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 VD-HCBS Flow Chart January 3, 2011: Lori Gerhard, Administration for Community Living Kevin Foley, 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: Understand sequential steps that Veterans will experience as they participate in the VD-HCBS program; Identify roles and responsibilities of various partners as the Veteran flows through the system; Discuss ways to ensure that gaps and system interruptions are minimized as Veterans flow through the system; and Provide participants an opportunity to identify how their current model could more closely align with ideal flow chart.

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 Definition of key terms 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/ Definition of Key Terms Assessment Invoice – A one-time (per Veteran) bill sent from the Aging Network to the VAMC for the cost of assessing a Veteran for VD-HCBS and related start-up service planning. The Assessment Fee is located on the Provider Agreement, specifically on the 10-1170. Billed at the time of completion and paid separately by the VAMC. Partial Assessment Invoice – A one-time (per Veteran) bill, the rate of which is ½ the monthly assessment, billed at the time of completion and paid separately by the VAMC for Veterans assessed for VD-HCBS and determine to be inappropriate placement or chooses not to participate in the program prior to completion of the development of the Service Plan. Monthly Invoice— A bill sent from the AAA/SAA to the VAMC that includes the VD-HCBS Administrative Fee and the Veteran-Directed Budget reflected on the Spending Plan. The invoice reflects approved amounts. Quarterly Reconciliation – The process that occurs in comparing undesignated funds and the allocation to Emergency back-up and Savings plan versus Total Budgeted Amount.

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/ Definition of Key Terms Rainy Day/Planned Savings – Rainy day funds are for care when Providers are required as back-up for workers the Veteran hires or for Respite Care. Planned savings are for the purchase of goods which cannot be supported in a single month’s budget. Veteran-Directed Budget - These are the funds the Veteran uses to purchase services & goods in order to remain independent in the community. This amount also includes a “Respite/Emergency Back-up” fund (rainy day fund) and planned savings fund. The “Respite/Emergency Back-up” fund is used for care when agency providers are required as back-up for workers the Veteran hires, or for respite care. Planned savings are for purchases which cannot be supported in a single month’s budget. VD-HCBS Administrative Fee - These are the funds for the service coordination and Financial Management Services (FMS) supplied by the Provider and Provider’s administrative costs. Services include assessment, options counseling/care management, Financial Management Services (FMS) and program administration.

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/ Referral Intake Assessment Candidate Not Appropriate for PD Bill 1 time half assessment fee* Candidate Not Appropriate for PD Bill 1 time half assessment fee* Candidate Appropriate for PD Authorization of Plan AAA bills 1 time full assessment fee* Authorization of Plan AAA bills 1 time full assessment fee* 8 Authorization of Budget Amount 6 Develop Veteran Monthly Budget 5 Develop Plan Plan Distribution Employer Paperwork Hiring Assistance 11 Employee Paperwork Establish Employment Initiate Services 14 Reports Programmatic Quality Assurance (QA) Monitoring Planned Savings Fund Rainy Day Fund Timesheets and Invoices 13 Payments 16 Reassessment Reimbursement Quarterly Reconciliation Fiscal QA Monitoring 4a 11 8 3 2 1 7 12 910 15 20 17 1819 24 232221 4b VD-HCBS Model Work Flow

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/ Initial VD-HCBS Referral and Assessment Referral VAMC refers veteran to AAA along with pertinent documentation. Referral VAMC refers veteran to AAA along with pertinent documentation. Intake AAA contacts veteran & schedules home visit. Compiles materials consistent with the VD- HCBS operational manual. Intake AAA contacts veteran & schedules home visit. Compiles materials consistent with the VD- HCBS operational manual. Assessment AAA assesses veteran & discusses VD-HCBS roles & responsibilities. Reviews materials in VD-HCBS operational manual and Veteran Handbook. Assessment AAA assesses veteran & discusses VD-HCBS roles & responsibilities. Reviews materials in VD-HCBS operational manual and Veteran Handbook. Candidate Not Appropriate for PD Veteran doesn’t want program or needs representative & none available. Referred back to VAMC. Bill 1 time half assessment fee * Candidate Not Appropriate for PD Veteran doesn’t want program or needs representative & none available. Referred back to VAMC. Bill 1 time half assessment fee * Candidate Appropriate for PD AAA documents need and preliminary budget/budget tier & sends to VAMC. Candidate Appropriate for PD AAA documents need and preliminary budget/budget tier & sends to VAMC. 1 2 3 4a 4b

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/ Development and Authorization of Budget/Plan 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 reviews veteran monthly budget and if agrees authorizes the budget amount & sends written approval to AAA. If VAMC does not agree, both orgs should work together. Authorization of Budget Amount VAMC reviews veteran monthly budget and if agrees authorizes the budget amount & sends written approval to AAA. If VAMC does not agree, both orgs should work together. 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 assessment 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 assessment fee* Develop Veteran Monthly Budget AAA /SUA or VAMC uses Assessment Information and Budget Methodology Develop Veteran Monthly Budget AAA /SUA or VAMC uses Assessment Information and Budget Methodology 5 6 7 8

