State Home Per Diem Program Monthly National Call

1. State Home Per Diem Program Monthly National Call Wednesday, July 17, 2019 VAMC employees, please enter your name, VISN, and station number in the chat pod. VISN level employees, enter your name and VISN number. State Veteran Homes, enter your facility name We will begin shortly!

2. REMINDERS • Quarterly Calls with the SVH and VAMCs are held on the second Wednesday of every October, January, April and July at 3pm ET • Target Audience • VAMC and VISN Staff involved in the admissions and/or payment process to State Veterans Homes • State Veteran Homes • This call is not with Geriatrics and Extended Care • Attachments • Available in download pod in Adobe Connect

3. REMINDERS cont. • Minutes and Attachments for today’s call • VA staff, please utilize the VA Pulse Page • https://www.vapulse.net/groups/state-home-per-diem-fsvp/overview • Please keep your phones MUTED • *6 to unmute • VHA10D1B3StateHomePerDiemInquiries@va.gov

4. ROLL CALL • VAMC employees • Please enter your name, VISN, and station number in the chat pod • VISN level employees • Please enter your name and VISN number • State Veteran Homes • Please enter your facility name

5. Colette Alvarez New business

6. Department of Internal Audits IPERA Audit update

7. 2019 over FY18 Data SH IPERA Audit • Audit Review Completed! • 400 Monthly Invoices • 100% complete • Preliminary Improper Payment = $2,464,307.58 • Leading causes of error: • Missing Documentation - $1,135,228.60 • Incomplete Documentation - $573,666.68 • Unverified Service Connection - $403,725.53

8. 2020 over FY19 Data IPERA Audit • Q1 & Q2 Samples • 200 Monthly Invoices • 20% complete • Preliminary Improper Payment = $409,103.75 • Leading causes of error • Missing Documentation • Unverified Service Connection This Photo by Unknown Author is licensed under CC BY

9. Jim Peters State Home Per Diem Program“Overview” Training

10. OVERVIEW TRAINING • Two training sessions are held each month • Who can/should attend? • New VHA State Home Per Diem POCs • Anyone who would like a refresher

11. OVERVIEW TRAINING DATES • July Overview Training dates • Friday, July 19th and Tuesday, July 23rd • All sessions start at 1pm MT • Email VHA10D1B3StateHomePerDiemInquiries@va.gov

12. Colette Alvarez SHPDP Monthly Call meeting time

13. Colette Alvarez UPCOMING NASVH CONFERENCE

14. NASVH Conference The Summer NASVH Conference will be held in Denver on August 5th through the 9th this year. 

15. Colette Alvarez State Home Per Diem ProgramDomiciliary Care Eligibility

16. Domiciliary Care Eligibility A Veteran is an eligible Veteran for the purposes of payment of per diem for domiciliary care in a State Veteran Home under 38 CFR 51 if VA determines that the Veteran is not barred from receiving care based on his or her service (see 38 U.S.C. 5303, 5303A), is not barred from receiving VA pension, compensation or dependency and indemnity compensation based on the character of a discharge from military service (see 38 CFR 3.12), and the Veteran is: • A Veteran whose annual income does not exceed the maximum annual rate of pension payable to a Veteran in need of regular Aid and Attendance, or • Any Veteran who the VA Secretary determines has no adequate means of support

17. No Adequate Means of Support 38 CFR 17.47(b)(2)) • No Adequate Means of Support refers to an applicant for domiciliary care whose annual income exceeds the annual rate of pension for a Veteran in receipt of regular aid and attendance, as defined in 38 U.S.C. 1503, but who is able to demonstrate to a competent VA medical authority, on the basis of objective evidence, that deficits in health and/or functional status render the Veteran incapable of pursuing substantially gainful employment (as determined by the VA medical center of jurisdiction Chief of Staff) and who is otherwise without the means to provide adequately for self, or to be provided for in the community.

18. Domiciliary Care Eligibility • Two questions are asked on the VA Form 10-10SH concerning “no adequate means of support” for payment in the State Veteran Home. • The VA Clinician must determine if a Veteran’s meets the below in order to provide Domiciliary Level of Care to a Veteran who exceeds the maximum annual rate of pension payable to a Veteran in need of regular Aid and Attendance : 83 - DOES VETERAN HAVE MEANS TO PROVIDE FOR SELF OR BE PROVIDED FOR IN THE COMMUNITY:  YES / NO 84 - DOES HEALTH AND/OR FUNCTIONAL DEFICITS RENDER VETERAN UNABLE OF PURSUING SUBSTANTIALLY GAINFUL EMPLOYMENT: YES / NO

19. Domiciliary Care Eligibility • An additional requirement for eligibility for domiciliary care is the ability of the Veteran to perform the following: • Without assistance, daily ablutions (hygiene), such as brushing teeth, bathing, combing hair, or eliminating body waste • Dress self with a minimum amount of help • Proceed to and return from the dining hall with aid • Feed self • Secure medical attention on the ambulatory basis or by use of personally propelled wheelchair • Have voluntary control over body eliminations or control by use of an appropriate prosthesis • Share in some measure, however slight, in the maintenance and operation of the SVH facility • Make rational and competent decisions as to his or her desire to remain or leave the facility

20. Brenda Wiggins Automated 10-10Sh Questions/Answers

21. Robin Lateef 10-5588 INVOICE Due Dates

22. WEB APPLICATION DATA Web Application data: The July 2019 invoice data is to be entered in the Web Application Portal August 21, 2019.  This data is what makes up the timeliness report which is sent to leadership thru the Active Strategy process.  The information is also used for the SECVA Pocket Card and the USA Spending Report and is reconciled with FMS for budget purposes. On Time 88%- Thank you so very much Web Application invoice entries are due by the 15th working day each month

23. Colette Alvarez Mail bag

24. MAIL BAG – QUESTION 1 We had a Veteran pass away before they were able to sign the 10-10EZ. Is per diem automatically denied?

25. MAIL BAG – ANSWER 1 No. First check to see if the Veteran had a Power of Attorney (POA) who could sign the 10-10EZ in their stead. Additionally, if the Veteran is admitting to the nursing home or adult day health care levels of care, the VAMC may have a signed 10-10EZ/EZR on file. If a form is on file, it can be used to complete the admission package. Be careful with pulling an existing 10-10EZ/EZR for DOM admissions because it must have the income information and be current within a year of admission.  If you are unable to have a POA sign the form or locate a completed 10-10EZ/EZR at the VAMC, the Veteran will be denied per diem for the days they were in the home before passing.

26. MAIL BAG – QUESTION 2 We had a nursing home Veteran on bed hold for four days. On the fourth day, the Veteran returned to the facility, but was readmitted to the hospital after midnight.  Will the 10-day bed hold count restart?

27. MAIL BAG – ANSWER 2 Yes. Per 38 CFR §51.40 (c)(1), Determining whether a veteran spent a day receiving nursing home care, “VA will pay per diem for each day that the veteran is receiving nursing home care and has an overnight stay at the State home.” Since, the Veteran had returned to the hospital after midnight, this counts as an overnight stay and the 10-bed hold day count resets.

28. ADDITIONAL INFORMATION • NEXT SHPDP NATIONAL CALL • August 14that 3pm EST/11am MST • VAMC’s, and VISN’s • SUGGESTIONS, QUESTIONS, AND TOPICS • Please submit your ideas for National Call topics to the SHPDP Inquiries Email Group no later than July 26th,2019 • VHA10D1B3StateHomePerDiemInquiries@va.gov

29. DO YOU HAVE A QUESTION? • *6 to unmute yourself • Type your question into the chat pod THANK YOU