0. Kelly Schneider, Program Manager State Home Per Diem Program
The VA State Home Per Diem Program Reimbursement and Electronic Invoicing Process Training for State Veterans Homes
Kelly Schneider, Program Manager
State Home Per Diem Program
February 2013

1. Agenda Invoice Process What has changed?
Submitting Invoice through OB10
System for Acquisition Management (SAM) Registration and DUNS
State Veteran Home Program Management
Reimbursement Overview
Reimbursement Chart
Veterans Eligible for Higher Per Diem
Per Diem Reimbursement
Per Diem Overview
Basic Admission Process Flow for State Homes
Instructions for SVHs Submission of for February 1, 2013
The purpose of this presentation is to cover electronic invoicing for State Veterans Homes claims and this applies to all Veterans that are eligible to receive per diem payments.

2. Agenda Cont’d Monthly Invoicing Processing Flowchart
Invoice Review and Payment Process Flowchart
Electronic Invoicing
Retroactive Payments
What has Changed?
Overview
Draft A (Retro Payment) Under OMB Review
State Home Per Diem Website
State Home Per Diem Contacts
Questions
The purpose of this presentation is to cover electronic invoicing for State Veterans Homes claims and this applies to all Veterans that are eligible to receive per diem payments.

3. Invoice Process What has changed?
MANDATE for electronic invoice submission to the VA Financial Services Center (VAFSC) to eliminate improper payment.
A Federal Register rule mandating electronic invoice submissions was published November 27, 2012 and can be located at:
State Homes were granted an extension to submit/upload their electronic invoicing by April 1, 2013.
VA Form and supporting documents must be submitted in Tag Image File Format (TIFF) in OB10.
VAMC must provide the Purchased Order (PO) number to the SVH so that they can invoice the VA through OB10.
State Homes will no longer be able to mail or submit paper copies of VA to the VA.
VA Form and supporting documents must be submitted in Tag Image File Format (TIFF) in OB10. Any other file formats such as PDF, Microsoft word, etc. can not be uploaded.
The State Home Per Diem Program office has sent out an requesting that each SVH must submit their primary and alternate points of contact (POC) to the VA State Veterans Home Per Diem Program office to be granted access to the OB10 web site. These individuals will be responsible for uploading electronically their VA Form and other supporting documents for payment via the OB10 web link. Please complete the attached excel spreadsheet for your SVH and forward it no later than COB Monday February 25, 2013 to Michelle Slusser in the VA SVH Program office via address -- Michelle may also be contacted at
SVHs will need to be registered by the VA Finance Service Center (FSC) in the OB10 website in order to submit invoices as hardcopy invoices will not be accepted by VA Medical Centers of jurisdiction after April 1, 2013.
Once the SVHs are registered in OB10, they will be receiving an from OB10 to validate their information. Please ensure that you follow the instructions in the .

4. Submitting Invoice through OB10
DEMO
OB10 US Help Desk support for State Home:
Additional OB10 and Veterans Affairs information can be found at:
Now we are going to do OB10 demo. I’ll now turn it over to Marcel King to provide the OB10 demonstrations specific to invoicing, reporting, and support.

5. System for Acquisition Management (SAM) Registration and DUNS
It is MANDATORY for all State Veteran Homes (SVHs) to have a DUNS number and be registered in the new System for Acquisition Management (SAM).
SAM transitioned from the Central Contractor Registry (CCR).
An active “Representations and Certifications” (ORCA) in SAM is also required.
State Homes should double-check their organization’s record in SAM to confirm that all of their information has migrated correctly into the new system.
Refer to the website:

6. System for Acquisition Management (SAM) Registration and DUNS Cont’d
If you are not registered in SAM, you will need a Duns & Bradstreet (DUNS) number to do so.
If you already have a DUNS number, the full registration process in SAM can take 3-5 days.
If you do not have a DUNS number, you can obtain one at
For assistance with SAM, contact the Federal Service Desk at or by phone at (toll-free).

