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State Home Per Diem Program Overview and IPERA Update

This presentation provides an overview of the State Home Per Diem Program (SHPDP) and updates on the Improper Payments Elimination and Recovery Act (IPERA). It covers program organization, budget, objectives, required documents, IPERA accuracy rates, error findings, and the strategic plan.

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State Home Per Diem Program Overview and IPERA Update

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  1. VHA Office of Community CareState Home Per Diem ProgramFebruary 12, 2019 Colette Alvarez, Chief State Home Per Diem Program

  2. AGENDA • State Home Per Diem Program (SHPDP) Organization and Overview • Improper Payments Elimination and Recovery Act (IPERA) Update • 2019 Strategic Plan

  3. State Home Per Diem Program Contacts Colette Alvarez Chief, State Home Per Diem Program Colette.Alvarez@va.gov (775) 842-5755 Gloria J. Sanford Deputy Chief Gloria.Sanford@va.gov (719) 229-7325 Robin Lateef Budget Analyst Robin.Lateef@va.gov 303-398-5541 Brenda Wiggins Program Analyst Brenda.Wiggins3@va.gov (202) 578-7550 Cheri Baloun Program Specialist Cheri.Baloun@va.gov (303) 780-4727 Steve Pellicer Senior Program Specialist Stephen.Pellicer@va.gov (386) 623-5534 Jim Peters Program Specialist James.Peters6@va.gov (303) 398-5154 Andrea Stylen Program Specialist Andrea.Stylen@va.gov (720) 889-2300 Administrative Support Vacant Desarine Melendrez Program Specialist Desarine.Melendrez@va.gov 303-398-3428

  4. BACKGROUND SHPDP • Partnerships with 156 State Veterans Homes (SVHs) • SVHs are located in each of the 50 states and Puerto Rico. • 148 nursing homes (NH) • 53 domiciliary (DOMs) • 3 adult day health care (ADHC) facilities • Budget of $1.4B. • They are owned, operated and managed by state governments. • To participate in the SVH programs, VA must formally recognize and certify a facility as a SVH.

  5. SHPDP OVERVIEW • Provides grant per diem funding • Responds to inquiries and provides assistance • Provides information on IPERA • Assists with establishing annual State Home Per Diem payment rates. • Assists in the development or implementation of per diem payment regulations and legislation. • Provides training and guidance to VA Medical Center (VAMC)s and State Veteran Homes (SVH)s 

  6. SHPDP BUDGET In Millions Projected

  7. AUDIT OBJECTIVES What is the IPERA Review? The Improper Payments Elimination and Recovery Act (IPERA) of 2012: • Requires federal agencies to identify high-risk programs and conduct audit reviews and report annually on programs to determine if claims or payments were paid properly, • The audit is coordinated by the Financial Assistance Office (FAO) and performed by Office of Community Care OCC Department of Internal Audits (DAIC) Team, • Evaluates our payment accuracy and identifies improper payments, and • Makes recommendations for process improvements.

  8. REQUIRED DOCUMENTS State Home Per Diem payments are reviewed against the following system information and documentation provided to determine the accuracy of the payments: • VA Form 10-5588 State Home Report and Statement of Federal Aid Claimed; • VA Form 10-10EZ – Application for Health Benefits*; • VA Form 10-10SH – State Home Program Application for Veteran Care Medical Certification*; • Station Census and/or Movement/Tracking Log for all Veterans residing in the facility; and • Service Connected Disability rating information from Hospital INQuiry (HINQ) or Veterans Information System (VIS). *10-10SH and 10-10EZ admission documents are required for all residents residing in the SVH and DOM

  9. IPERA ACCURACY RATES • IPERA standard is 98.5% • Current OCC Agency Financial Report (AFR) reduction target for SVH is 3.29%

  10. IPERA ERROR FINDINGS Error trends continue to limit the success of meeting SVH IPERA target rate of 98.5%. Two of the major IPERA errors findings are: • Missing 10-10SH/10-10EZ Documentation – Admission documents missing entirely and payment was not entitled or authorized. • Incomplete 10-10SH/10-10EZ Documents – 10-10SH Authorization for Payment section was not completed 100%. 10-10EZ financial discloser not completed for Domiciliary admissions.

  11. STRATEGIC PLAN Rollout Automated 10-10SH – Cloud Based Web Application Updates to meet Adult Day Health Care (ADHC) Regulation Updated Application and Invoice Forms Employee Education System (EES) Knowledge Assessment Training Collaboration with Geriatrics and Extended Care (GEC) to develop process for Replacement Facilities SHPDP Internal Control Reviews

  12. QUESTIONS

  13. THANK YOU This slide is meant for a large graphic or image only, with a slide title. No text other than a title.

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