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/ Finding/Employing Workers Plan Distribution AAA transmits the authorized plan to the veteran and to FMS) Plan Distribution AAA transmits the authorized plan to the veteran and to FMS) Employer Paperwork AAA or FMS assists veteran to complete the paperwork to be an employer Employer Paperwork AAA or FMS assists veteran to complete the paperwork to be an employer Hiring Assistance AAA assists the veteran in the hiring process: job descriptions, recruitment, interview and reference checks. Hiring Assistance AAA assists the veteran in the hiring process: job descriptions, recruitment, interview and reference checks. Employee Paperwork AAA or FMS collects required employee information and conducts background checks (if required). Employee Paperwork AAA or FMS collects required employee information and conducts background checks (if required). 109 11 12

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/ Initiating Services, Billing and Payments Payments FMS pays workers & invoices as detailed in Spending Plan Payments FMS pays workers & invoices as detailed in Spending Plan Timesheets and Invoices Veteran submits timesheets and invoices to FMS for use by FMS and AAA Timesheets and Invoices Veteran submits timesheets and invoices to FMS for use by FMS and AAA 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 Establish Employment FMS establishes Veteran as an employer, and processes worker information. Establish Employment FMS establishes Veteran as an employer, and processes worker information. 15 13 14 16

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/ Rainy Day/Saving Allocation, QA and Reporting Rainy Day Fund FMS records any remaining funds from veteran monthly budget in Rainy Day Fund (Fund cannot exceed veteran’s monthly budget less $100.) Rainy Day Fund FMS records any remaining funds from veteran monthly budget in Rainy Day Fund (Fund cannot exceed veteran’s monthly budget less $100.) Reports FMS sends detailed spending and Savings/Rainy Day Fund reports to veteran & AAA Reports FMS sends detailed spending and Savings/Rainy Day Fund reports to veteran & AAA Programmatic Quality Assurance Monitoring AAA monitors veteran health, safety and outcomes, at least monthly phone contact and quarterly visits Programmatic Quality Assurance Monitoring AAA monitors veteran health, safety and outcomes, at least monthly phone contact and quarterly visits Savings Fund FMS records contribution to Savings Fund if veteran saving for larger purchase. Savings are planned. Savings Fund FMS records contribution to Savings Fund if veteran saving for larger purchase. Savings are planned. 2019 18 17

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/ Reimbursement, Reconciliation, Reassessment and QA Monitoring Fiscal Quality Assurance Monitoring AAA/SUA reviews report for service delivery pattern, approved versus actual, Rainy Day and Savings Fund Balance Fiscal Quality Assurance Monitoring AAA/SUA reviews report for service delivery pattern, approved versus actual, Rainy Day and Savings Fund Balance Quarterly Reconciliation If the AAA bills the full budget each month, it reconciles actual expenses against billed amounts on quarterly basis and submits quarterly reconciliation invoice to the VACM. VAMC remits payment Quarterly Reconciliation If the AAA bills the full budget each month, it reconciles actual expenses against billed amounts on quarterly basis and submits quarterly reconciliation invoice to the VACM. VAMC remits payment Reimbursement AAA submits monthly invoice to the VAMC. VAMC remits payment. Reimbursement AAA submits monthly invoice to the VAMC. VAMC 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 24 22 21 23

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/ Referral Intake Assessment Candidate Not Appropriate for PD Bill 1 time half assessment fee* Candidate Not Appropriate for PD Bill 1 time half assessment fee* Candidate Appropriate for PD Authorization of Plan AAA bills 1 time full assessment fee* Authorization of Plan AAA bills 1 time full assessment fee* 8 Authorization of Budget Amount 6 Develop Veteran Monthly Budget 5 Develop Plan Plan Distribution Employer Paperwork Hiring Assistance 11 Employee Paperwork Establish Employment Initiate Services 14 Reports Programmatic Quality Assurance (QA) Monitoring Planned Savings Fund Rainy Day Fund Timesheets and Invoices 13 Payments 16 Reassessment Reimbursement Quarterly Reconciliation Fiscal QA Monitoring 4a 11 8 3 2 1 7 12 910 15 20 17 1819 24 232221 4b VD-HCBS Model Work Flow

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/ Appendix: VD-HCBS 2 Page Flow Chart

