Administrators Update New Member Orientation Presented By Melissa

Administrator’s Update & New Member Orientation Presented By: Melissa Jackson NASVH 1 st Vice President 2020 Winter Conference Arlington, Virginia

Take a moment to ensure you get credit for the conference If you don’t have or use your NAB number, you won’t get CEU credit. Jonathan has worked hard to get us 13 CEUs Let’s take a moment to get you set up www. nabweb. org

www. nabweb. org, member login

Past Presidents “Attending” Thank you for your continued leadership and involvement! Kelley Kash, ME 2018 - 2019 Sharon Murphy, MD 2017 - 2018 Kim Justice, AL 2016 - 2017 Bill Peterson, DE 2015 – 2016 Fred Sganga, NY 2011 – 2012 Alfie Alvarado, WA 2004 – 2005 Jack Tarter, WY 1983 – 1984 Walter Baker, MI 1953 – 1954 First ***

Welcome! This session’s theme is engagement and updating members on current regulatory changes and operational issues. Please use the next several days to meet and network with your peers, NASVH Leadership and VA representatives. Continue those relationships as you go back home and serve the veterans entrusted to our care. It will be the best investment you ever make!

Introduction of New Members/First Time attendees § Please identify yourself, your role and what state you are from. § Regional Directors – if a new member is from your region please stand introduce yourself. Regional membership is outlined both in the Constitution and on nasvh. org under Committees, Executive/Regional.

Broad Range of SVH structure We are not all the same. • Structure & governing board vary. • Majority of SVH are managed and operated by State Government, with oversight provided by State Veterans Affairs and/or an advisory board or commission; • Several states have elected to contract out the management and operation of the SVH to a private contractor. The followings states have at least one SVH under contract: Alabama, Colorado, Hawaii, Maryland, Montana, North Carolina, South Carolina, Texas, Utah, Oregon, Wisconsin and Puerto Rico. • Some receive general fund support, other funding streams, some are receipts based only, some a combination. (Kentucky $20 million/yr general fund + receipts)

NASVH Membership Directory Great go to resource, copy to each member facility Complete listing of all SVHs, with contact information NASVH Constitution, By-Laws, Officer Duties, MOU with USDVA Contact Information for State Veterans Home Program, Chief Business Office, VISN Districts, VA MC’s of Jurisdiction, Construction Grants You are responsible for updating content. Please inform your Regional Director of any change in administrator, contact information, etc. (Including your most current photo…)

NASVH Annual Dues Best Value around, flat $900/facility Invoice sent in September by Jack Tarter for the following calendar year. • Prompt payment appreciated!!!

State Veterans Home Program 2018 Statistics § § State Veterans Homes are the largest provider of long-term care to veterans. There are 156 State Veteran Homes across all 50 States and the commonwealth of Puerto Rico totaling more than 34, 000 beds Provides 3 levels of care: • Nursing Home (7 million days) • Domiciliary (1. 5 million days) • Adult Day Healthcare

State Veterans Homes Statistics: Provide 53% of the VA’s long-term care workload at 16% of the VA total expenditures for long-term care 1 at less than half of the daily cost 2 of the VA Community Living Center 3 1. 2. 3. GAO-1489, Report to the Ranking Member, Committee on Veterans’ Affairs, House of Representatives, December 2013 2. VA FY 2016 Rates for the State Homes Per Diem Program, VA 10 N Memorandum dated October 27, 2015 Department of Veterans Affairs, Volume II, Medical Programs & Information Technology Programs Congressional Submission, FY 2017 Funding and FY 2018 Advance Appropriations Request, VHA-91.

MISSION: NASVH promotes and enhances the quality of care and life of Veterans and families in State Veterans Homes through Education, Networking, and Advocacy VISION: NASVH is the premier advocate and resource for State Veterans Homes

Strategic Goals 1. Increase resources and capacity. 2. Build and strengthen alliances. 3. Increase member engagement.

NASVH Resources

NASVH Conferences Two yearly conferences • Winter Conference always in Washington D. C. area. • Summer Conference - rotating location • July 13 – 17, 2020 San Diego, CA Our conferences allow for: • • Continuing Education Credits (13 CEUs this year) USDVA Updates Presented by VA Program Staff CFO Updates & Best Practices Learning Best Practices Leadership Development Presentations Educating Your Congressional Delegation Networking – make the most of this opportunity!!!!

