1. HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING - WITH REAL-WORLD PERSPECTIVE. Kevin Foley Administration for Community Living (ACL) March 13, 2013 kevin.foley@acl.hhs.gov Veterans Directed Home and Community Based Services

2. www.lewin.com Outline Background What is VD-HCBS? Key Components and Status of VD-HCBS Opportunity to serve Veterans and Caregivers Lessons Learned Q&A 1

3. www.lewin.com Session Outline 2 "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

4. www.lewin.com ACL Anniversary 3 "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

5. www.lewin.com 4 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

6. www.lewin.com 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 5

7. www.lewin.com 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 6

8. www.lewin.com 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 7

9. www.lewin.com 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 caregivers 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 8

10. www.lewin.com 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 9

11. www.lewin.com 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 10

12. www.lewin.com 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 11

13. www.lewin.com 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 12

14. www.lewin.com VD-HCBS NATIONAL STATUS 13

15. www.lewin.com 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 14

16. www.lewin.com VD-HCBS launched, 49 ADRC grants w/(5 year plans) 2007 2008 2009 2010 2011 2012 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 43 states, 147 sites, 30% of pop. ADRCs 47 states, 300 sites, 49% 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. 2003

17. www.lewin.com 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. 16

18. www.lewin.com VA Medical Centers in California VISN 22 VA Greater Los Angeles Healthcare System (GLA)Los Angeles VA Long Beach Healthcare SystemLong Beach VA San Diego Healthcare SystemSan Diego VA Loma Linda Healthcare SystemLoma Linda 17 VISN 21 VA Central California Health Care SystemFresno San Francisco VA Medical CenterSan Francisco Menlo Park Division Medical CenterMenlo Park Livermore Division Medical CenterLivermore VA Palo Alto Health Care SystemPalo Alto VA Northern California Health Care SystemMather

19. www.lewin.com Lessons Learned from Operational Sites You are never in this process alone. When you need help ask: ACL State Liaison, Darrick Lam darrick.lam@acl.hhs.gov ACL Project Officer, Elizabeth Leef elizabeth.leef@acl.hhs.gov NRCPDS, Sandy Barrett/Merle Edwards-Orr (readiness reviews) sandragbarrett@sbcglobal.net merle.edwards-orr@bc.edu Lewin leads: Patrick Brady/Roger Auerbach patrick.brady@lewin.com rogerauerbach@yahoo.com Or, ask to get connected with a colleague in an operational site. 18

20. www.lewin.com 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 19

21. www.lewin.com 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: Jan 10,2012 7. Identifying Your VD-HCBS Business Model Part II: January 12, 2012 8. Billing & Invoicing: January 17, 2012 9. Completing Your VD-HCBS Program Readiness Review: January 24, 2012 10. Cash Flow Management & Accounts Receivable: January 31, 2012 11. Quality Assurance Monitoring: February 2, 2012 12. Data, Performance, and Outcomes: February 7, 2012 20 http://www.adrc-tae.org/tiki-index.php?page=VDHCBStraining2011

22. www.lewin.com 21 National Quarterly VD-HCBS Webinars ACL/VHA will be holding quarterly educational webinars 6/12/13 9/18/13

23. www.lewin.com 22 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/