1. State Home Per Diem (SHPD) Program Automation of 10-10SH Form (STATE HOME PROGRAM APPLICATION FOR VETERAN CARE MEDICAL CERTIFICATION) VISN 12 Pilot Presented By: Brenda Wiggins National Association State Veteran Home (NASVH) Winter Conference Alexandria, VA February 29-March 4, 2016

2. VETERANS HEALTH ADMINISTRATION Automation of 10-10SH Form: VISN 12 Pilot (Purpose and Why Automate 10-10SH Form) Purpose: Assist SHPD Program with design, launch, support and evaluation of automated 10-10 SH Pilot with support of CBOPC and CBO Systems Management (SM) What have our pilots shown? Moving from manual data and manual verification of processing 10-10SH The pilot reduced paperwork, redundancy, burden hours and improper payments  The pilot was not perfect: it pointed out the need to tailor processes 2

3. VETERANS HEALTH ADMINISTRATION Automation of 10-10SH Form (Pilot Goals Accomplishments) Converted current 10-10SH PDF form into a web-based, fillable form – accomplished! All required fields/information have information in them before submitting– accomplished! Require an electronic signature or equivalent prior to submission – accomplished! Standardize determinations – accomplished! Allow the VA representative to return incomplete applications to the SVH along with a notification to them and record the receipt of a “completed” application – accomplished! Include reconfiguration of recently 10-10SH form approved by OMB ; end users can now use and printout updated 10-10SH form (June 2015) instead of May 2009 – accomplished! 3

4. VETERANS HEALTH ADMINISTRATION Automation of 10-10SH Form (Key Features of Automation of 10-10SH Form Acts as a guide Includes data field validation Requires an electronic signature or equivalent prior to submission. Date/time stamps upon receipt at VA facility Landing page provides link to 10-10EZ VA portion of application also includes business rules to assist VA representatives in making uniform determinations 4

5. VETERANS HEALTH ADMINISTRATION Automation of 10-10SH Form: VISN 12 Pilot (Where Are We Today) Timelines/major Milestones: 8/2014: Launched Phase I - VISN 12 Pilot (Marquette SVH and Iron Mountain VAMC) 3/2015: Launched Phase II: Held kickoff meeting with VISN 10 Sandusky SVH and Cleveland VAMC), with continuation of VISN 12 (Marquette SVH and Iron Mountain VAMC 6/2015: OMB approved new form (10-5588A), updated 10-5588 and 10-10SH forms with expiration date of 1/31/2016  June 2015 (10-10SH) updated/replaced the old form (May 2009). May 2009 form is no longer being used. 7/2015: Proposed pilot with an SVH facility (Rocky Hill) to test the feasibility of using an electronic drop box, called a Secure File Transfer Protocol to exchange completed 10-10SH forms with the VAMC 2/2016: Exploring the possibility of using a document rights management (DRM) service to enable SVHs to exchange completed 10-10SH forms without the need for encrypted email 5

6. VETERANS HEALTH ADMINISTRATION Automation of 10-10SH Form: VISN 12 Pilot (Future Goal and Planning) In the future, we would like to combine some of the following activities: Determine if the Veteran has a 10-10EZ on file o If there is a 10-10EZ on file – provide eligibility information to the SVH prior to beginning the 10-10SH o If the Veteran does not have a 10-10EZ on file, allow the SVH to submit one and return the Veteran’s eligibility to the SVH Use 10-10SH’s data fields to submit Veteran’s data to a system where it can be recalled and reused by both SVH and VA Provide SVH electronic date/time stamp notification upon receiving Veteran’s new application Provide SVH electronic letter of approval/denial upon completion of Veteran’s eligibility determination decision 6

7. VETERANS HEALTH ADMINISTRATION Automation of 10-10SH Form: VISN 12 Pilot (Lesson Learned) – Centralized email site did not work. – We helped the VAMC and SVH with their internal workflow process and helped SVH to obtain/reapply and meet VA PKI encryption/firewall requirements. (We are still trying to streamline process). – We fixed issues with the electronic signature block and uploading attachments with submission of electronic form. – We are currently reviewing/validating form capability to send SVH receipt confirmation and exploring an alternative solution to VA encryption requirements in order to allow us to send/receive encrypted data to the SVHs. 7

