Contract Nursing Home Program

1. Contract Nursing Home Program Simone Hogan, LICSW CNH Point of contact Minneapolis VA Health care system

2. VA Health Care System VA medical system consists of integrated networks of care (VISNs) that are focused on pooling and aligning resources to better meet local health care needs and provide greater access to care.

5. Eligibility… In order to be eligible for the Contract Nursing Home Program or any other home and community care services – a veteran should be enrolled in the Minneapolis VA Health Care System You can contact the Patient Access Center at 612-467-2071 to review eligibility and enrollment criteria/process

6. Contract Nursing Home Program Details regarding the program

7. Types of Contracts Mill Bill (aka Millenium Bill or Long-Term) • For Veterans rated 70% service connected or greater through the Veteran's Benefits Administration • For Veterans rated 60% service connected or less if the reason for placement at a contract nursing home is related to the service connection disability • VA Contract Nursing Home team makes the determination if the reason for SC is related to the reason for the CNH placement.

8. Types of Contracts Hospice • For Veterans who are currently enrolled for care at the Minneapolis VA Health Care System, have updated eligibility paperwork, and are enrolled in a hospice service (VA Primary Care Provider not req.) • VA is responsible for room and board at a VA contract facility • Hospice service is billed to either Medicare or VA, depending on patient preference and Medicare enrollment

9. Types of Contracts Respite: • Veterans must be enrolled for care at the Minneapolis VA HCS, have Primary Care established, and have updated eligibility paperwork completed including LTC co-pay test if needed • Eligible for 30 days of respite care in a contract nursing home each calendar year • We prefer that Veterans use this benefit in increments of one-two weeks • Most respites are coordinated by Primary Care SW

10. Types of Contracts Other: • Veterans can be admitted from a private hospital, with Medicare as the appropriate payer source (usually 20 days) and then transfer to a VA contract when pre-authorized • Veteran cannot go from a VA contract to Medicare, unless there is a qualifying stay that interrupts the placement • When the service-connected veteran admits from a VA facility, VA is the required payer from day one

11. Types of Contracts Other: • Other contracts may be available periodically depending on other factors affecting the medical center • These contracts will be announced by VA leadership for temporary periods of time • Example: most recently, short-term 28-day contracts were being offered due to construction in our Community Living Center (CLC)

12. Contract Nursing Home Program VA Relationship: Benefits and Challenges

13. Benefits with VA relationship • Broadens the pool of available funding • Higher daily funding than MA provides • Increased opportunities to serve America’s veterans • Increases the gender mix/more male referrals • May contribute to Culture Transformation • Unique geographic offering • Access to increased VA clinics for support • VA RN and SW visits to veterans on contract

14. Reasons a facility may not want… • Paperwork & accountability • Perceived too few referrals for the effort • NH is not geographically required by the VA • NH too small to offer unique options to the VA • NH occupancy is generally already 100% • NH is not 100% fire sprinkled • Therapy VA pre-authorization

15. Current Numbers: Counties represented in MN 22 Counties represented in WI 9 Total CNH Facilities Currently 58 Total # of Veterans in CNH Program 294

16. Contract Nursing Home Program Clinical oversight – monthly/quarterly and sentinel events

17. The Minneapolis CNH Staff • CNH Point of Contact • CNH Coordinator Team • Clinical Social Workers • Nurse Coordinators • Consulting Pharmacist • Medical Director • Fee Basis Claims Assistant • Contracting Officer • Life Safety Inspectors • Program Support Assistant

18. VA Personnel Visits to CNH • While Veterans are on contract in CNHs, authorized VA Social Workers and Nurses regularly visit veterans to provide follow-up and support. • Monthly or quarterly visits occur – depending on geography • These Social Workers and Nurses should be your main point of contract regarding Veteran issues.

19. VA Personnel Visits Purpose of visits: • to assist in the Veteran’s CNH adjustment and the continuity of care; consult with staff • address business office questions • identify eligibility concerns; assist with VA appointments • assist with care coordination with the Veteran, family, CNH, and the VA VA contract stipulates that VA personnel will have access to the veteran's CNH medical record

20. Sentinel Events A Sentinel Event may include but is not limited to the following: • falls resulting in death or injury • elopement resulting in a missing Veteran • Veteran abuse confirmed or under investigation • medication error resulting in Veteran illness/injury • death or injury secondary to restraint usage, and • all deaths related to unconfirmed or suspicious nature.

