1. Programmatic Readiness Reviews and Resources Dianne Kayala National Resource Center for Participant-Directed Services February 15, 2011

2. Purpose To help programs walk through necessary components of the veteran-directed program To provide the Veterans Health Administration a reasonable assurance that the agency with whom they are entering into a provider agreement is prepared to operate the program and has the needed components in place 2

3. 3

4. Basis for Readiness Review VHA Procedures for VD- HCBS NRCPDS Operational Experience Concurrence of VHA central office staff in what is needed 4

5. Three Parts Program Documents Answers to questions Completion of Flow Chart with VAMC contact 5

6. Three Parts Program Documents Answers to Questions Completion of Flowchart with VAMC 6

7. Program Documents Functional Assessment Tool Spending/Service Plan Template Program Policy Manual ** Veterans Manual ** The Program Policies are sometimes a part of the Veterans Manual 7

8. Questions Understanding Veteran Direction Principles Intake and Assessment Budget and Service Planning Veteran Hiring and Employer Skills Risk Mitigation and Dignity of Risk 8

9. Questions, continued Monitoring Services and Supports FMS Model and Contract Oversight Quality Monitoring Plan Administrative Capacity Flow of processes and communication 9

10. Understanding Principles of Veteran Direction Agency/Staff Experience Agency/Staff Training How will new staff be trained in model? How will Veterans be involved in informing the process? 10

11. Understanding Principles of Veteran Direction - Resources Experience: has anyone involved done this before?  Are there others in your state with materials? Training: on-line webinars  www.participantdirection.org, click on the Training links www.participantdirection.org Veteran Participation: possibly advisory board, QA Committee, surveys, etc. 11

12. Intake and Assessment Have you thought through a process and what are the expected timelines from referral to completed Service Plan? Is it reflective of information needed to establish a realistic budget amount? Veteran Rights and Responsibilities Does it supplement or duplicate VAMC-provided information? 12

13. Budget and Service Planning How is budget amount determined – what is method within range? How is Veteran goal-setting facilitated? How does aging network agency maintain knowledge of the broadest range of goods and services available? What tool is used for service planning? How is back-up plan assured to be ready if needed? How is the service plan approved and implemented? 13

14. VA Goods and Services Policy 1. Meet the identified needs and outcomes in the Veteran’s plan and to assure the health and safety of the Veteran; AND 2. Collectively provide a feasible alternative to an institution; AND 3. Be the least costly alternative that reasonably meets the enrollee’s identified needs; AND 4. Be for the benefit of the veteran; AND 5. Be needed as the result of the Veteran's disability. 14 The Purchase of goods and services should meet all of the following criteria:

15. Goods and Services, continued Maintain the ability of the Veteran to remain in the community; Enhance community inclusion and family involvement; Develop or maintain personal, social, physical, or work related skills; Decrease dependency on formal support services; Increase independence of the Veteran; Increase the ability of unpaid family members and friends to receive training and education needed to provide support. 15 Goods and services are appropriate purchases when they meet the criteria on the previous slide and are reasonably necessary to meet the following Veteran outcomes:

16. Veteran Hiring and Employer Skills How is the veteran assisted in learning to be an employer?  Job descriptions, interviewing, performance reviews, rate of pay  Time sheets, responsibility, role clarification  Recruitment Techniques, suggestions Are there any hiring restrictions (i.e training, criminal background checks) 16

17. Risk Mitigation How is risk identified and negotiated with Veteran? What is policy for Representatives? How is Veteran well-being monitored? What are your involuntary discharge policies? 17

18. Monitoring Services and Supports How does the counselor review Veteran spending?  How often is this done?  What is approach if significant under- or over-utilization occurs or is attempted? How are Service Plan changes triggered?  What are the timeline expectations to change a Plan? 18

19. Financial Management Services Model Will you be using a Fiscal/Employer Agent, or Agency with Choice Model? Are you directly providing this or sub-contracting for it to be done? How are you assuring that the legal and programmatic requirements of the Financial Management Services are being met? A full FMS review is completed separately 19

20. Quality Monitoring Plan How do you get feedback on how well the program works:  Survey  Performance Indicators to track  Incidents or complaints How do you systematically review your findings? What process do you use to remediate problems? 20

21. Administrative Capacity How will you front the payroll and goods and services costs until reimbursed? How do you manage information flow – Referrals, Service Plans, Billing, Payments? HIPAA Compliance in personal data transmission and/or storage Contract management and oversight? Staff sufficiency as program grows 21