8. VETERANS HEALTH ADMINISTRATION Automation of 10-10SH Form: VISN 12 Pilot (What’s Next) Complete Phase II of pilot using updated 10-10SH electronic form Finalize security/firewall solution prior to nationwide implementation Develop Metrics and Analysis for the Pilot Continue Quarterly Briefings with NASVH Leadership Once the process/procedure have matured for the VISN 12 pilot, measurement intervals we have mapped will be used to gather needed metrics. In collaboration with CBOPC and CBO Systems Management (SM), the SHPD community looks forward to the future to implementing the automation of the 10-10SH nationwide. 8

9. VETERANS HEALTH ADMINISTRATION VA Form 10-10SH This link opens the VA Form 10-10SH 9

10. State Home Per Diem (SHPD) Program Contact Colette Alvarez State Home Per Diem Program Manager Colette.Alvarez@va.gov (775) 842-2529 or (775) 326-5721 Colette Alvarez State Home Per Diem Program Manager Colette.Alvarez@va.gov (775) 842-2529 or (775) 326-5721 Brenda Wiggins Program Analyst Brenda.Wiggins3@va.gov (202) 382-2529 Brenda Wiggins Program Analyst Brenda.Wiggins3@va.gov (202) 382-2529 Gloria J. Sanford Deputy Program Manager Gloria.Sanford@va.gov (303) 331-7856 Gloria J. Sanford Deputy Program Manager Gloria.Sanford@va.gov (303) 331-7856 Andre’ Bynum Technical Operations Supervisor Andre.Bynum@va.gov (303) 372-4659 Andre’ Bynum Technical Operations Supervisor Andre.Bynum@va.gov (303) 372-4659 Jeanne Crook Program Specialist Jeanne.Crook@va.gov (303) 398-5224 Jeanne Crook Program Specialist Jeanne.Crook@va.gov (303) 398-5224 Christina Goebel Budget Analyst Christina.Goebel@va.gov (303) 370-1602 Christina Goebel Budget Analyst Christina.Goebel@va.gov (303) 370-1602 Euradell McRae Contact Representative Euradell.McRae@va.gov (303) 780-4727 Euradell McRae Contact Representative Euradell.McRae@va.gov (303) 780-4727 Stephanie Haddock Program Specialist Stephanie.Haddock@va.gov (303) 331-7504 Stephanie Haddock Program Specialist Stephanie.Haddock@va.gov (303) 331-7504 Isabel Saunders Program Specialist Isabel.Saunders@va.gov (303) 372-6209 Isabel Saunders Program Specialist Isabel.Saunders@va.gov (303) 372-6209 Stephen Pellicer Program Specialist Stephen.Pellicer@va.gov (386) 623-5534 Stephen Pellicer Program Specialist Stephen.Pellicer@va.gov (386) 623-5534 James A. Peters Contact Representative James.Peters6@va.gov (303)398-5154 James A. Peters Contact Representative James.Peters6@va.gov (303)398-5154 Willie L. Hamilton Program Specialist Willie. Hamilton@va.govHamilton@va.gov (303) 398-5138 Willie L. Hamilton Program Specialist Willie. Hamilton@va.govHamilton@va.gov (303) 398-5138 Andrea C. Stylen Administrative Support Assistant Andrea.Stylen@va.gov (720) 889-2300 Andrea C. Stylen Administrative Support Assistant Andrea.Stylen@va.gov (720) 889-2300 Monica Scott-Carter Program Assistant Monica.Scott-Carter2@va.gov (303) 378-4733 Monica Scott-Carter Program Assistant Monica.Scott-Carter2@va.gov (303) 378-4733

11. VETERANS HEALTH ADMINISTRATION QUESTIONS 11 Questions regarding a Retroactive Payment may be directed to the VHAStateHomePerDiemInquiries@va.gov email group.VHAStateHomePerDiemInquiries@va.gov

12. VETERANS HEALTH ADMINISTRATION Thank You This slide is meant for a large graphic or image only, with a slide title. No text other than a title. 12