21. Sentinel Events • If you are reporting an occurrence regarding this Veteran to the common entry point (CEP) or Department of Health, you’ll need also to report the occurrence to VA

22. Oversight • Currently we have a CNH Coordinator Team that meets weekly to review the CNH program, sentinel events, Veteran/family complaints and process improvement. • CNH Coordinator Team members are SW Simone Hogan, HCC Director Shawna Clausen, CNH Program Support Assistant Gordon Hofman and SW Supervisor Deb Smith Wagner • Simone Hogan (612-467-4527) is our new CNH Point of Contact and can be contacted for any questions or issues

23. Contract Nursing Home Program New Contracts and Renewal of Contracts

24. VA Renewal of Contracts “To be considered for a first-time VA contract, or to annually renew an existing contract, VA takes the approach that a broad review of all available data is essential”

25. VA contract renewal and quality oversight The Minneapolis VA CNH staff annually reviews: • the 2567 • NH Compare • Quality improvement plans • Complaint reports • Ombudsman activity • All medical records of Veterans served at the CNH • Complaints from Veterans

26. VA contract renewal and quality oversight We also review the following information: • NH Compare • quality measures • staffing reports • Minnesota Health Facilities Complaint Office • Department of Health Information • Number of State Deficiencies • Minnesota Nursing Home Report Card • Review of VA medical record and documentation from VA staff oversight visits

27. VA contract renewal and quality oversight Coordination with the following agencies: • Veterans Benefit Administration • Guardians, conservators, fiduciaries • Nursing Home Ombudsman • Hx of complaints, trends • Amenableness to complaint resolution • Evidence of consultation efforts by the NH • Staffing/turnover issues • Integration of resident/family council process • Support of cultural transformation • General view of care provided

28. VA contract renewal and quality oversight Seven VA Standards: • Are there three level “G” or higher deficiencies in the current survey? • In the current survey, are the total number of health requirement deficiencies twice the state average? • In the current survey, is there a level ‘E’ or higher deficiency in any of the following areas: • Restraints (F221 or F222) • Abuse (F223) • Staff treatment of patients (F225 or F226) • Dignity (F241) • Licensure (F491)

29. VA contract renewal and quality oversight Seven VA Standards (cont.): • In the NH Compare review are the RN hours per resident day below the state average? • In the NH Compare review are the total nursing staff hours per resident below the state average? • Are six or more of the MDS quality measures from NH compare above the state average? • In the current survey is there a level “E” or higher deficiency in any of the following areas: • Nursing services (F353) • Nursing aide training (F494, F495, or F496) • Regular in-service training (F497) • Proficiency of nursing aides (F498) • Staff Qualifications (F499)

30. VA contract renewal and quality oversight To consider the contract, we apply the 7 VA standards and review all other relevant performance information in the determination process • If a newly proposed contract, proceed or decline • Renewal of existing contract (most common) • Renewal with added clinical oversight • Renewal with additional stipulations • Suspension of placements • Suspension/termination of contract

31. New Contracts? Needs Assessment is Completed: • Current availability of VA funding, • Implications for growth/decline in the current contract facilities, • Density/proximity of existing contract facilities, • Tendency for openings within the existing pool of contracted facilities, • Unique facilities that serve specialized needs, • The desire to providing ample business to existing contract facilities to warrant their continued affiliation.

32. In summary, through the contract program, VA believes that enhancing the NH care for veterans within the CNH further enhances the care for all residents.

33. Contract Nursing Home Program Contacts: Gordon Hofman – CNH PSA@ 612-467-5202 Simone Hogan, LICSW – CNH Point of Contact @ 612-467-4527 or simone.hogan@va.gov Shawna Clausen, MS, RN – HCC Director @ 612-467-1658 Deb Smith-Wagner, LICSW – EC&R SW supervisor @ 612-467-1561

34. Questions?