22. 22

23. Program Flowchart Can be used as an organizing tool while developing the program. Many components may already be done in your state – check with sister agencies and State partners Think through how you’d like to do this before you meet with the VAMC about it! 23

24. Referral VAMC refers veteran to AAA. Includes (veteran information?) Referral VAMC refers veteran to AAA. Includes (veteran information?) Intake AAA contacts veteran & schedules home visit. Compiles materials (which Forms, manuals?) Intake AAA contacts veteran & schedules home visit. Compiles materials (which Forms, manuals?) Assessment AAA assesses veteran & discusses VD-HCBS roles & responsibilities. Reviews materials (Which forms, manuals?) Assessment AAA assesses veteran & discusses VD-HCBS roles & responsibilities. Reviews materials (Which forms, manuals?) Develop Plan AAA works with veteran to develop a spending plan. Helps identify goals & then potential workers and other goods & services. Sends to VAMC. Develop Plan AAA works with veteran to develop a spending plan. Helps identify goals & then potential workers and other goods & services. Sends to VAMC. Authorization of Budget Amount VAMC authorizes the budget amount or tier & sends to AAA Authorization of Budget Amount VAMC authorizes the budget amount or tier & sends to AAA Authorization of Plan VAMC reviews plan to assure no duplications exist & that items relate to a need because of disability. Sends approval to AAA. AAA bills 1 time full admin fee* Authorization of Plan VAMC reviews plan to assure no duplications exist & that items relate to a need because of disability. Sends approval to AAA. AAA bills 1 time full admin fee* Establish Employment (FMS) establishes Veteran as an employer, and processes worker information. Establish Employment (FMS) establishes Veteran as an employer, and processes worker information. Employee Paperwork collects required employee information and conducts background checks. Employee Paperwork collects required employee information and conducts background checks. Hiring Assistance AAA assists the veteran in the hiring process: job descriptions, recruitment, interview & reference checks. Hiring Assistance AAA assists the veteran in the hiring process: job descriptions, recruitment, interview & reference checks. Employer Paperwork assists veteran to complete the paperwork to be an employer Employer Paperwork assists veteran to complete the paperwork to be an employer Plan Distribution AAA transmits the authorized plan to the veteran and to XXXXXX (FMS). Plan Distribution AAA transmits the authorized plan to the veteran and to XXXXXX (FMS). Poor Candidate Veteran doesn’t want program or needs representative & none available. Referred back to VAMC. Bill 1 time half admin fee* Poor Candidate Veteran doesn’t want program or needs representative & none available. Referred back to VAMC. Bill 1 time half admin fee* Good Candidate AAA documents need and preliminary budget/budget tier & sends to VAMC. Good Candidate AAA documents need and preliminary budget/budget tier & sends to VAMC.

25. Savings/Rainy Day Fund XXXX assists veteran to complete the paperwork to be an employer Savings/Rainy Day Fund XXXX assists veteran to complete the paperwork to be an employer Payments XXXX (FMS) pays workers & invoices as in Spending Plan Payments XXXX (FMS) pays workers & invoices as in Spending Plan Timesheets and Invoices Veteran submits timesheets and invoices to XXXX (FMS) Timesheets and Invoices Veteran submits timesheets and invoices to XXXX (FMS) Initiate Services Veteran trains workers and begins services as authorized in the Spending Plan Initiate Services Veteran trains workers and begins services as authorized in the Spending Plan Reports XXXX (FMS) sends detailed spending and Savings/Rainy Day Fund reports to veteran & AAA Reports XXXX (FMS) sends detailed spending and Savings/Rainy Day Fund reports to veteran & AAA Monitoring AAA monitors veteran health, safety and outcomes, at least monthly phone contact and quarterly visits Monitoring AAA monitors veteran health, safety and outcomes, at least monthly phone contact and quarterly visits Reimburse AAA submits invoice to the VAMC. VAMS remits payment Reimburse AAA submits invoice to the VAMC. VAMS remits payment Reassessment Veteran reassessments and spending plans are done annually or sooner when changes occur Reassessment Veteran reassessments and spending plans are done annually or sooner when changes occur

26. Process for Program Readiness Review Review the tool and answer or compile needed materials Check resources if you get stuck, or ask your contact for help Once you think it is complete, we will schedule a call to review the answers with you, and identify any outstanding issues Once everything is final, we will schedule a call with you and the VAMC to finalize the flow chart 26

27. General Resources Tools available in Resource Guide at http://www.bc.edu/schools/gssw/nrcpds/meta- elements/pdf/Consumer_Directed_Pr1.pdf Also, browse Archived Trainings and the accompanying Resource Guides at participantdirection.org Resource List Handout 27