Transcript Contract Nursing Home Program

Contract Nursing Home
Program
SIMONE HOGAN, LICSW
CNH POINT OF CONTACT
MINNEAPOLIS VA HEALTH
CARE SYSTEM
VA Health Care System
VA medical system consists of
integrated networks of care
(VISNs) that are focused on
pooling and aligning resources to
better meet local health care
needs and provide greater access
to care.
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ELIGIBILITY…
In order to be eligible for the Contract Nursing Home
Program or any other home and community care
services – a veteran should be enrolled in the
Minneapolis VA Health Care System
You can contact the Patient Access Center at 612-4672071 to review eligibility and enrollment
criteria/process
Contract Nursing Home
Program
DETAILS REGARDING THE
PROGRAM
Types of Contracts
Mill Bill (aka Millenium Bill or Long-Term)
 For Veterans rated 70% service connected or greater
through the Veteran's Benefits Administration
 For Veterans rated 60% service connected or less if
the reason for placement at a contract nursing home
is related to the service connection disability
 VA Contract Nursing Home team makes the
determination if the reason for SC is related to the
reason for the CNH placement.
Types of Contracts
Hospice
 For Veterans who are currently enrolled for care at
the Minneapolis VA Health Care System, have
updated eligibility paperwork, and are enrolled in a
hospice service (VA Primary Care Provider not req.)
 VA is responsible for room and board at a VA
contract facility
 Hospice service is billed to either Medicare or VA,
depending on patient preference and Medicare
enrollment
Types of Contracts
Respite:
 Veterans must be enrolled for care at the
Minneapolis VA HCS, have Primary Care
established, and have updated eligibility paperwork
completed including LTC co-pay test if needed
 Eligible for 30 days of respite care in a contract
nursing home each calendar year
 We prefer that Veterans use this benefit in
increments of one-two weeks
 Most respites are coordinated by Primary Care SW
Types of Contracts
Other:
 Veterans can be admitted from a private hospital,
with Medicare as the appropriate payer source
(usually 20 days) and then transfer to a VA contract
when pre-authorized
 Veteran cannot go from a VA contract to Medicare,
unless there is a qualifying stay that interrupts the
placement
 When the service-connected veteran admits from a
VA facility, VA is the required payer from day one
Types of Contracts
Other:
 Other contracts may be available periodically
depending on other factors affecting the medical
center
 These contracts will be announced by VA leadership
for temporary periods of time
 Example: most recently, short-term 28-day contracts
were being offered due to construction in our
Community Living Center (CLC)
Contract Nursing Home
Program
VA RELATIONSHIP:
BENEFITS AND
CHALLENGES
Benefits with VA relationship
• Broadens the pool of available funding
• Higher daily funding than MA provides
• Increased opportunities to serve America’s
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veterans
Increases the gender mix/more male referrals
May contribute to Culture Transformation
Unique geographic offering
Access to increased VA clinics for support
VA RN and SW visits to veterans on contract
Reasons a facility may not want…
• Paperwork & accountability
• Perceived too few referrals for the effort
• NH is not geographically required by the VA
• NH too small to offer unique options to the VA
• NH occupancy is generally already 100%
• NH is not 100% fire sprinkled
• Therapy VA pre-authorization
Current Numbers:
Counties represented in MN
Counties represented in WI
22
9
Total CNH Facilities Currently
58
Total # of Veterans in CNH Program 294
Contract Nursing Home
Program
CLINICAL OVERSIGHT –
MONTHLY/QUARTERLY AND
SENTINEL EVENTS
The Minneapolis CNH Staff
 CNH Point of Contact
 CNH Coordinator Team
 Clinical Social Workers
 Nurse Coordinators
 Consulting Pharmacist
 Medical Director
 Fee Basis Claims Assistant
 Contracting Officer
 Life Safety Inspectors
 Program Support Assistant
VA Personnel Visits to CNH
 While Veterans are on contract in CNHs, authorized
VA Social Workers and Nurses regularly visit
veterans to provide follow-up and support.
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Monthly or quarterly visits occur – depending on geography
 These Social Workers and Nurses should be your
main point of contract regarding Veteran issues.