7. System for Acquisition Management (SAM) Registration and DUNS Cont’d
Please confirm you are registered in SAMS and that the DUNS number is valid by sending an to Ms. Jeanne Crook at
For questions, contact Ms. Cook via at or by phone (303)
Failure to register in SAMS and/or having an invalid DUNS number will result in VA not being able to reimburse the SVH for services provided until the issues have been resolved.

8. State Veteran Home (SVH) Program Management
SVH Responsibilities:
Provide services as defined in 38 CFR Part 51
Complete/submit 10-10SH and 10-10EZ to VAMC
Maintain health records of residents
Maintain tracking log
Track and report per diem cost
Submit monthly gains and losses to VAMC
Completed OB10 invoice, prepare and upload VA and any supporting documentation electronically into the OB10 web link

9. Reimbursement
To receive payment, SVHs must upload a completed VA Form in OB10 by the 5th workday following the end of the month in which services were rendered.
All payments by VA to the SVH will be made by electronic funds transfers (EFTs).
VA Form is considered to be complete when all required information is provided and when the form is signed by the SVH Administrator.
In cases where the SVH is operated under a contractual agreement for the State, the form must be signed by a State representative.

10. Reimbursement Cont’d
Failure to upload a timely and completed VA Form and required supporting documentation may result in delayed or denied payments.
For services that the SVH is not responsible for providing pursuant to 38 CFR Part 51 (such as hospital care, hearing aids, eyeglasses, etc.):
On behalf of the Veteran, the SVH may contact its VA Medical Center of Jurisdiction to request VA to consider providing or paying for such services.

11. Reimbursement Chart

12. Veterans Eligible for Higher Per Diem
VA will reimburse the SVH the prevailing rate for nursing home care for certain eligible Veterans residing in State Veterans Homes.
The definition for eligible Veterans remains unchanged, which include s Veterans who are 70 percent or more service-connected, who require nursing home care because of a service-connected (SC) disability, or are totally disabled and unemployable.
Public Law states that the VA payment for these eligible Veterans “constitutes payment in full to the State home” for nursing home care provided to the Veteran.
Veterans with SC disabilities 60% or below and are receiving nursing home care unrelated to their SC disability will receive the basic rate.
The Prevailing Rate is calculated using the methodology in effect prior to enactment of Section 105 of Public Law
Methodology is set forth in 38 CFR 51.41(b)(1).

13. Per Diem Reimbursement
Question: As of February 2, 2013, what will go away?
Answer: For higher per diem payments - the language stating “the lesser of the two figures,” which is either the daily care cost or the prevailing rate $ $
No Change
Basic Per Diem
Change
Higher Per Diem

14. Per Diem
State home per diem rates are non-negotiable and established by VA as a rate that is payable per resident per day.
VA uses two primary methods for reimbursement of nursing home services:
A “prevailing rate” for certain Veterans with service connected disabilities.
A “basic rate” for Veterans who do not have a service-connected disability that qualifies them for the prevailing rate.
VA also uses a basic rate for domiciliary and ADHC services.
Basic rates for each level of care (nursing home, domiciliary, and ADHC) are standardized nationally and are not subject to regional variations.
These rates are readjusted every fiscal year.

15. Per Diem Cont’d The FY 2013 rates were released in October 2012.
Whatever prevailing rate applies for your particular SVH is what will be used after February 2, 2013 for both the provider agreement and contract .
To compute the prevailing rate, VA uses the national CMS RUG rates instead of the individual case mix of Veterans that reside in the SVH.
VA has been paying these rates on a yearly basis.
One rate is calculated every year.
The formula takes the average of all the CMS rates for each fiscal year.
A wage index is factored for each geographic area of the SVH.
A physician visit amount is tacked onto the amount.
That is how the average rate is calculated for each SVH in a particular geographic area.

16. Basic Admission Process Flow for State Homes
Applicant is an eligible Veteran or an eligible Veteran-related category (spouse, surviving spouse, or gold star parent)
Eligible for Admission
Yes .
Admissions Review No
Can the home provide the level of care required? No
Admission Denied
Yes No
Can the Applicant Pay?
Yes
Applicant Qualifies for Pay Sources
(e.g., VA Per Diem, Medicare, Medicaid, A&A, Private Pay, etc.)

