diem Program The State Home Per Diem Program is a health care benefit administration and payment processing program which is managed by the VHA Chief Business Office for Purchased Care (CBOPC) Responsibilities for managing the State Home Program are shared by the following Veterans Health Administration (VHA) Offices: • Chief Business Office for Purchased Care • Office of Geriatrics and Extended Care • Office of Capital Asset Management and Support

4. State Home Per Diem Program Cont’d CBOPC is responsible for managing the State Home Per Diem Program, which includes: • Regulatory and national policy development related to eligibility and per diem payment methodologies • Oversight of State Home Per Diem eligibility, application authorizations, and the per diem payment program • Operational oversight and training for VHA and Non-VA Stakeholders

5. State Home Per Diem Program Cont’d • Promoting collaborative relationships with VA and Non-VA Stakeholders by maintaining communication and networking with program leaders through interactive forums, such as meetings, mail groups, and national conference calls • Managing the state home budgeting process, the provision of fiscal year per diem funds to the VA Medical Centers of Jurisdiction based on projected needs, and the provision of supplemental per diem funds (when required) • Compiling products/reports that depict State Home workloads and expenditure trends

6. Public Law 112-154, Section 105 August 6, 2012: President Obama signed the law that requires VA to enter into contracts or provider agreements to reimburse State Veterans Homes for nursing home care provided to Veterans that have been rated by VA as one of the following: • The Veteran has a service-connected disability of 70 percent or greater and needs nursing home care; or • The Veteran has a rating of total disability based on individual unemployability and is in need of nursing home care; or • The Veteran is in need of nursing home care for a VA adjudicated service-connected disability.

7. Public Law 112-154, Section 105 Cont’d • To reimburse State Homes for the care provided under the contract (or provider agreement), payment under each contract (or provider agreement) will be based on methodology developed by the VA Secretary in consultation with State Veterans Homes. • Effective February 2, 2013: All nursing home care provided in State Veterans Homes for specific service-connected Veterans in need of nursing home care must be paid for under a contract or provider agreement.

8. Implementation Plan • The State Home Per Diem Program Office executed the following actions to meet the February 2, 2013 implementation due date: • August 28, 2012: Established a VHA Implementation Working Group and included subject matter experts from: • VA Office of General Counsel • VHA Office of Regulatory Affairs • VHA Office of Procurement and Logistics • VA Office of Intergovernmental Affairs • VHA Office of Geriatrics and Extended Care

9. VA Consults with State Homes • September-December 2012: Launched the first series of consultative meetings with State Veterans Home Stakeholders and the VA Implementation Team. • State Home Stakeholders included: • State Veteran Home administrators • National Association of State Veterans Home (NASVH) • National Association of State Directors of Veterans Affairs (NASDVA)

10. January 2013 Milestones • January 7, 8, & 11 2013: Provided five Public Law Implementation training sessions for VAMCs of Jurisdiction Per Diem Points of Contacts, Contracting Officer Representatives (CORs), Provider Agreement Coordinators (PACs), and separate sessions for State Home Stakeholders. • Over 1,100 attendees participated • 92% overall satisfaction rating for the 6 training sessions • January 14, 2013: Distributed the State Home Provider Agreement to VISN Directors and Business Implementation Managers (BIMs).

11. February 2013 Milestones • February 1, 2013: Confirmed that 133 of 134 State Veterans Homes had certified provider agreements. • One State Veterans Home declined to participate • February 4, 2013: Written public comment period closed.

12. State Home Per Diem Program FY 2012 Expenditures The Grant Per Diem Program provides ear marked funds to 97 VAMCs of Jurisdiction to pay per diem for State Home Veterans • 143 State Veterans Home Facilities • Three programs: • 134 Nursing home care programs (24,526 beds) • 53 Domiciliary care programs (5,801 beds) • 2 Adult day health care programs (85 slots) • Costs: • FY 2011:$823,693,587 • FY 2012: $851,046,624

13. Bed Distribution FY 2013

14. State Home Per DiemFY 2013 Budget Projections SH Domiciliary (DOM):                     $57,534,147 SH Nursing (BASIC) NHC:               $653,303,911 SH Nursing Higher (P1) NHC:         $269,358,375 SH Adult Day Health Care (ADHC):    $1,009,311 TOTAL :                                             $1,005,735,888

15. Accomplishments • Educational Fact Sheets • Contract Solicitation • VAMC Training 2013 • Monthly education conference calls (2011) • Bi-monthly in FY 2013 • Customer Service Support (Ongoing) • Field Assistance Visits/VAMC training calls • Public Law 112-154, Section 105 • Contracts and Agreements • Designation as State Home Program Liaison • 2013 Per Diem Rates

16. Future State: FY 2013 - 2014 • Revise State Home Per Diem Handbook • VAMC training, State Home Procedure Guides, Desk Procedures, and Quick Reference Guide • Revised Regulation • 12 calendar day admission rule • Revised VA State Home Memorandum of Understanding • Automated 10-10SH and 10-5588 forms • Revised 10-10SH, 10-5588, & 10-5588A (Retro Payments) • Electronic Invoicing • New deadline of April 1, 2013

17. Kelly J. Schneider State Home Per Diem Program Manager Kelly.Schneider2@va.gov (308)389-5106 or (402)613-2379 Brenda Wiggins Program Analyst Brenda.Wiggins3@va.gov (202) 461-6757 Jeanne Crook Program Specialist Jeanne.Crook@va.gov (303) 398-5224 State Home Per Diem Program Contacts Gloria J. Sanford Deputy Program Manager Gloria.Sanford@va.gov (303) 331-7856 Gloria Testa Budget Analyst Gloria.Testa@va.gov (303) 398-5573 Gus Harris Program Specialist Gus.Harris@va.gov (303) 398-4761 Stephanie Haddock Administrative Support Stephanie.Haddock@va.gov (303) 331-7504 Michelle Slusser Project Manager Michelle.Slusser@va.gov (303) 780-4826

18. Questions for State Homes • Do you anticipate the number of highly service-connected Veteran admissions to increase significantly over the next several years? • What factors are driving the increased admissions? • Do you anticipate State Homes to open adult day health care programs in the next several years? • What State Homes are interested?

19. Thank You!