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

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Presentation on theme: "The VA State Home Per Diem Program Reimbursement and Electronic Invoicing Process Training for State Veterans Homes Kelly Schneider, Program Manager State."— Presentation transcript:

1 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

2 VETERANS HEALTH ADMINISTRATION 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,

3 VETERANS HEALTH ADMINISTRATION 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 2

4 VETERANS HEALTH ADMINISTRATION 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: https://federalregister.gov/a/ https://federalregister.gov/a/ State Homes were granted an extension to submit/upload their electronic invoicing by April 1, 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. 3

5 VETERANS HEALTH ADMINISTRATION Submitting Invoice through OB10 DEMO OB10 US Help Desk support for State Home: Additional OB10 and Veterans Affairs information can be found at: 4

6 VETERANS HEALTH ADMINISTRATION System for Acquisition Management (SAM) Registration and DUNS 5 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: https://www.sam.gov/portal/public/SAMhttps://www.sam.gov/portal/public/SAM

7 VETERANS HEALTH ADMINISTRATION System for Acquisition Management (SAM) Registration and DUNS C ont’d 6 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).www.fsd.gov

8 VETERANS HEALTH ADMINISTRATION System for Acquisition Management (SAM) Registration and DUNS Cont’d 7 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.

9 VETERANS HEALTH ADMINISTRATION 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 8

10 VETERANS HEALTH ADMINISTRATION 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. 9

11 VETERANS HEALTH ADMINISTRATION 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. 10

12 VETERANS HEALTH ADMINISTRATION Reimbursement Chart 11

13 VETERANS HEALTH ADMINISTRATION 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). 12

14 VETERANS HEALTH ADMINISTRATION Per Diem Reimbursement Change Higher Per Diem $ $ 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 13

15 VETERANS HEALTH ADMINISTRATION 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. 14

16 VETERANS HEALTH ADMINISTRATION Per Diem Cont’d The FY 2013 rates were released in October 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. 15

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

18 VETERANS HEALTH ADMINISTRATION Basic Admission Process Flow for State Homes Cont’d. 17 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 Reviewed by VA Physician Skilled Care Required Admission not Approved, per diem cannot be paid Admission not approved, per diem cannot be paid 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. No

19 VETERANS HEALTH ADMINISTRATION Instructions for SVHs Submitting for February 1, 2013 The SVHs will complete one invoice and upload one for the month of February 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. 18

20 VETERANS HEALTH ADMINISTRATION Monthly Invoicing Processing Flowchart 19 Develop Gains & Losses Report Compiled Based on Eligibility Category (Service Connected v. Basic Rate) 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) Compute Total Cost of Care (Direct and Indirect) Costs in Accordance with Cost Principles: 2 CFR 225 (A-87) 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 5 th of month, effective date April 1, 2013 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 5 th of month, effective date April 1, 2013 Complete Form Complete Form Reconcile and Correct Errors to Gains & Losses Report with VAMC Reconcile and Correct Errors to Gains & Losses Report with VAMC

21 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 If rejected, FSC returns the invoice/ to SVH to correct SVH corrects invoice/ and uploads into OB10 Link. Austin sends alert to VAMC 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 prints & signs to certify the amount payable and enter into SQL VAMC Fiscal Service completes audit of printed Certifying official certifies payment VAMC Fiscal Service completes audit of printed Certifying official certifies payment Invoice Review & Payment Process Flowchart 20

22 VETERANS HEALTH ADMINISTRATION 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. 21

23 VETERANS HEALTH ADMINISTRATION 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). 22

24 VETERANS HEALTH ADMINISTRATION Retroactive Payments PL , 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, 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. 23

25 VETERANS HEALTH ADMINISTRATION 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, 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

26 VETERANS HEALTH ADMINISTRATION Draft A (Retro Payment) Under OMB Review 25 Admissions Review required? Admission Denied Can the Applicant Pay? Applicant Qualifies for Pay Sources (e.g., VA Per diem, Medicare, Medicaid, A&A, Private Pay, etc.) Yes NoNo No NoNo

27 VETERANS HEALTH ADMINISTRATION State Home Per Diem Program Website 26

28 VETERANS HEALTH ADMINISTRATION State Home Per Diem Program Contacts Kelly J. Schneider State Home Per Diem Program Manager (308) or (402) Kelly J. Schneider State Home Per Diem Program Manager (308) or (402) Brenda Wiggins Program Analyst (202) Brenda Wiggins Program Analyst (202) Jeanne Crook Program Specialist (303) Jeanne Crook Program Specialist (303) Gloria Testa Budget Analyst (303) Gloria Testa Budget Analyst (303) Gus Harris Program Specialist (303) Gus Harris Program Specialist (303) Stephanie Haddock Administrative Support (303) Stephanie Haddock Administrative Support (303) Michelle Slusser Project Manager (303) Michelle Slusser Project Manager (303) Gloria J. Sanford Deputy Program Manager (303) Gloria J. Sanford Deputy Program Manager (303)

29 VETERANS HEALTH ADMINISTRATION Questions 28


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