17. Basic Admission Process Flow for State Homes Cont’d
Applicant Qualifies for Pay Source(s) .
Veteran Only
Eligible Veteran-Related can be Admitted, but VA Per Diem is not Authorized for Payment
(other pay sources may be used)
Applies for VA per VAMC of Jurisdiction
Meets Administrative Eligibility Criteria No
Admission not Approved, per diem cannot be paid
Reviewed by VA Physician
Admission not approved, per diem cannot be paid
Skilled Care Required No
Per diem payments can be approved effective on the admission date when applications are received within ten days of admission. If received after ten days of admission, per diem payments begin on the day the application is received.

18. Instructions for SVHs Submitting 10-5588 for February 1, 2013
The SVHs will complete one invoice and upload one for the month of February 2013.
The SVHs will separate the old methodology (February 1, 2013) from the new methodology (February 2, 2013 and going forward) on the
For February 1, 2013 only:
SVHs will use the old methodology by manually recording the one day of care in the remark section of the report.
This involves the lesser of, “the daily cost of care or the prevailing rate”.
It is important for the SVH to add the amount of the one day of care stated in the remark section to the overall total.
If the SVH was eligible to receive the VA prevailing rate prior to February 1, 2013 as the daily cost of care exceeded the prevailing amount:
The SVHs will complete the in the usual way with no changes made to the report; please clarify in remarks section.
In accordance to PL , Section 105 , VA had 180 days to implement new law. Therefore, for statutory purposes, we had no flexibility to start the new law on February 1st.
NOTE: The SVH will not have to record the one day of care (February 1, 2013) in the remark session of the report if they are eligible to receive the prevailing rate rather than the daily cost of care if the prevailing rate is the lesser of the two figures. In this case, the SVH will complete the with no change. This total will automatically get added to the total amount since the SVH is eligible to receive the prevailing rate. In the remarks section please clarify that your SVH was receiving the prevailing rate prior to February 1, 2013.

19. Monthly Invoicing Processing Flowchart
Develop Gains & Losses Report
Compiled Based on
Eligibility Category
(Service Connected v. Basic Rate)
Compute Total Cost of Care
(Direct and Indirect)
Costs in Accordance with
Cost Principles: 2 CFR 225 (A-87)
Complete Form
SVH Responsibilities: Include maintaining an internal log that tracks the daily movements and status of all eligible Veterans who reside in the SVH by level of care.
This includes tracking the gains and losses to determine facility census (total days, average daily census, veterans who are 70% disabled or admitted for service-connected condition).
Track total direct and indirect costs related to provision of patient care for Veterans.
Calculate the per diem claims amount and total claimed amount on Form and submit completed and signed Form by the 5th business day of the following month for each monthly report period.
SVH Administrator signs Form attesting to its completeness and accuracy.
Reconcile and Correct Errors to Gains & Losses Report with VAMC
Enter information into OB10 Link and upload VA Form and supporting documentation
(Gains & Losses Report/Spreadsheet
electronically via VA Finance Service Center’s OB10 Link
by the 5th of month, effective date April 1, 2013

20. Invoice Review & Payment Process Flowchart
8 CBO Staff
SVH will complete invoice & upload and any other supporting documentation into OB10
The and supporting documentation is automatically populated in OLCS
Austin sends alert to VAMC of Jurisdiction Certifying Official(s) to certify invoices for payment
VAMC reconciles by accepting or rejecting for payment via OLCS
If rejected,
FSC returns the invoice/
to SVH to correct
SVH corrects invoice/
and uploads into OB10 Link. Austin sends alert to VAMC
VAMC prints & signs
to certify the amount payable and enter into SQL
VAMC
Fiscal Service completes audit of printed Certifying official certifies payment
This is the Invoice Processing Flow Chart.

21. Electronic Invoicing Beginning April 1, 2013:
All monthly SVH invoices will be processed electronically
VA Form , State Home Report and Statement of Federal Aid Claimed, must be scanned and uploaded by each SVH after the close of each monthly reporting period into the VA Finance Service Center’s OB10 Link:
To ensure timely payment, the State home may wish to upload a supporting documentation spreadsheet that lists:
the name of each Veteran (last name, first name),
last four digits of their social security number, and
total days of care claimed with the corresponding VA per diem payment rate approved for the fiscal year. 
In this spreadsheet, we recommend that Veterans on whose behalf VA pays the basic per diem rate are reported separately from other Veterans.
Once uploaded into the OB10 system, the invoice and supporting documentation will be transmitted into the On-line Certification System. 
The Finance Service Center will then send an notice to the Medical Center of Jurisdiction’s designated staff to certify the payment. 

