veterans directed home and community based services
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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. - PowerPoint PPT PresentationTRANSCRIPT
HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING - WITH REAL-WORLD PERSPECTIVE.
Kevin Foley
Administration for Community Living (ACL)March 13, [email protected]
Veterans Directed Home and Community Based Services
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Outline
BackgroundWhat is VD-HCBS?Key Components and Status of VD-HCBS Opportunity to serve Veterans and CaregiversLessons LearnedQ&A
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Session Outline
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"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
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"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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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
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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
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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
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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
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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
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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
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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
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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
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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
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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
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VD-HCBS launched, 49 ADRC grants w/(5 year plans)
2007
2008
2009
2010
20112012
Nursing Home Diversion/Community Living Program
VDHCBS Expands to 53 ADRC/AAA, 21 VAMCs and 15 States
VDHCBS Expands to 93 ADRC/AAA, 41 VAMCs and 24 States
Milestones of VDHCBS Development
ADRCs 24 states, 42 sites, 8% of pop.ADRCs 24 states, 42 sites, 8% of pop.
ADRCs 43 states, 147 sites, 30% of pop.ADRCs 43 states, 147 sites, 30% of pop.
ADRCs 47 states, 300 sites, 49% of pop.ADRCs 47 states, 300 sites, 49% of pop.
51 states, 467 sites, 70% of pop.
51 states, 467 sites, 70% of pop.
ADRC
VDHCBS Expands to 81 ADRC/AAA, 33 VAMCs and 20 States
National Roll out of VD-HCBS & VD-Respite
ADRCs12 states, 8 sites, 2% of pop.ADRCs12 states, 8 sites, 2% of pop.2003
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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 22
VA Greater Los Angeles Healthcare System (GLA) Los Angeles
VA Long Beach Healthcare System Long Beach
VA San Diego Healthcare System San Diego
VA Loma Linda Healthcare System Loma Linda
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VISN 21
VA Central California Health Care System Fresno
San Francisco VA Medical Center San Francisco
Menlo Park Division Medical Center Menlo Park
Livermore Division Medical Center Livermore
VA Palo Alto Health Care System Palo Alto
VA Northern California Health Care System Mather
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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] [email protected]
Lewin leads: Patrick Brady/Roger Auerbach [email protected] [email protected]
Or, ask to get connected with a colleague in an operational site.
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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
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Where can I learn More?
Title & Dates
1. Planning & Development: December 6, 20112. Identifying Your VD-HCBS Business Model: December 8,
20113. Finalizing Your VD-HCBS Provider Agreement: December
13, 20114. FMS Strategy and Readiness Review: December 20, 20115. VDHCBS Flowchart Session: January 3, 20126. Person Centered Planning & Developing a Veteran Directed
Budget: Jan 10,2012
7. Identifying Your VD-HCBS Business Model Part II: January 12, 2012
8. Billing & Invoicing: January 17, 20129. Completing Your VD-HCBS Program Readiness Review:
January 24, 201210. Cash Flow Management & Accounts Receivable: January
31, 201211. Quality Assurance Monitoring: February 2, 201212. Data, Performance, and Outcomes: February 7, 2012
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http://www.adrc-tae.org/tiki-index.php?page=VDHCBStraining2011
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National Quarterly VD-HCBS Webinars
ACL/VHA will be holding quarterly educational webinars
►6/12/13
►9/18/13
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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/