HEALTH CARE AND HUMAN SERVICES POLICY, RESEARCH, AND CONSULTING - WITH REAL-WORLD PERSPECTIVE.
Veterans Directed Home and Community Based Services
Kevin Foley
Administration for Community Living (ACL)
March 13, 2013
kevin.foley@acl.hhs.gov
Outline
 Background
 What is VD-HCBS?
 Key Components and Status of VD-HCBS
 Opportunity to serve Veterans and Caregivers
 Lessons Learned
 Q&A
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Session Outline
"For too long, too many Americans have faced the
impossible choice between moving to an
institution or living at home without the longterm 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
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ACL Anniversary
"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
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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
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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
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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
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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
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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 caregiver’s 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
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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
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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
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•
•
•
•
•
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
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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
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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
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VD-HCBS NATIONAL STATUS
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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
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Milestones of VDHCBS
Development
VDHCBS Expands
to 81 ADRC/AAA,
33 VAMCs and 20
VDHCBS Expands
States
to 53 ADRC/AAA,
21 VAMCs and 15
States
VD-HCBS
launched, 49
ADRC grants
w/(5 year plans)
Nursing Home
Diversion/Community
Living Program
2007
VDHCBS Expands
to 93 ADRC/AAA,
41 VAMCs and 24
States
National
Roll out of
VD-HCBS &
VD-Respite
2012
2011
2010
2009
51 states, 467 sites, 70% of pop.
2008
ADRCs 47 states, 300 sites, 49% of pop.
ADRCs 43 states, 147 sites, 30% of pop.
ADRC
ADRCs 24 states, 42 sites, 8% of pop.
2003
ADRCs12 states, 8 sites, 2% of pop.
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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.
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VA Medical Centers in California
VISN 21
VA Central California Health Care System
Fresno
San Francisco VA Medical Center
San Francisco
Menlo Park Division Medical Center
Menlo Park
Livermore Division Medical Center
Livermore
VA Palo Alto Health Care System
Palo Alto
VA Northern California Health Care System
Mather
VISN 22
VA Greater Los Angeles Healthcare System (GLA)
Los Angeles
VA Long Beach Healthcare System
Long Beach
VA San Diego Healthcare System
San Diego
VA Loma Linda Healthcare System
Loma Linda
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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.
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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
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Where can I learn More?
Title & Dates
1.
2.
3.
4.
5.
Planning & Development: December 6, 2011
Identifying Your VD-HCBS Business Model: December 8, 2011
Finalizing Your VD-HCBS Provider Agreement: December 13, 2011
FMS Strategy and Readiness Review: December 20, 2011
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
http://www.adrc-tae.org/tiki-index.php?page=VDHCBStraining2011
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National Quarterly VD-HCBS Webinars
 ACL/VHA will be holding quarterly educational
webinars
►6/12/13
►9/18/13
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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/
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