1. VHA State Home Per Diem Program Cyndi Kindred, SES Deputy Chief Business Officer For Purchased Care 2013 NASVH & NASDVA Summer Conference

2. VETERANSHEALTHADMINISTRATION State Home Per Diem Program Accomplishments 2

3. VETERANSHEALTHADMINISTRATION Grant Program Update – 2013 Grant Awards VA will award 62 state home construction projects – 34 conditional grant awards ($78M) – 28 final grant awards ($124M) – There are 50+ homes approved for 2013 funding and the ARRA projects are all closed Conditional grant awards signed August 30th Complete grant application by February 2014 3

4. VETERANSHEALTHADMINISTRATION VA received 56 initial state applications for FY2014 15 safety projects 2 bed replacement projects 2 adult day health care 7 new construction projects Reminder: State grant applications may be submitted year round in grants.gov. grants.gov. 4 Grant Program Update Initial Applications 2014

5. 5 How you can help us !

6. VETERANSHEALTHADMINISTRATION VA’s Landing Page www.va.gov/aca

7. VETERANSHEALTHADMINISTRATION New State Home Survey Contract Contract awarded by Geriatrics and Extended Care Operations office (GEC-Ops) July 31, 2013 to current vendor, Ascellon Corporation Survey Team- Contractor, VAMC Representative, and VAMC fiscal surveyor – Conduct all SVH annual, recognition, for cause, and abbreviated surveys during the base year - August 1, 2013 – July 31, 2014 – If exercised, four option years - August 1, 2014 – July 31, 2018 – The Ascellon Corporation will conduct the clinical & life safety components of the surveys in State Home, skilled nursing, domiciliary, & adult day health care facilities 7

8. VETERANSHEALTHADMINISTRATION New State Home Survey Contract (continued) The VA Medical Center Representative and the fiscal surveyor will survey the administrative and fiscal components GEC-Ops has oversight of the State Home survey process The standards used to survey State Homes will not change; they will continue using VA State Home Per Diem federal regulation standards 8

9. VETERANSHEALTHADMINISTRATION Types of Surveys Annual – Done during the anniversary month of the State Home’s recognition or agreed upon month by VA and the State Home Recognition – A recognition Survey is the VA survey of a State Home used to determine its compliance with VA standards for the purpose of recognizing the home as a State Home by VA – Must be on site 10 business days after official notification and are announced surveys 9

10. VETERANSHEALTHADMINISTRATION Types of Surveys (continued) For Cause -- Survey authorized by GEC- Ops to investigate specific, or a series of, incidents, complaints, deficiencies, or events that may jeopardize the health or safety of residents – covers specific standards related to the event or series of events. – The scope of standards reviewed for a for cause survey can be expanded, if deemed necessary by the survey team. – Must be on site 15 business days after official notification and are unannounced surveys Abbreviated – NEW - An Abbreviated Survey is a survey authorized by GEC Ops to investigate a specific standard or deficiency found during a survey – Will cover only the specific deficiency found during a survey – Includes follow up visits to investigate deficiencies found during a previous survey. – Must be on site 15 business days after official notification and are unannounced surveys 10

11. VETERANSHEALTHADMINISTRATION Homeless Programs in SVHs VHA workgroup established to address the issue – Representatives from GEC Operations, Office of General Counsel, Chief Business Office, Homeless Programs, and Construction and Grants – Evaluating program requirements to determine how State Homes can establish homeless programs State Home requirements – Addressing whether the VA recognized beds are needed for the original intent – Validating resources are in place to meet the homeless program requirements Program requirements and process for converting State Home Domiciliary beds are yet to be developed 11

12. VETERANSHEALTHADMINISTRATION Newly Recognized State Homes (2013) Representing 585 additional beds: – 470 Nursing Home Beds – 80 Domiciliary Beds – 35 Adult Day Health Care Slots 12

13. 13 New HomeAdditionReplacementConversionBeds Pell City, AL174 NH80 Dom Hanson, KY36 additional NH * Minneapolis, MN** Minneapolis, MN** 100 NH * 35 ADHC Black Mountain, NC100 NH * Spring City, PA** Spring City, PA* 72 NH **120 NH Scranton, PA16 Dom to NH Chippewa Falls, WI72 NH

14. VETERANSHEALTHADMINISTRATION State Home Internet Site Data Repository of Regulation, Policy and Reports – Per Diem Rates – Construction Grant Guidance – Bed Changes – Survey Appeals – Occupancy Reports, authorized beds – Handbooks & Directives – Training Link: http://www.nonvacare.va.gov/state-homes.asp http://www.nonvacare.va.gov/state-homes.asp 14

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16. VETERANSHEALTHADMINISTRATION General Overview – State Veterans Homes Total State Home Facilities - 146 – Skilled Nursing Programs - 137 (24,853 beds) – Domiciliary Programs - 53 (5,865 beds) – Adult Day Health Care Programs - 2 (85 slots) Total Programs – 192 16

17. VETERANSHEALTHADMINISTRATION Statistical Updates FY 2012 and YTD 2013 Average Daily Census FY 2012FY 2013 YTD (May 2013) Nursing Home Basic 17,79717,410 Nursing Home SC Veterans 1,871 2,152 * Public Law Impact Domiciliary 3,6443,527 ADHC2130 Data Source: SQL database State Home Per Diem Program 17

18. VETERANSHEALTHADMINISTRATION FY 2013 Year to Date Budget FY 2013 Year to Date Budget FY 2013 Budget - $975,274,023 – Projected Expenditures – $942,570,145 – Average monthly expenditure - $77,040,261 FY 2014 Budget - $1,070,848,000

19. VETERANSHEALTHADMINISTRATION FY 2014 Per Diem Rates Rates have been established The rates require VHA approval Target date for release is September 2013 19

20. VETERANSHEALTHADMINISTRATION 10-10SH Applications Accurately and Timely Program Audits: Improper Payment Elimination Recovery Improvement Act - IPERIA – The VHA Office of Finance conducts annual audits for a variety of programs including the State Home Per Diem program – The findings revealed administrative errors which will require VAMC’s to request applications that were submitted previously – Your cooperation to assure that we have a 10-10SH for every Veteran is greatly appreciated 20

21. VETERANS HEALTH ADMINISTRATION Timely Per Diem Payments We want to ensure your payments are timely Implementation of the electronic invoicing requirements have improved timeliness of monthly invoices Timely retroactive payments continue to be a concern for some State Homes Please reach out to the State Home Per Diem office if you are unable to resolve payment delays with your local VAMC – Point of Contact - Kelly Schneider Kelly.Schneider2@va.gov or (520) 395-0310Kelly.Schneider2@va.gov 21