1. Veterans Directed Home and Community-Based Services Flow Chart February 2009

2. © The Lewin Group 2 Veteran Directed Home and Community-Based Services

3. © The Lewin Group 3 Flexibility for AAA/ADRCs As long as a AAA/ADRC is working within the broader vision for this program, VDHCBS allows for flexibility:  Assessing service needs  Developing service plans and budgets  Developing non-traditional services  Structuring case management/service coordination  Developing support mechanisms for Vets  Arranging fiscal management services  Establishing pay rates for providers Flexibility and Consistency for AAAs/ADRCs VDHCBS gives several opportunities for flexibility in operations and service delivery from site to site.  

4. © The Lewin Group 4 Veteran Directed Home and Community-Based Services

5. © The Lewin Group 5 Veteran Directed Home and Community-Based Services

6. © The Lewin Group 6  The presentation of the VDHCBS option may have a big impact on take- up rates for the program  The fairest presentations balance the new opportunities and the new responsibilities associated with participant direction  Bad = “We have a new option where you can hire your own workers but you need to pay all the taxes and deal with the IRS. Are you interested?”  Several states have developed great marketing materials and talking points. (At cashandcounseling.org, select “resources and publications” and search by selecting the topic “communications and social marketing”)  We recommend establishing a feedback loop between AAA/ADRC and the VAMC to discuss whether Veterans referred to VDHCBS are getting good information before they express interest in the program Offering VDHCBS to Veterans

7. © The Lewin Group 7 Veteran Directed Home and Community-Based Services

8. © The Lewin Group 8  After a referral from the VAMC, the AAA/ADRC will schedule a meeting with the Veteran  The meeting gives an opportunity to:  More fully assess the Veteran’s goals, preferences, and service needs  Discuss the supports that are available to the Veteran  Discuss the rights and responsibilities of the Veteran under VCHCBS  Develop a plan for hiring workers and purchasing services  Include family and friends in the planning process  The assessment process is a “business function” where there is often opportunity for improvements and efficiency. AAAs can streamline access by:  Leveraging existing data sources (e.g., info sent from the VAMC)  Using standardized instruments  Capturing the data you need for evaluating the program  Capturing and storing data electronically Assessments

9. © The Lewin Group 9  Payment from VAMCs to AAAs will be based on three payment tiers  Basic  Intermediate  Extensive  Monthly payments will be bundled amounts intended to cover the costs of direct services, fiscal management, taxes, case management / support brokerage, and administrative overhead  Basic and Intermediate will be fixed amounts  The Extensive Tier will be reserved for special cases (e.g., Veterans with TBI or recent combat-related injuries)  Payment will be determined on a case-by-case basis  Payment from VAMC to AAA does not necessarily dictate the percentages spent on individual budgets, FMS, etc Payment Tiers

10. © The Lewin Group 10  Under VDHCBS, Veterans will have control over spending from their individual budget  In similar programs, participants have generally been very disciplined about staying within their budgets  Veterans can carry over funding from month to month. This allows a Veteran to save up for a planned purchase ( e.g, assistive technology ) or maintain a cushion for months when more services are needed.  AAA/ADRCs will monitor spending against individual budgets ( may contract with vendor for this function )  Over- or under-spending may be a signal that the Veteran needs additional support/counseling, or that a change in condition warrants a new plan of care or tier assignment Individual Budgets/Spending Plans

11. © The Lewin Group 11 Veteran Directed Home and Community-Based Services

12. © The Lewin Group 12 Data collection, analysis, and reporting are generally left to the VAMC and AAA/ADRC. We strongly recommend capturing information on: Reporting and Data Analysis  Satisfaction  Quality of life  Functional status  Service utilization  Service expenditures vs. individual budgets  Caregiver and social supports Lewin has developed a matrix of data elements and resources available through adrc-tae.org 

13. © The Lewin Group 13  There are multiple junctures of communication between VAMC and AAA/ADRC  Maintaining good communication, especially during program start-up, is essential to making this program work  Basic communication considerations  Regularly scheduled check-in meetings between organizations  Written policies and procedures on information sharing and reporting  Clearly identifying points of contact between organizations  Specific elements  Feedback loop on referrals (are they appropriate? Were Veterans appropriate counseled before choosing VDHCBS?)  Service delivery and related resources (are Veterans appropriately using VA services outside the VDHCBS program?)  Are VAMC and AAA/ADRC appropriately sharing information on critical events (e.g., hospitalizations, NF placements, major changes in living arrangements) Communication between VAMC and AAA/ADRC

14. © The Lewin Group 14 The Lewin Group 3130 Fairview Park Drive Suite 800 Falls Church, VA 22042 Main: (703) 269-5500 www.lewin.com The Lewin Group | Health care and human services policy research and consulting | www.lewin.com 3130 Fairview Park Drive, Suite 800 Falls Church, VA 22042 From North America, call toll free: 1-877-227-5042 inquiry@lewin.com The Lewin Group is an Ingenix Company. Ingenix, a wholly-owned subsidiary of UnitedHealth Group, was founded in 1996 to develop, acquire and integrate the world's best-in-class health care information technology capabilities. For more information, visit www.ingenix.com. The Lewin Group operates with editorial independence and provides its clients with the very best expert and impartial health care and human services policy research and consulting services. The Lewin Group and logo, Ingenix and the Ingenix logo are registered trademarks of Ingenix. All other brand or product names are trademarks or registered marks of their respective owners. Because we are continuously improving our products and services, Ingenix reserves the right to change specifications without prior notice. Ingenix is an equal opportunity employer. Original © 2008 Ingenix. All Rights Reserved