1. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ VD-HCBS Training Series Planning and Developing the VD-HCBS Program December 6, 2011 Trainers: Lori Gerhard, Kevin Foley, Abigail Morgan, Suzanne Crisp and Patrick Brady

2. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Learning Objectives At the end of this one hour session, participants should: 1.Understand the value of developing a VD-HCBS Implementation Plan 2.Understand the components of a VD-HCBS Scalability Plan 3.Identify population that may be served through the VD-HCBS infrastructure 4.Understand how to develop the operating budget, project growth and expansion of the infrastructure and population served.

3. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Agenda Definition of key terms What is VD-HCBS? Planning & Projecting need Program Development Next steps and timelines Questions and answers

4. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Key Terms Veteran’s Directed Home and Community Based Services (VD- HCBS)— a product that the VA purchases from the Aging Network. The program includes 2 components—Veteran’s Monthly Budget and Veteran’s Administration Services. Veteran’s Monthly Budget— These are the funds the Veteran uses to purchase services & goods in order to remain independent in the community. This amount also includes a “Respite/Emergency Back-up” and planned savings fund. The “Emergency/Respite rainy day” fund is used for care when agency providers are required as back-up for workers the Veteran hires, or for respite care. Planned savings are for purchases which cannot be supported in a single month’s budget. Veteran’s Administration Services— These are the funds for the service coordination and Financial Management Services (FMS) supplied by the Provider and Provider’s administrative costs. Services include assessment, options counseling/care management, Financial Management Services (FMS) and program administration.

5. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Key Terms VD-HCBS Operating Components— Options Counseling/Care Management/Support Broker, Financial Management Services (FMS), Program Administration. Options Counseling/Care Management/Support Broker— A person-centered, interactive, decision-support process whereby individuals receive assistance in their deliberations to make informed long-term support choices in the context of their own preferences, strengths, and values. Financial Management Services— Service/function that assists the family or participant: (a) manage and direct the distribution of funds; (b) facilitate the employment of staff by acting as the participant’s agent with employer responsibilities such as processing payroll, withholding and filing federal, state, and local taxes, and making tax payments to appropriate tax authorities; and (c) performing fiscal accounting and making expenditure reports to the participant and/or family and state authorities. Program Administration— Program management/oversight, financial management, quality assurance, reporting, program performance

6. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Key Terms Operating Statement- summarizes revenue sources and expenses, and shows the excess or shortage or revenues compared to expenses Scalability Plan— Community Environment/Marketplace—

7. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Defining Veterans-Directed Veteran Decides When Provided Decides How Provided Decides Who Provides Decides What Services & Supports Primary Decision- Maker Primary Decision- Maker

8. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ What’s Different About VD-HCBS Traditional Aging Network Programs Federal/State/Local Oversight Possible Contracts with other Agencies Funded through grants Minor Reporting and Data Collection Required VD-HCBS New Federal Partnership with the Veterans Health Administration VAMCs and AAAs/ADRCs enter into VA Provider Agreements VAMCs provide funding through service reimbursement (CASH FLOW) Monthly reports and invoices are required in order to receive reimbursement

9. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ VD-HCBS Product Components Veteran’s Budget Spending Plan Rainy Day Fund (Emergency/Respite Fund) Administration Options Counseling/Care Management Services Fiscal Management Services Program Administration Assessment Monthly Admin Services Case Management Options Counseling Financial Management Services (FMS One Time Initial Assessment (full/partial) AAA Administrative Veteran’s Monthly Budget/Spending Plan Goods Emergency/Back- up/Respite Services

10. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Business Model Components Assessment Options Counseling Care Management Assessment Options Counseling Care Management Program Administration FMS

11. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Integrating Core Functions Across Programs

12. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Community Environment – Who lives here ? Who do we currently serve ? Who don’t we serve ? – What are the community challenges/needs ? – Who else is operating in my marketplace ?

13. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Community Scan – Serving Individuals ADRC Veteran Person with Physical Disabilities Person with Physical Disabilities Person with Chronic Conditions Nursing Facility Patient Nursing Facility Patient Caregiver Older Adult Hospital Patient

14. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Community Scan – Buyers ADRC Foundations Private Insurance Employer Assistance Programs Employer Insurance Plans Medicare FFS/MAP/SNP OAA Medicaid VA Medical Center PACE

15. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Assessing Current Capacity Organizational Capacity – Workforce Capacity Staff development Quantity/staffing ratios – Management Systems – Technology/IT – Fiscal Operations – Quality Assurance – Human Resources – Partnerships – Communication Systems

16. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Community Scan People Served Cultivating Buyers VAMC Hospital Local Health Dpt. Nursing Facility Assisted Living Veteran HospitalPatient Older Adult Caregiver Persons with Disability Medicare Private Insurance Medicare/Medicaid VAMC/Hospital OAA Organizational Scan Intake Assessment Patient Activation Care Plan Service Connection 16

17. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ 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

18. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Growth/Trajectory # of People

19. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Determine when to Add/Train New Staff Assess Capacity of Contracted Entities Quality Assurance Program with Dedicated staff Track Program Performance Indicators Management Reports Identify Staff Training Needs Reassign Existing Options Counselors/Care Managers, Administrative Support and Supervisory Staff Identify IT/Track Activity Prepare for Realistic Enrollment Serving 1 to 25 Consumers Serving Scalability Plan Planning for Growth Serving 25 to 50 Consumers 25 to 50 ConsumersServing

20. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Data collection & Reporting System Management Reports – Monthly Surplus/loss statements – Accounts Receivable (A/R) Report – Cash Flow Report – Census Report Continuous Quality Imrovement Reports

21. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Operating Budget 1CensusMonthly Rate Assumptions JanFebMarAprilMayJun…DecTotal 2VD-HCBS +5 81318232833 3OAA 25/month 25 4Care Transitions 10/month 10 5MFP +4 48121620 6Census Total 7Revenue 8VD-HCBS $400 $$$$$ 9VD-HCBS Assessments $900/assessment 10OAA I&R, Care Management 11Care Transitions $250 12MFP $100/month/person 13Revenue Total 14Expenses 15Payroll OC—1:25 16Contracted Services FMS-$ per month 17Supplies 18Office Space 19Total Expenses 20Operating Surplus/Loss

22. U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES, ADMINISTRATION FOR COMMUNITY LIVING, WASHINGTON DC 20201 PHONE 202.619.0724 | FAX 202.357.3523 | WEB http://www.hhs.gov/acl/ Business Model Components Assessment Options Counseling Care Management Assessment Options Counseling Care Management Program Administration FMS