Geriatrics and Extended Care

1
Geriatrics and Extended Care

• Update on Recent Changes
• that affect the
• State Home Per Diem Program
• Jacquelyn S. Bean
• prepared for
• The National Association of State Veterans Home
  Administrators Conference
• New Orleans, Louisiana
• July 8-12, 2007

2
Background

• New Public Law 109-461 was signed by the
  President on
• December 22, 2006
• Adds a new section 1745 to title 38, United
  States Code.
• Requires VA to begin paying states a higher rate
  for nursing home care furnished to certain
  veterans in State nursing homes. The higher rate
  must be paid for veterans with a
  service-connected (SC) disability rated 70 or
  higher, and those receiving care for a SC
  disability.
• The new law also requires VA to furnish
  medications for certain additional veterans
  receiving care in a State home.
• The first two provisions described above were
  effective 90 days after the law was signed.

3
Recent Actions Taken to Implement Provisions in
this Legislation

• A VHA workgroup has been formed to identify
  actions that are required to implement and
  administer the new provisions.
• This group is comprised primarily of members from
  
• Geriatrics and Extended Care (GEC)
• Chief Business Office (CBO)
• Pharmacy Benefit Management (PBM)
• Office of General Counsel (OGC)
• Chief Information Office (CIO)
• NASVH input was solicited.

4
Recent Actions Taken to Implement Provisions in
this Legislation (continued)

• Regulations will be promulgated through the
  normal process of publication in the Federal
  Register after public notice and comment.
• GEC has contracted with a Regulation Specialist
  to revise the State Home Per Diem regulations to
  implement the first two provisions of this new
  public law.
• These regulations are being written now.

5
Recent Actions Taken to Implement Provisions in
this Legislation (continued)

• Actions Associated with Regulation Development
• (1) Draft Proposed Final Rule
• (2) VHA Concurrence Process
• (3) VA Concurrence Process
• (4) Submission to OMB (90)
• (5) Publish in Federal Register for notice
• and comment period (60)
• (6) Develop Final Rule

6
Recent Actions Taken to Implement Provisions in
this Legislation (continued)

• Modifications have been submitted to revise two
  of VAs state home program management forms
• (1) VA Form 10-5588 to capture data and claim
  information on 70 service connected veterans.
• (2) VA 1010-SH to capture admission information
  that will help to determine which veterans are
  eligible for the higher SC per diem rates and
  under the new medications program.

7
Recent Actions Taken to Implement Provisions in
this Legislation (continued)

• Workgroups have been formed with VHAs Chief
  Information Office to determine internal VA
  software systems that will provide IT support for
  additional processes for new per diem
  computations and for free medications for
  eligible veterans.
• These systems are being projected to become
  operational at the same time that the regulation
  development process has been completed.

8
Proposed Rate Chart Methodology for New SC
Eligible Residents

• A new rate chart has been developed that is
  specifically for the service connected veterans
  who are eligible for the full cost of care.
• This chart uses CMS rates in the catchment areas
  where current State Veterans Homes are located.
• CMS RUGIII Nursing Home rates will be used for FY
  2007 as an initial base.
• These rates will be adjusted for changes on an
  annual basis.

9
Proposed Rate Chart Methodology for New SC
Eligible Residents (continued)

• The published rates can be found at
• http//www.cms.hhs.gov/snfpps.downloads/coms-153
  0-n-pdf.
• Both the case mix rates and geographic wage index
  were used to project a per diem cost for each
  individual state veterans nursing home.
• The RUGIII Rate is specific for each state
  veteran nursing home. It uses the average rate
  of the 53 RUGIII nursing home case mix levels
  multiplied by the CMS geographic wage index
  (which is determined by the county of the nursing
  home).

10
Proposed Rate Chart Methodology for New SC
Eligible Residents (continued)

• 13 is omitted from this rate to eliminate the
  profit margin that is calculated into the initial
  CMS rates.
• An additional 3 is then added into the final
  rate to cover additional doctor visits that are
  not included in the CMS rates.
• The formula used to calculate the per diem cost
  is as follows (RUGIII Rate) 87 3

11
Proposed Rate Chart Methodology for New SC
Eligible Residents (Sample Depiction of Rates
by Home)
12
Recent Actions Taken to Implement Provisions in
this Legislation (continued)

• We have also been working with VHAs Pharmacy
  Benefits Management to implement the new law to
  include 50 or more service connected veterans
  for free medications.
• Our initial intention was to implement this
  provision by using a transmittal. This would
  have allowed the change to avoid the rule-making
  process. However, it has been determined that
  rule-making for this is mandatory. As such, we
  will be incorporating this provision in our
  regulations with the 70 service connected
  provision.

13
Effect on Per Diem for Veterans without SC
Disabilities

• Other veterans on whose behalf VA pays per diem
  to state homes (but do not have SC Disabilities)
  will still be eligible to receive the standard
  national per diem rate that VA presently pays.
• This rate is adjusted each fiscal year.

14
Proposed SH Per Diem Rates for FY 2008 (for
Veterans without the new SC Eligibility)

• Nursing Home 71.42
• Hospital 71.42
• Domiciliary 33.01
• Adult Day Health Care 64.13

15
NASVHs Role in this Initiative

• Recommendations concerning options for processes
  that may be used to implement this new public law
  were previously requested from members of the
  National Association of State Home
  Administrators.
• Your ongoing input concerning this is valued.
  Its important to us as we move through the
  development process.

16
Updates on Progress

• The Office of Geriatrics and Extended Care will
  keep you advised of new developments for the
  implementation of these programs.
• For additional information, please contact
• Jackie Bean, Chief
• State Home Per Diem Program
• Telephone [phone]