22. Electronic Invoicing Cont’d
Prior to certification, the designated VA Medical Center staff will review each monthly invoice report and any supporting documentation for completeness & accuracy and will resolve any discrepancies with the SVH. 
The Report must not be certified if the report is incomplete.
For example, all appropriate blocks are completed and report is signed by the SVH administrator and, if applicable, the State employee if the SVH is operated by a contractor.
When the form is complete and accurate:
accounting should sign the printed and date the audit block, and
the individual assigned to certify will complete the certification in the On-line Certification System.   
As of April 1, 2013: All payments must be made through the On-line Certification System. 
Payment will be made by electronic funds transfer (EFT).  

23. Retroactive Payments PL 112-154, Section 105: Contracts and Agreements for Nursing Homes
What Has Changed?
Veterans under VA provider agreement with SVHs ARE authorized retroactive payment using the prevailing rate effective February 2, 2013.
Prior to February 2, 2013, the old methodology for retroactive payments is in effect.
To date (February 2013) VAMCs of jurisdiction do not have contract agreements in place with State Homes.

24. Retroactive Payments Cont’d
Veterans under VA Contract (nursing home beds) with a new SVH that passed their Recognition Survey and received the signed letter from the VA Under Secretary for Health are not authorized for retroactive per diem payment after February 2, 2013
If a new home is recognized and approved by the Under Secretary for Health prior to February 1,2013, they will be allowed to receive retroactive payments based on the old methodology.
Veterans under a VA provider agreement are allowed to collect retroactive per diem payments using the prevailing rate as of February 2, 2013.
Prior to February 2, 2013, the old methodology for retroactive payments is in effect.
A SVH may not opt for the basic rate for highly service-connected Veterans as outlined in Public Law
Therefore, a new SH (nursing home) can receive retroactive payments from the last day of the completion of the inspection or survey that recognized the SH as meeting VA’s standards, as determined by the Under Secretary for Health.
For the higher per diem Veterans in receipt of nursing home care, a provider agreement must be signed prior to the VA being authorized to pay retroactive payments back to the date of the signed agreement.
Veterans under a VA provider agreement with SVHs ARE authorized retroactive payment using the prevailing rate effective - February 2, Prior to February 2, 2013, the old methodology for retroactive payments is in effect.

25. Draft 10-5588A (Retro Payment) Under OMB Review
Admissions Review No
required? No
Admission Denied
Yes No
Can the Applicant Pay?
We are in the process of developing a new form for the SVH submit retroactive claims (optional), A. This will the SH program to better track and reconcile retroactive payments. To process retroactive active payment, the SVH is encouraged to submit the new form, along with the original for each month of the request and retroactive payment letter indicating they have or will reimburse any payer sources they have collected from on behalf of the Veteran. Regardless of whether the return of payment is made prior to VA’s payment or immediately after VA’s payment, the responsibility for the return of a payment rests with the SH that received the payment.
On the new , formulas will be built-in and included for the SVH to complete form. Another new addition to the form is that the SVH will provide Veterans information such as the name of each Veteran, SSN, SC Award Effective Date, SC Disability and SC Rating daily cost of care, FY prevailing rate, amount claimed at the SC rate, and amount due, which will be crossed checked by the VA Medical Center of Jurisdiction.
The form also has a remark section and signature /date of SVH Administrator.
Yes
Applicant Qualifies for Pay Sources
(e.g., VA Per diem, Medicare, Medicaid, A&A, Private Pay, etc.)

26. State Home Per Diem Program Website

27. 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)

28. Questions VHAStateHomePerDiemInquiries@va.gov
Please submit future written questions to our VA State Home Per Diem Program office staff to ensure a timely response to your questions. The link is included in this slide.
Thank you!