VA Personnel Visits
Purpose of visits:
 to assist in the Veteran’s CNH adjustment and the
continuity of care; consult with staff
 address business office questions
 identify eligibility concerns; assist with VA
appointments
 assist with care coordination with the Veteran,
family, CNH, and the VA
VA contract stipulates that VA personnel will have
access to the veteran's CNH medical record
Sentinel Events
A Sentinel Event may include but is not limited to the
following:
 falls resulting in death or injury
 elopement resulting in a missing Veteran
 Veteran abuse confirmed or under investigation
 medication error resulting in Veteran illness/injury
 death or injury secondary to restraint usage, and
 all deaths related to unconfirmed or suspicious
nature.
Sentinel Events
 If you are reporting an occurrence regarding this
Veteran to the common entry point (CEP) or
Department of Health, you’ll need also to report the
occurrence to VA
Oversight
 Currently we have a CNH Coordinator Team that
meets weekly to review the CNH program, sentinel
events, Veteran/family complaints and process
improvement.
 CNH Coordinator Team members are SW Simone
Hogan, HCC Director Shawna Clausen, CNH
Program Support Assistant Gordon Hofman and SW
Supervisor Deb Smith Wagner
 Simone Hogan (612-467-4527) is our new CNH
Point of Contact and can be contacted for any
questions or issues
Contract Nursing Home
Program
NEW CONTRACTS AND
RENEWAL OF CONTRACTS
VA Renewal of Contracts
“To be considered for a first-time VA contract,
or to annually renew an existing contract,
VA takes the approach that
a broad review of all available data is essential”
VA contract renewal and quality oversight
The Minneapolis VA CNH staff annually reviews:
 the 2567
 NH Compare
 Quality improvement plans
 Complaint reports
 Ombudsman activity
 All medical records of Veterans served at the CNH
 Complaints from Veterans
VA contract renewal and quality oversight
We also review the following information:
• NH Compare
• quality measures
• staffing reports
• Minnesota Health Facilities Complaint Office
• Department of Health Information
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Number of State Deficiencies
• Minnesota Nursing Home Report Card
• Review of VA medical record and documentation from VA
staff oversight visits
VA contract renewal and quality oversight
Coordination with the following agencies:
• Veterans Benefit Administration
• Guardians, conservators, fiduciaries
• Nursing Home Ombudsman
• Hx of complaints, trends
• Amenableness to complaint resolution
• Evidence of consultation efforts by the NH
• Staffing/turnover issues
• Integration of resident/family council process
• Support of cultural transformation
• General view of care provided
VA contract renewal and quality oversight
Seven VA Standards:
 Are there three level “G” or higher deficiencies in the
current survey?
 In the current survey, are the total number of health
requirement deficiencies twice the state average?
 In the current survey, is there a level ‘E’ or higher deficiency
in any of the following areas:
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Restraints (F221 or F222)
Abuse (F223)
Staff treatment of patients (F225 or F226)
Dignity (F241)
Licensure (F491)
VA contract renewal and quality oversight
Seven VA Standards (cont.):
 In the NH Compare review are the RN hours per
resident day below the state average?
 In the NH Compare review are the total nursing staff
hours per resident below the state average?
 Are six or more of the MDS quality measures from NH
compare above the state average?
 In the current survey is there a level “E” or higher
deficiency in any of the following areas:
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Nursing services (F353)
Nursing aide training (F494, F495, or F496)
Regular in-service training (F497)
Proficiency of nursing aides (F498)
Staff Qualifications (F499)
VA contract renewal and quality oversight
To consider the contract, we apply the 7 VA standards and
review all other relevant performance information in the
determination process
 If a newly proposed contract, proceed or decline
 Renewal of existing contract (most common)
 Renewal with added clinical oversight
 Renewal with additional stipulations
 Suspension of placements
 Suspension/termination of contract
New Contracts?
Needs Assessment is Completed:
 Current availability of VA funding,
 Implications for growth/decline in the current contract facilities,
 Density/proximity of existing contract facilities,
 Tendency for openings within the existing pool of contracted facilities,
 Unique facilities that serve specialized needs,
 The desire to providing ample business to existing contract facilities to
warrant their continued affiliation.
In summary, through the contract program,
VA believes that enhancing the NH care for
veterans within the CNH further enhances
the care for all residents.
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Contract Nursing Home
Program
CONTACTS:
GORDON HOFMAN – CNH PSA@ 612-467-5202
SIMONE HOGAN, LICSW – CNH POINT OF
CONTACT @ 612-467-4527 OR
[email protected]
SHAWNA CLAUSEN, MS, RN – HCC DIRECTOR
@ 612-467-1658
DEB SMITH-WAGNER, LICSW – EC&R SW
SUPERVISOR @ 612-467-1561
Questions?