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/ Referral VAMC refers veteran to AAA along with pertinent documentation. Referral VAMC refers veteran to AAA along with pertinent documentation. Intake AAA contacts veteran & schedules home visit. Compiles materials consistent with the VD- HCBS operational manual. Intake AAA contacts veteran & schedules home visit. Compiles materials consistent with the VD- HCBS operational manual. Assessment AAA assesses veteran & discusses VD-HCBS roles & responsibilities. Reviews materials in VD-HCBS operational manual and Veteran Handbook. Assessment AAA assesses veteran & discusses VD-HCBS roles & responsibilities. Reviews materials in VD-HCBS operational manual and Veteran Handbook. 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 Both parties review veteran monthly budget and if agree the VAMC sends written approval to AAA. If both don’t agree, both orgs should work together. Authorization of Budget Amount Both parties review veteran monthly budget and if agree the VAMC sends written approval to AAA. If both don’t agree, both orgs should work together. 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 assessment 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 assessment fee* Plan Distribution AAA transmits the authorized plan to the veteran and to FMS) Plan Distribution AAA transmits the authorized plan to the veteran and to FMS) Candidate Not Appropriate for PD Veteran doesn’t want program or needs representative & none available. Referred back to VAMC. Bill 1 time half assessment fee* Candidate Not Appropriate for PD Veteran doesn’t want program or needs representative & none available. Referred back to VAMC. Bill 1 time half assessment fee* Candidate Appropriate for PD AAA documents need and preliminary budget/budget tier & sends to VAMC. Candidate Appropriate for PD AAA documents need and preliminary budget/budget tier & sends to VAMC. VD-HCBS Model Work Flow—Page 1 1 2 3 Develop Veteran Monthly Budget AAA /SUA or VAMC uses Assessment Information and Budget Methodology Develop Veteran Monthly Budget AAA /SUA or VAMC uses Assessment Information and Budget Methodology 4a 4b 8 6 57 9 Employer Paperwork AAA or FMS assists veteran to complete the paperwork to be an employer Employer Paperwork AAA or FMS assists veteran to complete the paperwork to be an employer Hiring Assistance AAA assists the veteran in the hiring process: job descriptions, recruitment, interview and reference checks. Hiring Assistance AAA assists the veteran in the hiring process: job descriptions, recruitment, interview and reference checks. Employee Paperwork AAA or FMS collects required employee information and conducts background checks (if required). Employee Paperwork AAA or FMS collects required employee information and conducts background checks (if required). 1011 12

16. 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/ Rainy Day Fund FMS records any remaining funds from veteran monthly budget in Rainy Day Fund (Fund cannot exceed veteran’s monthly budget less $100.) Rainy Day Fund FMS records any remaining funds from veteran monthly budget in Rainy Day Fund (Fund cannot exceed veteran’s monthly budget less $100.) Payments FMS pays workers & invoices as detailed in Spending Plan Payments FMS pays workers & invoices as detailed in Spending Plan Timesheets and Invoices Veteran submits timesheets and invoices to FMS for use by FMS and AAA Timesheets and Invoices Veteran submits timesheets and invoices to FMS for use by FMS and AAA 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 Programmatic Quality Assurance Monitoring AAA monitors veteran health, safety and outcomes, at least monthly phone contact and quarterly visits Programmatic Quality Assurance Monitoring AAA monitors veteran health, safety and outcomes, at least monthly phone contact and quarterly visits Reports FMS sends detailed spending and Savings/Rainy Day Fund reports to veteran & AAA Reports FMS sends detailed spending and Savings/Rainy Day Fund reports to veteran & AAA Reimbursement AAA submits monthly invoice to the VAMC. This is either actual cost, or an invoice for the full budget amount. VAMC remits payment Reimbursement AAA submits monthly invoice to the VAMC. This is either actual cost, or an invoice for the full budget amount. VAMC 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 VD-HCBS Model Work Flow—Page 2 24 Quarterly Reconciliation If the AAA bills the full budget each month, it reconciles actual expenses against billed amounts on quarterly basis and submits quarterly reconciliation invoice to the VAMC. VAMC remits payment Quarterly Reconciliation If the AAA bills the full budget each month, it reconciles actual expenses against billed amounts on quarterly basis and submits quarterly reconciliation invoice to the VAMC. VAMC remits payment Establish Employment FMS establishes Veteran as an employer, and processes worker information. Establish Employment FMS establishes Veteran as an employer, and processes worker information. Savings Fund FMS records contribution to Savings Fund if veteran saving for larger purchase. Savings are planned. Savings Fund FMS records contribution to Savings Fund if veteran saving for larger purchase. Savings are planned. Fiscal Quality Assurance Monitoring AAA/SUA reviews report for service delivery pattern, approved versus actual, Rainy Day and Savings Fund Balance Fiscal Quality Assurance Monitoring AAA/SUA reviews report for service delivery pattern, approved versus actual, Rainy Day and Savings Fund Balance 15 20 13 22 19 14 21 23 18 12 17 16