1. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ VD-HCBS Training Series FINALIZING YOUR PROVIDER AGREEMENT (ProVA) December 13, 2011 Trainers: Kevin Foley, Administration for Community Living Lori Gerhard, Administration for Community Living

2. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Learning Objectives At the end of this one hour session, participants should: 1.Understand the history of Provider Agreements, how they are used in VA and how they are different than Contracts 2.Understand the different components of Provider Agreements for VD-HCBS 3.Describe lessons learned from other AAAs/SUAs and VAMCs that have been able to successfully execute Provider Agreements... 4.Be able to know what a Provider Agreement is and have the tools and knowledge to successfully implement a Provider Agreement

3. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Agenda Background What is a Provider Agreement? Policy guidance and procedures Decision points Lessons learned and recommendations Next steps and timelines Questions and answers

4. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Provider Agreements Provider Agreements are an instrument used by the Government to purchase health care services VA has been using Provider Agreements to purchase home care, nursing home care, hospice and VD-HCBS since 2006 Provider Agreements are not contracts! 2 Documents make up the Provider Agreement (ProVA): Provider Agreement Narrative (5-7 Page Word Document) Application for Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs (VA Form 10-1170)

5. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Review Provider Agreement Narrative/VA Form 10-1170

6. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Provider Agreements and Contracts: What’s the Difference? Provider AgreementContract 5-7 PagesHundreds of Pages Implemented and Signed in Short Timeframe Can Take 1-2 Years or Longer to process and sign Rates Established by VA Central Office Negotiated Rates

7. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ VD-HCBS ProVA: Section A Criteria Meet Requirements Set by Veterans Health Administration – Be recognized by VA to provide care – Readiness Review Completion Provide Quality Care – Must have a QA Program Allow VA Review of Veteran Care – Telephone contact with Veteran, review of reports, on- site monitoring, etc. Security of Veteran Information – HIPAA compliant

8. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ VD-HCBS ProVA: Section B Rate Structure and Reimbursement Rate Determination – VA Central Office provides rates to VAMC – The Veteran’s monthly budget (spending plan) is established between the VAMC and Aging Network (AAA/SUA) – Included in the bundled monthly budget is: Veteran Directed Budget funds including Respite/Emergency Backup Fund and any planned savings; VD-HCBS Administration Fee (which includes Service Coordination (Options Counseling), Admin Costs and Financial Management Services (FMS)) Reimbursement (VA Pays Using Electronic Funds Transfer) – Invoice: Bundled Monthly Budget (Approved Spending Plan + Admin Fee) Initial Assessment Fee (full or partial)

9. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ VD-HCBS ProVA: Section C-G and Addendum A Referrals Hospitalization/Nursing Home Placement Procedures Death of Veteran Termination of Services Dispute Resolution Addendum A: – Outlines the services the Provider will assist with and the consumer-directed services that the Veteran can purchase using their monthly budget.

10. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ VD-HCBS ProVA: Form 10-1170 “Application for Furnishing Long-Term Care Services to Beneficiaries of Veterans Affairs” (VA Form 10- 1170) – OMB Approved form for furnishing LTC Services to Veterans (NH, HC, Hospice, VD-HCBS) – Signature binds the Provider Agreement Template and Addendum between VAMC and Provider (AAA/SUA) [sections 18,19] – Some portions not applicable for VD-HCBS Providers (sections 2, 3, 4, 5, 6, 7, 8, 9(a-d), 10A and 10B, 11, 12)

11. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ General Provider Information

12. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Final Schedule of Services and Price Final Signatures & Effective Date of Agreement

13. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Steps and Decision Points ProVAs can be entered into between the VAMC and either the SUA or AAA Currently, both models are operating Potential Roles of SUA – SUAs may be in a position to assist with Cash-Flow issues for AAA’s – If the SUA holds the ProVA it may be easier to bring new Aging Network Sites on board – The State may contract out FMS for the Aging Network to use state buying power SUA’s/AAA’s will need to collaboratively determine best operating model

14. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Steps and Decision Points Aging Network Sites and VAMCs need to work collaboratively and closely in order to work through processes of Provider Agreement. Model Operating Policies: – The respite/emergency backup fund is housed at the Aging Network – The Veteran’s monthly budget is established using an assessment and case mix by AAA or SUA with VAMC approval of monthly budget (spending plan). – Invoices are based on approved monthly bundled budget (spending plan + administrative fee) with quarterly reconciliation Close working partnerships are essential to program success

15. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Lessons Learned Use VA approved invoice—excel spreadsheet. Talk to your local VAMC whether any additional information needs to be included. Discuss what services would be covered under additional benefits the Veteran may have Talk early and often throughout the process and whenever possible, face-to-face or over the phone