Transcript 6-VeteransDirectedHCBS_4_9_13
HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING -
WITH REAL-WORLD PERSPECTIVE
.
Veterans Directed Home and Community Based Services
Kevin Foley Administration for Community Living (ACL)
March 13, 2013 [email protected]
Outline
Background What is VD-HCBS?
Key Components and Status of VD-HCBS Opportunity to serve Veterans and Caregivers Lessons Learned Q&A www.lewin.com
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Session Outline
"For too long, too many Americans have faced the impossible choice between moving to an institution or living at home without the long term services and supports they need. The goal of the new
Administration for Community Living
will be to help people with disabilities and older Americans live productive, satisfying lives." Secretary Kathleen Sebelius
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ACL Anniversary
"For too long, too many Americans have faced the impossible choice between moving to an institution or living at home without the long-term services and supports they need. The goal of the new
Administration for Community Living
Secretary Kathleen Sebelius will be to help people with disabilities and older Americans live productive, satisfying lives." -
www.lewin.com
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Growing Access to Participant Directed Programs
ACL & VHA promote a person centered approach to serving all populations Evidence based practice Individuals exercise choice and control Options Counseling + flexible service budgets Driving culture change www.lewin.com
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Development of VD-HCBS
Partnership between ACL and VHA Builds on CLP and ADRC development in Aging & Disability Networks Meets goals of ACL to increase access and availability of person centered/participant- directed service systems to all populations Assists VA to meet increasing demand for LTC and their goal to help Veterans stay in their own homes www.lewin.com
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VHA Philosophy for LTC
Provide Care in the least restrictive environment and whenever possible in home & community based settings Nursing home care should be reserved for situations in which the veteran can no longer be safely maintained in the home www.lewin.com
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What is VD-HCBS?
The Veteran-Directed Home and Community-Based Services (VD-HCBS) program serves Veterans of any age who are at risk of institutional placement as well as their family caregivers. VA Medical Centers (VAMCs) purchase these services on behalf of Veterans from: State Units on Aging, Area Agencies on Aging, and Aging and Disability Resource Centers www.lewin.com
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What is VD-HCBS?
A Veteran in the program: Receives an assessment and care planning assistance Decides for themselves, or with a participant representative, what mix of goods and services will best meet their, and their family caregiver’s care needs Manages a flexible, individual budget Hires and supervises their own workers, including family or friends Purchases items or services as needed to live independently in the community Have financial management and support services which facilitate service delivery www.lewin.com
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What is VD-HCBS?
VAMCs will refer eligible Veterans (or must approve Veterans referred from other avenues) • Eligible Veterans: require a considerable amount of personal care assistance and/or experience difficulties with traditional agencies and desire to self direct their care Agency will do an assessment, and with Veteran, develop a plan of services • • Agency will provide ongoing support for Veteran including use and assistance with financial management services VA expects that the Agency, at least performs: Reassessments semi-annually in the first year Conducts quarterly visits with the Veteran to monitor well-being Agency must provide monthly invoices for reimbursement with estimated or actual expenses as agreed between VAMC and Agency www.lewin.com
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Planning for VD-HCBS
Completion of a Readiness Review is required.
• • • • • • • • Agency demonstrates ability to assist Veterans with: Assessment and care planning Development of a plan for a mix of goods and services that best meet the needs and preferences of each Veteran Managing a flexible, individual budget Hiring and supervising their own workers Purchasing items and services to help them live independently Working with an FMS to facilitate payment and service delivery Utilizing traditional services as emergency back up Note: Readiness Review completed with NRCPDS www.lewin.com
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Planning for VD-HCBS
• • • • • Completing a Provider Agreement (ProVA) between VAMC and Network provider that outlines the policies and procedures for the program to include: Payment for VD-HCBS is for a bundled package of services that includes planned purchases of services and goods, a “rainy day” fund, and an agency oversight fee for service coordination, agency administrative costs and financial management services Approach to rates (case-mix and individual assessment) determined locally within caps set by VA Central Office An initial assessment that is reimbursed separately from the budget, at a set rate, for each Veteran referred.
