1. Area Agency on Aging of Central Texas H. Richard McGhee, AAA Director Thomas Wilson, AAA VD-HCBS Consultant Jim Reed, CTCOG Executive Director

2. ADRC Partners

3. Veteran’s Directed Home and Community Based Services The Veteran’s Directed Home and Community Based Services is a pilot program for a new Veteran’s directed approach to home and community services partnered by: U.S. Department of Veterans Affairs Administration on Aging Texas Department of Aging and Disability Services Area Agency on Aging of Central Texas Central Texas Veterans Healthcare System => VAMC

4. VD-HCBS is a Consumer Directed Program The Veteran can recruit, hire, train and fire their own employees and backup employees (including family, friends or neighbors) The Veteran sets wages and benefits for the veteran’s employees based on a service budget created with the help of the AAA VD-HCBS Consultant The Veteran sets schedules and submits time sheets for the Veteran’s employees to a Fiscal Management Agency (FMS)

5. Target Population All Veterans enrolled in the VA health care system are eligible The Veteran is “in need of nursing home care” and interested in consumer directed care. AND one or more of these conditions is met:  3 or more deficits with Activities of Daily Living  Significant cognitive impairment  Receiving Hospice Services

6. OR Two Activities of Daily Living Dependencies and two or more of the following:  Three or more Instrumental activities of daily living  Recently discharged from a Nursing Facility  75 years or older  2 hospitalizations or 12 outpatient clinic or emergency evaluations  Clinically depressed  Lives alone *** Even if the Veteran does not meet any criteria but is still clinically determined by the local VAMC to need services, the VD-HCBS is a possible program for the Vet.

7. AAA VD-HCBS Services AAA VD-HCBS Staff assists the Veteran as a Service Consultant and provides activities that will: Assist the Veteran to develop a Service Plan that works for the Veteran Orients the Veteran to be an Employer Assists the Veteran Employer in training and educating the Veteran’s employee Provides support consultation services to the Veteran over length of approved services Provides linkage to Financial Management Services (FMS) These services are provided for 20% of the Veteran’s budget.

8. Financial Management Services Processes criminal background checks for Veteran’s Employee applicants Process the Veteran employee timesheets/payroll Process receipts and invoices for goods & services Acts as the Veteran’s agent to pay federal and state employment taxes These services are provided for a cost of $25 initial set-up fee & monthly maintenance fee of $45 and comes out of the 20% administrative payment paid to the AAA.

9. Referrals are directly referred by the VA Medical Center (VAMC) or may come from the community through the ADRC and are approved by the VAMC. One of the major tasks of the VAMC is to assure that the Veteran is within the grouping eligible for medical services and is recommended for Home Health Attendants (HHA) by their Primary Care Physician. Telephonic Joint Initial Screening completed by the AAA VD-HCBS Consultant and a VA HHA Social Worker for the Veteran to verify eligibility and Veteran wishes to direct their own care and services. Starting VD-HCBS

10. Enrollment Phase Visit One: Presentation of VD-HCBS Guidebook, In- home baseline assessment, release of Information authorization, and completion of 2060. From the completed 2060 form, the Veteran’s monthly service budget and benefit is established: 2060 Score 17-24 Basic $2,100 2060 Score 25-39 Intermediate $2,550 2060 Score 40-60 Extensive $ Case by Case Between Visit One and Two the Veteran completes Support Plan Budget and Worksheets that help the Veteran to prioritize needs.

11. Enrollment Phase (Continued) Visit Two: The AAA VD-HCBS consultant assists the Veteran in completing the Support and Budget Plan and Worksheets. The Employer Orientation is done and all required forms signed and collected. These forms are faxed and originals mailed to PALCO (the program Financial Management Service). PALCO registers the Veteran as an employer with the IRS and the Texas Workforce Commission.

12. Enrollment Phase (Continued) Visit Three: The AAA VD-HCBS Consultant assists the Veteran Employer to Orient the Veteran’s employees. All required Orientation Forms are completed and submitted to PALCO for criminal background check. Criminal background check completed, PALCO approves the hiring of the worker, a date is set for the first day of the work. The AAA VD-HCBS Consultant notifies the VAMC worker who authorizes the start of funds for the client on that date.

13. How does VD-HCBS Consultant Support Work ? Veteran Employer submits times sheets/ service billings bi-weekly to PALCO who will pay salaries, IRS Taxes, Medicare Taxes, and pay authorized budgeted bills. Monthly Support Consultant visits are made in person or telephonically to assure the program is working and there are no problems, if problems arise or the Veteran has new needs arise, the consultant will work with the Veteran to revise the support plan and budget as needed. Annual Review Month 12: The Consultant meets with the Veteran to create the service plan and budget for the next year.

14. Services, supports and goods NOT COVERED in VD-HCBS Services already being provided to a veteran or their family caregiver(s) by or through the Department of Veterans Affairs. Services, supports or goods provided to or benefiting persons other than you Room and board, including rent and mortgage payments Personal items and services not related to your disability Experimental treatments Vacation expenses (except for the cost of the services you may need while you are on vacation)

15. Transparent and Seamless System Supported by ServicePoint™ MIS CONSUMER PATHWAY TO SERVICES ↓ ADRC ↔ VAMC ↔ S&W ↘ ↓ ↙ VAMC Clinic (HHA Consult) ↓ HHA Staff & Veteran ↓ Veteran’s Directed HCBS

16. Questions?