2013 NASVH & NASDVA Summer Conference

1. 2013 NASVH & NASDVA Summer Conference VHA State Home Per Diem Program Cyndi Kindred, SES Deputy Chief Business Officer For Purchased Care

2. State Home Per DiemProgram Accomplishments

3. Grant Program Update – 2013 Grant Awards • VA will award 62 state home construction projects • 34 conditional grant awards ($78M) • 28 final grant awards ($124M) • There are 50+ homes approved for 2013 funding and the ARRA projects are all closed • Conditional grant awards signed August 30th • Complete grant application by February 2014

4. Grant Program Update Initial Applications 2014 • VA received 56 initial state applications for FY2014 • 15 safety projects • 2 bed replacement projects • 2 adult day health care • 7 new construction projects • Reminder: State grant applications may be submitted year round in grants.gov.

5. How you can help us !

6. VA’s Landing Page www.va.gov/aca

7. New State Home Survey Contract • Contract awarded by Geriatrics and Extended Care Operations office (GEC-Ops) July 31, 2013 to current vendor, Ascellon Corporation • Survey Team- Contractor, VAMC Representative, and VAMC fiscal surveyor • Conduct all SVH annual, recognition, for cause, and abbreviated surveys during the base year - August 1, 2013 – July 31, 2014 • If exercised, four option years - August 1, 2014 – July 31, 2018 • The Ascellon Corporation will conduct the clinical & life safety components of the surveys in State Home, skilled nursing, domiciliary, & adult day health care facilities

8. New State Home Survey Contract (continued) • The VA Medical Center Representative and the fiscal surveyor will survey the administrative and fiscal components • GEC-Ops has oversight of the State Home survey process • The standards used to survey State Homes will not change; they will continue using VA State Home Per Diem federal regulation standards

9. Types of Surveys • Annual– Done during the anniversary month of the State Home’s recognition or agreed upon month by VA and the State Home • Recognition – A recognition Survey is the VA survey of a State Home used to determine its compliance with VA standards for the purpose of recognizing the home as a State Home by VA  • Must be on site 10 business days after official notification and are announced surveys

10. Types of Surveys (continued) • For Cause -- Survey authorized by GEC- Ops to investigate specific, or a series of, incidents, complaints, deficiencies, or events that may jeopardize the health or safety of residents • covers specific standards related to the event or series of events. • The scope of standards reviewed for a for cause survey can be expanded, if deemed necessary by the survey team.  • Must be on site 15 business days after official notification and are unannounced surveys • Abbreviated – NEW - An Abbreviated Survey is a survey authorized by GEC Ops to investigate a specific standard or deficiency found during a survey • Will cover only the specific deficiency found during a survey • Includes follow up visits to investigate deficiencies found during a previous survey.  • Must be on site 15 business days after official notification and are unannounced surveys

11. Homeless Programs in SVHs • VHA workgroup established to address the issue • Representatives from GEC Operations, Office of General Counsel, Chief Business Office, Homeless Programs, and Construction and Grants • Evaluating program requirements to determine how State Homes can establish homeless programs • State Home requirements • Addressing whether the VA recognized beds are needed for the original intent • Validating resources are in place to meet the homeless program requirements • Program requirements and process for converting State Home Domiciliary beds are yet to be developed

12. Newly Recognized State Homes (2013) • Representing 585 additional beds: • 470 Nursing Home Beds • 80 Domiciliary Beds • 35 Adult Day Health Care Slots

14. State Home Internet Site • Data Repository of Regulation, Policy and Reports • Per Diem Rates • Construction Grant Guidance • Bed Changes • Survey Appeals • Occupancy Reports, authorized beds • Handbooks & Directives • Training • Link: http://www.nonvacare.va.gov/state-homes.asp

16. General Overview – State Veterans Homes Total State Home Facilities -   146 • Skilled Nursing Programs - 137  (24,853 beds) • Domiciliary Programs - 53  (5,865 beds) • Adult Day Health Care Programs - 2   (85 slots) • Total Programs – 192

17. Statistical Updates FY 2012 and YTD 2013

18. FY 2013 Year to Date Budget • FY 2013 Budget - $975,274,023 • Projected Expenditures – $942,570,145 • Average monthly expenditure - $77,040,261 • FY 2014 Budget - $1,070,848,000

19. FY 2014 Per Diem Rates • Rates have been established • The rates require VHA approval • Target date for release is September 2013

20. 10-10SH ApplicationsAccurately and Timely Program Audits: Improper Payment Elimination Recovery Improvement Act - IPERIA • The VHA Office of Finance conducts annual audits for a variety of programs including the State Home Per Diem program • The findings revealed administrative errors which will require VAMC’s to request applications that were submitted previously • Your cooperation to assure that we have a 10-10SH for every Veteran is greatly appreciated

21. Timely Per Diem Payments • We want to ensure your payments are timely • Implementation of the electronic invoicing requirements have improved timeliness of monthly invoices • Timely retroactive payments continue to be a concern for some State Homes • Please reach out to the State Home Per Diem office if you are unable to resolve payment delays with your local VAMC • Point of Contact - Kelly Schneider Kelly.Schneider2@va.gov or (520) 395-0310