VA review of Veteran care through telephone contact, satisfaction surveys and periodically meeting with the agency and Veteran Monthly invoices provided to the VAMC for reimbursement www.lewin.com
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Planning for VD-HCBS: Scalability Plan
Purpose: to guide program growth and trigger operational development Includes: ► Volume or quantity of people served by the infrastructure ► Trajectory of quantity of people served (program expansion) ► Key milestones ► Mechanism to track progress to goal ► Operational changes that need to occur as program grows www.lewin.com
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VD-HCBS NATIONAL STATUS
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VD-HCBS: Status and Future Direction
42 Operational Programs nationwide ► Offered through VA Medical Centers (hospital systems) ► 25 States and DC 101 AAAs/ADRCs Over 1400 Veterans Served to Date ► 321 Under 60 years of age ► 215 Served in OEF/OIF/OND Continued Expansion ► 6-10 new sites over next 6 months VD-Respite www.lewin.com
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Milestones of VDHCBS Development
VDHCBS Expands to 53 ADRC/AAA, 21 VAMCs and 15 States VD-HCBS launched, 49 ADRC grants w/(5 year plans) Nursing Home Diversion/ Community Living Program 2008 2009 2010 VDHCBS Expands to 81 ADRC/AAA, 33 VAMCs and 20 States 2011 VDHCBS Expands to 93 ADRC/AAA, 41 VAMCs and 24 States 2012
ADRCs 47 states, 300 sites, 49% of pop.
National Roll out of VD-HCBS & VD-Respite
51 states, 467 sites, 70% of pop.
ADRC 2003 2007
ADRCs 43 states, 147 sites, 30% of pop.
ADRCs 24 states, 42 sites, 8% of pop.
ADRCs12 states, 8 sites, 2% of pop.
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Veteran-Directed Respite
New respite option for Veterans enrolled in the Program of Comprehensive Assistance for Family Caregivers (Stipend Program). Participation Rate Expected to be High Creative alternative to traditional respite care to meet the needs of the unique population being served.
Quick Start to Occur at Central Texas VAMC.
Requires Full & Successful Readiness Review by NRCPDS prior to start VD-HCBS expansion possibilities through VDR.
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VA Medical Centers in California
VISN 21
VA Central California Health Care System San Francisco VA Medical Center Menlo Park Division Medical Center Livermore Division Medical Center VA Palo Alto Health Care System VA Northern California Health Care System VA Greater Los Angeles Healthcare System (GLA) VA Long Beach Healthcare System VA San Diego Healthcare System VA Loma Linda Healthcare System
VISN 22
Fresno San Francisco Menlo Park Livermore Palo Alto Mather Los Angeles Long Beach San Diego Loma Linda www.lewin.com
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Lessons Learned from Operational Sites
You are never in this process alone. When you need help ask: ACL State Liaison, Darrick Lam [email protected]
ACL Project Officer, Elizabeth Leef [email protected]
NRCPDS, Sandy Barrett/Merle Edwards-Orr (readiness reviews) [email protected]
Lewin leads: Patrick Brady/Roger Auerbach [email protected]
Or, ask to get connected with a colleague in an operational site.
www.lewin.com
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Lessons Learned from Operational Sites
Keep in close contact with VAMCs: meet regularly and often, and whenever possible, in person.
VD-HCBS is a complex, multi-faceted program. Working through these components early with the VAMC will ensure a successful program once Veteran enrollment commences www.lewin.com
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Where can I learn More?
Title & Dates
1. Planning & Development: December 6, 2011 2. Identifying Your VD-HCBS Business Model: December 8, 2011 3. Finalizing Your VD-HCBS Provider Agreement: December 13, 2011 4. FMS Strategy and Readiness Review: December 20, 2011 5. VDHCBS Flowchart Session: January 3, 2012
6. Person Centered Planning & Developing a Veteran Directed Budget:
8. Billing & Invoicing: January 17, 2012
9. Completing Your VD-HCBS Program Readiness Review:
11. Quality Assurance Monitoring: February 2, 2012 12. Data, Performance, and Outcomes: February 7, 2012 Jan 10,2012 7. Identifying Your VD-HCBS Business Model Part II: January 12, 2012 January 24, 2012 10. Cash Flow Management & Accounts Receivable: January 31, 2012 http://www.adrc-tae.org/tiki-index.php?page=VDHCBStraining2011 www.lewin.com
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National Quarterly VD-HCBS Webinars
ACL/VHA will be holding quarterly educational webinars ► 6/12/13 ► 9/18/13 www.lewin.com
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Additional Resources
ACL.gov
► http://www.acl.gov/Programs/Integrated_Programs/VeteranServices/Index.aspx
► http://www.acl.gov/About_ACL/FederalInitiatives/VeteransCare.aspx
ADRC-TAE ► http://www.adrc-tae.acl.gov/tiki-index.php?page=NewVDHCBS National Resource Center for Participant Directed Services (NRCPDS) ► http://www.bc.edu/schools/gssw/nrcpds/ www.lewin.com
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