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 Completing Your VDHCBS Program Readiness Review January 24 th, 2012 Sandra Barrett, National Resource Center for Participant Directed Services 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: 1.Know the purpose of the readiness review process 2.Understand how to answer the readiness review questions 3.Understand the requirements for additional program documents 4.Know where to get more information and assistance

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 Templates and Tools 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 Employer Authority: The Veteran may only use the budget to hire workers Budget Authority: The Veteran accepts responsibility to manage the budget and make decisions about the acquisition of goods and services authorized on the Veteran’s plan Veteran Directed Services: The Veteran makes decisions about how the budget will be used to meet needs and goals Representative: An individual who knows enough about the Veteran to make decisions based on the Veteran’s preferences

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 Financial Management Service (FMS): The first and primary choice is fiscal/employer agent operating under IRS rules to act as the agent for Veterans, paying timesheets, invoices, and employer related taxes based on the service/spending plan. Agency with Choice may be used when state statute prohibits Veterans from becoming the employer of record as in NH and MT. Risk: The probability that something bad will happen with negative consequences.

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/ Definition of Key Terms Risk Mitigation: A plan developed by the Veteran with support of the counselor addresses ways to reduce the possibility of negative outcomes associated with risk Options Counselor: The Veteran’s partner in VD- HCBS. Trained in person-centered planning and the principles of participant direction. Knowledgeable in all aspects of the program

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/ Definition of Key Terms Methodology for determining the amount of the Veteran’s monthly budget: There are several methods for determining the amount of the Veteran’s budget, but the understanding is always that the Veteran is given the amount of the budget and may use the funds creatively to meet individual needs. Three suggested methods are: – Case Mix: A score is assigned to ADLs and the total of the score results in assignment to case mix. – Tier System: The system develops three or more tiers and Veterans are assigned to a tier based on the assessment. – Individual Calculation: The assessment results are converted into a budget using a formula-type system.

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/ Definition of Key Terms Service/Spending Plan: An outline of how the Veteran or representative plans to spend the budget to meet needs and goals. Should include hiring workers with number of hours of work and salary and purchase of other goods or services. Should include rainy day/emergency funding for unexpected needs and may also include savings to purchase items costing more than the amount of the budget. Back-up Plan: A plan of how essential needs will be met if the primary worker is unable to work.

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/ Definition of Key Terms Rainy Day Fund: Budget funds saved to pay for unforeseen or unplanned circumstances such as respite care and/or using agency providers when a primary worker is unable to work. Contains budget funds remaining after expenses and planned savings are deducted. The fund may roll-over month to month, but the amount of the rainy day fund may not exceed the amount of the monthly budget minus $100. Planned Savings: Designated monthly savings amount to permit purchasing a higher cost item.

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/ Templates & Tools VD-HCBS Procedure Document http://web.bc.edu/libtools/details.php?entryid=141 &page=1&topics=10,&types=&keywordhttp://web.bc.edu/libtools/details.php?entryid=141 &page=1&topics=10,&types=&keyword= VD-HCBS Program Readiness Review Template http://web.bc.edu/libtools/details.php?entryid=138 &page=1&topics=10,&types=&keywordhttp://web.bc.edu/libtools/details.php?entryid=138 &page=1&topics=10,&types=&keyword= VD-HCBS Flowchart Example http://web.bc.edu/libtools/details.php?entryid=140 &page=1&topics=10,&types=&keywordhttp://web.bc.edu/libtools/details.php?entryid=140 &page=1&topics=10,&types=&keyword=

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/ Purpose of the Readiness Review Walk through the VD-HCBS operating model with AAA/SUA and VAMC Assure that both partners understand how the program will operate and who will have responsibilities for which components 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

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/ Initial Steps and Decision Points Communication – AAA, ACL– Central and Regional Officers, State Unit on Aging – VHA, VISN, VAMC – National Resource Center for Participant Directed Service Contact Agency Self-Assessment – Staff trained in concepts of participant direction – Experience in operating a program that offers participant direction – Have an existing relationship with a financial management agency

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 in Completing the Readiness Review It is advantageous to develop an advisory committee. You may want to use an existing committee but it would be nice to add a Veteran to that committee. The committee should be used to assist in making program decisions as you complete the readiness review and as a sounding board for decisions made by the program staff. Download the Program Readiness Review. Use the readiness review document as your guide to develop the program.

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 in Completing the Readiness Review Readiness Review asks questions in an essay format. Use the directions with each question as your guide to assure that you provide all of the required information. Readiness Review asks questions in a sequence that will guide you in thinking about how Veterans will move through the program process.

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/

16. Steps in Completing the Readiness Review 1 Understanding the Principles of Veteran Directed – Think about the knowledge and experience your staff has with participant direction. If needed, online training webinars are available at www.participantdirection.orgwww.participantdirection.org 2 Intake and Assessment - Establish how you will accept referrals from the VAMC, identify the database use, if any, and establish timelines for contacting the Veteran.

17. 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 in Completing the Readiness Review 3 Budget and Service Planning - Identify the methodology for determining the budget. Discuss the Veteran-centered process for supporting the Veteran in developing the service or spending plan to use the budget to meet needs and goals. The development of the back-up plan and the approval process for the service plan are important steps. 4 Veteran Hiring and Employer Skills – Discuss how the Veteran will be trained to be an employer and the process for assuring the directly hired workers are paid. Include any requirements or restrictions for directly hired workers, i.e., criminal background checks and training.

18. 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 in Completing the Readiness Review 5 Risk Mitigation - Discuss the process for identifying and mitigating risks, the policy for using representative decision-makers, the policy for involuntary discharges and how you will monitor Veterans. 6 Monitoring Services and Supports - Discuss the policy for monitoring budget expenditures, the schedule of options counselor/Veteran contact, and what triggers a service plan amendment and the process for approval for the spending plan.

19. 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 in Completing the Readiness Review 7 Financial Management Services – Include an overview of the planned financial management service, as a separate FMS readiness review is required and will be discussed in detail in a future ACL Training. 8 Quality Management Plan - Describe your process and timeline for getting feedback on your program including surveys, performance indicators to track, and incidents or complaints. Include your process for review and remediation.

20. 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 in Completing the Readiness Review 9 Administrative Capacity - Discuss your plans for fronting Veteran expenditures, managing information flow including referrals, service plans, expenditures and invoicing, HIPPA compliance, contract compliance and oversight and staff sufficiency as program grows. 10 VD-HCBS Model Work Flow - An example may be downloaded and used as a guide. This flowchart will be reviewed in a conference call with aging staff and VAMC staff. The flowchart was discussed in an earlier ACL Training.

21. 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/ Required Supporting Documents Functional Assessment Tool Spending/Service Plan Template Program Policy Manual Veteran Program Manual

22. 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 Sites with experience operating a program with a participant-directed option can develop a VD- HCBS program in a shorter period of time. Ensuring that the AAA or SUA and the VAMC are both interested in VD-HCBS assures that the provider agreement can be competed timely. You are never in this process alone. When you need help, ask your ACL Regional Staff or Project Officer, NRCPDS, or Lewin leads for assistance or seek guidance from a colleague in an operational site.

23. 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/ Recommendations Review the VD-HCBS training series on Business Model, VD-HCBS Model Work Flow and Provider Agreement Review the tool and begin compiling information to answer the questions Look within your state to gather information on other programs with participant-directed options Establish communication with the VAMC that serves Veterans in your area and make them a partner in the planning process Ask for help from your ACL contact in the central office and regional office, your NRCPDS contact and your Lewin contact