0. Cyndi Kindred, Acting Deputy, Chief Business Office for Purchased Care
National Association of
State Veterans Home
State Home Per Diem Program Update
Cyndi Kindred, Acting Deputy, Chief Business Office for Purchased Care
February 2013

1. Agenda State Home Per Diem Program Overview
Public Law , Section 105
Implementation Plan
VA Consults with State Homes
January 2013 Milestones
February 2013 Milestones
FY 2012 State Home Expenditures
FY 2013 Distribution of Facilities
FY 2013 Budget Projections
Accomplishments
State Home Per Diem Program Future State
State Home Per Diem Program Contacts
Questions for State Homes

2. State Home Per Diem Program
The State Home Per Diem Program is a health care benefit administration and payment processing program which is managed by the VHA Chief Business Office for Purchased Care (CBOPC)
Responsibilities for managing the State Home Program are shared by the following Veterans Health Administration (VHA) Offices:
Chief Business Office for Purchased Care
Office of Geriatrics and Extended Care
Office of Capital Asset Management and Support

3. State Home Per Diem Program Cont’d
CBOPC is responsible for managing the State Home Per Diem Program, which includes:
Regulatory and national policy development related to eligibility and per diem payment methodologies
Oversight of State Home Per Diem eligibility, application authorizations, and the per diem payment program
Operational oversight and training for VHA and Non-VA Stakeholders

4. State Home Per Diem Program Cont’d
Promoting collaborative relationships with VA and Non-VA Stakeholders by maintaining communication and networking with program leaders through interactive forums, such as meetings, mail groups, and national conference calls
Managing the state home budgeting process, the provision of fiscal year per diem funds to the VA Medical Centers of Jurisdiction based on projected needs, and the provision of supplemental per diem funds (when required)
Compiling products/reports that depict State Home workloads and expenditure trends

5. Public Law , Section 105
August 6, 2012: President Obama signed the law that requires VA to enter into contracts or provider agreements to reimburse State Veterans Homes for nursing home care provided to Veterans that have been rated by VA as one of the following:
The Veteran has a service-connected disability of 70 percent or greater and needs nursing home care; or
The Veteran has a rating of total disability based on individual unemployability and is in need of nursing home care; or
The Veteran is in need of nursing home care for a VA adjudicated service-connected disability.
This does not apply to Veterans residing in State Home Nursing Home Care for basic rates, Domiciliaries or enrolled in the State Home ADHC program(s). Applies to Veteran residing in State Home nursing home beds in receipt of higher per diem payments for Veterans that has a SC of 70% of greater, has a rating of total disability based on individual unemployability or Veterans with VA adjudicated SC disability ratings of 0% to 60% that are receiving nursing home care based on their SC ratings.
In order to receive per diem payments under the provider agreement or contract, the SVH must be recognized and certified by VA in accordance with 38 CFR §

6. Public Law 112-154, Section 105 Cont’d
To reimburse State Homes for the care provided under the contract (or provider agreement), payment under each contract (or provider agreement) will be based on methodology developed by the VA Secretary in consultation with State Veterans Homes.
Effective February 2, 2013: All nursing home care provided in State Veterans Homes for specific service-connected Veterans in need of nursing home care must be paid for under a contract or provider agreement.

7. Implementation Plan
The State Home Per Diem Program Office executed the following actions to meet the February 2, 2013 implementation due date:
August 28, 2012: Established a VHA Implementation Working Group and included subject matter experts from:
VA Office of General Counsel
VHA Office of Regulatory Affairs
VHA Office of Procurement and Logistics
VA Office of Intergovernmental Affairs
VHA Office of Geriatrics and Extended Care

8. VA Consults with State Homes
September-December 2012: Launched the first series of consultative meetings with State Veterans Home Stakeholders and the VA Implementation Team.
State Home Stakeholders included:
State Veteran Home administrators
National Association of State Veterans Home (NASVH)
National Association of State Directors of Veterans Affairs (NASDVA)

9. January 2013 Milestones
January 7, 8, & : Provided five Public Law Implementation training sessions for VAMCs of Jurisdiction Per Diem Points of Contacts, Contracting Officer Representatives (CORs), Provider Agreement Coordinators (PACs), and separate sessions for State Home Stakeholders.
Over 1,100 attendees participated
92% overall satisfaction rating for the 6 training sessions
January 14, 2013: Distributed the State Home Provider Agreement to VISN Directors and Business Implementation Managers (BIMs).

10. February 2013 Milestones
February 1, 2013: Confirmed that 133 of 134 State Veterans Homes had certified provider agreements.
One State Veterans Home declined to participate
February 4, 2013: Written public comment period closed.

11. State Home Per Diem Program FY 2012 Expenditures
The Grant Per Diem Program provides ear marked funds to 97 VAMCs of Jurisdiction to pay per diem for State Home Veterans
143 State Veterans Home Facilities
Three programs:
134 Nursing home care programs (24,526 beds)
53 Domiciliary care programs (5,801 beds)
2 Adult day health care programs (85 slots)
Costs:
FY 2011: $823,693,587
FY 2012: $851,046,624

12. Bed Distribution FY 2013
Adult Day Health Care represents 85 participant slots

13. State Home Per Diem FY 2013 Budget Projections
SH Domiciliary (DOM): $57,534,147 SH Nursing (BASIC) NHC: $653,303,911 SH Nursing Higher (P1) NHC: $269,358,375 SH Adult Day Health Care (ADHC): $1,009,311 TOTAL : $1,005,735,888

14. Accomplishments Educational Fact Sheets Contract Solicitation
VAMC Training 2013
Monthly education conference calls (2011)
Bi-monthly in FY 2013
Customer Service Support (Ongoing)
Field Assistance Visits/VAMC training calls
Public Law , Section 105
Contracts and Agreements
Designation as State Home Program Liaison
2013 Per Diem Rates

15. Future State: FY 2013 - 2014 Revise State Home Per Diem Handbook
VAMC training, State Home Procedure Guides, Desk Procedures, and Quick Reference Guide
Revised Regulation
12 calendar day admission rule
Revised VA State Home Memorandum of Understanding
Automated 10-10SH and forms
Revised 10-10SH, , & A (Retro Payments)
Electronic Invoicing
New deadline of April 1, 2013

16. State Home Per Diem Program Contacts
Kelly J. Schneider
State Home Per Diem Program Manager
(308) or (402)
Brenda Wiggins
Program Analyst
(202)
Jeanne Crook
Program Specialist
(303)
Gloria J. Sanford
Deputy Program Manager
(303)
Gloria Testa
Budget Analyst
(303)
Gus Harris
Program Specialist
(303)
Stephanie Haddock
Administrative Support
(303)
Michelle Slusser
Project Manager
(303)

17. Questions for State Homes
Do you anticipate the number of highly service-connected Veteran admissions to increase significantly over the next several years?
What factors are driving the increased admissions?
Do you anticipate State Homes to open adult day health care programs in the next several years?
What State Homes are interested?

18. Thank You!