1. 1111 2010 Winter Conference National Association of State Veterans Home February 26 - March 4, 2010 Washington, DC Theresa Hayes State Home Per Diem Program Veterans Health Administration

2. Per Diem for SVHs from 2002-2009

3. 3333 VA State Home Basic Per Diem Rates NHC/HOSP DOM ADHC 2000 $46.49 $20.36 N/A 2001 $51.38 $22.03 N/A 2002 $53.17 $23.74 N/A 2003 $56.24 $26.95N/A 2004 $57.78 $27.19N/A 2005 $59.36 $27.44N/A 2006 $63.40 $29.31$37.91 2007 $67.71 $31.30$40.48 2008 $71.42 $33.01 $64.13 2009 $74.42 $34.40 $66.82 2010 $77.53$35.84 $69.63 2011 $94.59$38.90TBA

4. 4444 Number of State Veterans Nursing Homes, Domicilaries, and ADHC’s for FY 2000 – 2009 Number of State Veterans Nursing Homes, Domicilaries, and ADHC’s for FY 2000 – 2009

5. 5555 Total Number of Authorized Beds for FY 2009  Total State Home programs: 137 in 50 states and Puerto Rico  Total State Veteran Nursing Homes: 131 in 50 states and Puerto Rico (24,302 beds)  Total State Domiciliary facilities: 53 in 33 states and Puerto Rico (6,086 beds)  Total State ADHC programs: 1 state (50 slots)

6. 6 FY 2009 Annual ADC, Percentage of VA Cost Average Per Diem Cost & Occupancy Rates Average Daily Census Average Percentage of Cost Paid by VA Average Daily Census Average Percentage of Cost Paid by VA  Nursing Home: 19,027 32%  Domiciliary Care: 2,837 25%  Hospital Care: 62 (Hospital Closed 3 rd QTR) 14%  Adult Day Health Care: 14 40% Average Per Diem CostOccupancy Rates Average Per Diem CostOccupancy Rates  Nursing Home: $238.91 75% Vet-----85%Total  Hospital Care: $991.48 100%Vet---- 48%Total  Domiciliary Care: $140.52 93% Vet ---68%Total  Adult Day Health Care: $165.22 32% Vet----73%Total

7. 7 38 U.S.C. 1745 (Implementation date May 29, 2009) Requires VA to begin paying States higher rate for SNF to certain veterans in State nursing homes with SC disability rated 70% or higher and those requiring nursing home care for a SC disability. The new per diem rate is the lesser of the following: The applicable or prevailing rate payable in the geographic area in which the State home is located. A rate not to exceed the daily cost of care in the SNF. The law thus requires VA to use the actual cost of care in State homes based on a report from the home in determining the higher per diem, and the home will receive its actual cost if LESS than the applicable or prevailing rate.

8. 8 Effect on Per Diem for Veterans Without a SC Disability  Other Veterans on whose behalf VA pays per diem to State homes (but do not require nursing home care because of SC disabilities) will still receive the basic per diem rate from VA. Current basic per diem rate for NHC is $77.53.  This rate is adjusted each fiscal year.

9. 9999 38 U.S. C. 1745 The new law requires VA to furnish medications needed to treat a SC disability. Aid and Attendance rules also apply. The new law requires VA to furnish medications needed to treat a SC disability. Aid and Attendance rules also apply.

11. 11 National Estimated Higher Per Diem Rates for Nursing Home Care FY 2007: $258.64 FY 2008: $268.80 FY 2009: $278.39 FY 2010: $275.53 FY 2010: $275.53 (Includes Drug Costs) (Includes Drug Costs)

12. 12 The Importance of Form 10-5588 Per Diem Cost –The VA Form 10-5588 is a tool for communicating with the VA the SVH’s cost and request for federal aid. –Complete and accurate reporting of per diem costs is the only way the VA can determine the per diem amount to pay per 38 U.S.C. 1745. –Must enter monthly reporting data in Citrix CORRECTLY and ON TIME.

13. 13 VA Form 10-5588 Consists of Several Parts  Gains and Losses  Days of Care  Average Daily Census  Total Per Diem Cost (Daily Cost of Care for the Month)  Per Diem Claimed  Total Amount Claimed For Hospital, Nursing Home, Domiciliary and Adult Day Health Care.

14. 14 The State home should submit the 10-5588 to VA Medical Center of Jurisdiction by the end of the 5th workday after the close of each monthly report period. VA medical center of jurisdiction staff will review each monthly 10-5588 for accuracy, resolve any discrepancies with the State home, make payment by electronic fund transfer and file the report. A report should not be accepted if the report is incomplete, calculations not accurate, or missing the authorized signature of the SVH.

15. 15 For additional information, please contact: For additional information, please contact: Theresa Hayes @ (202) 461-6771 theresa.hayes@va.gov or or Brenda Wiggins @ (202) 461-6757 brenda.wiggins3@va.gov brenda.wiggins3@va.gov