NASVH Website www. nasvh. org Complete listing of SVHs NASVH Leadership VA Contact Information Regulations NASVH Resolutions Conference Presentations Employment Opportunities Timely & Pertinent Information Member’s Only Section

2019 -2020 Legislative Agenda § SVH Domiciliary Program § Ending Duplicative Surveys § VA Construction Grant Program

SVH Domiciliary Program § § § Current VA Per-Diem Rate is $48. 50/day, antiquated model and insufficient funding. Many SVHs are struggling to provide this service, facing strategic decisions. AO 88 regulation enforcement has created confusion (please read, link on nasvh. org, Links, Updated VA Regulations, Final Rule AO 88. (Critical read)

Ending Duplicative Surveys HR 4138 § Many SVHs undergo two annual Federal inspections per year, VA surveys – conducted by a contract group “Ascellon”, then their CMS certification survey. SVHs that don’t participate in Medicare and Medicaid still have licensure surveys carried out by varying arrangements at the state level by a wide variety of entities. § Having two surveys by CMS and VA is disruptive and redundant. § Duplicative Surveys are costly to the American Taxpayer. § We are advocating that CMS accept the VA survey findings.

How does NASVH carry out its mission?

President • • One Year Term Executive head of the association. Chairs the executive committee, the association’s winter and summer conferences. Appoints committee chairs. Acts as the official representative of the association. Mark Bowman Kentucky

Vice Presidents 1 st Vice President 2 nd Vice President Melissa Jackson Vermont Heyward Hilliard

Officers and Duties Treasurer Jason Mc. Arthur Oregon Veterans Home Business Manager Jack Tarter Wyoming Secretary Linda Smith Michigan

Officers and Duties Judge Advocate/Historian Legislative Officer Joint Liaison Officer Lourdes “Alfie” Alvarado. Ramos Kelley Kash CEO Maine Veterans Homes Director, Washington State Department of Veteran Affairs Fred Sganga Executive Director Long Island State Veterans Home

Regional Director Duties Shall be the Executive Head of their Region, elected by their regional membership while in caucus at the summer conference. Participate as a member of NASVH Executive Committee Shall attend NASVH sponsored conferences, meetings, workshops, teleconferences Promote NASVH legislative efforts Educate regional members Serve as a point of contact for NASVH sponsored surveys, requests for information Assist webmaster and Secretary/Treasurer in maintaining and updating current SVH information

Northeast Regional Director Cheryl Poppe Superintendent, Soldiers Home in Massachusetts Chelsea cpoppe@massmail. state. ma. us Connecticut, Delaware, District of Columbia, Maine, Maryland, Massachusetts, New Hampshire, New Jersey, New York, Rhode Island, Vermont, Virginia, West Virginia

North Central Regional Director Steve Rolston Michigan Health Systems rolstons@michigan. gov Illinois, Indiana, Iowa, Kansas, Kentucky, Michigan, Minnesota, Nebraska, North Dakota, Ohio, Pennsylvania, South Dakota, Wisconsin

Southwest Regional Director Whitney Bell North Carolina State Veterans Home WRBell@pruitthealth. com Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, Missouri, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas

Western Regional Director Kelly Odegaard Oregon State Veterans Home Kelly. odegaard@ovhlebanon. org Alaska, Arizona, California, Colorado, Hawaii, Idaho, Montana, Nevada, New Mexico, Oregon, Utah, Washington, Wyoming

Committee Involvement Please identify a committee that aligns with your knowledge, skill, talent and passion and contact the Committee Chairperson in order to get involved.

Committees Executive Committee Budget, Finance & Audit Committee Constitution, Bylaws & Resolution Committee Education Committee Networking Committee Quality Enhancement Committee Joint Liaison Committee NASDVA Liaison Committee Nominating Committee Summer Conference Planning Committee

Executive Committee Composed of the President (Chair), First Vice President, Second Vice President, Secretary, Treasurer, Chairs of the Association’s Standing Committees, Joint Liaison Committee Chair, Legislative Officer, Judge Advocate/Historian, and the four (4) Regional Directors Responsible for the policy-making and strategic planning of the Association Other members include past Presidents who are currently administrators of a State Veterans Home or who have served as an administrator of same and are still an active member of the Association Communicates monthly via conference call All official actions taken by this Committee require a simple majority vote

BUDGET, FINANCE & AUDIT COMMITTEE • Fiduciary oversight of the fiscal affairs of the Association • Prepare and present annual budget for consideration and approval of the membership at the Summer Conference • Oversee and audit financial transactions of NASVH • Prepare and present annual written report of NASVH’s fiscal affairs to membership Sally Davis, Chair North Carolina State Veterans Homes

Constitution, Bylaws and Resolution Committee • Maintains current and workable Constitution and Bylaws • Ensures that the Association operates within the Constitution and Bylaws • Prepares and presents any recommended changes to the Constitution and/or Bylaws to the membership at the Summer or Winter Conference • Defines the actions that the Association should consider undertaking by promulgating, evaluating and preparing in written form, resolutions for consideration and action by the membership at the Association’s Summer and Winter Conferences Terry Prince Ohio Veterans’ Homes

Education Committee § Responsible for organizing and coordinating all educational programs • Uses internal and external resources, at its discretion, to provide the Association’s members with a relevant, high quality and timely CEU earning curriculum • Responsible for planning all educational offerings in conjunction with the President and Executive Committee Jonathan Spier, Chair Long Island State Veterans Home

Joint Liaison Committee • Proposes and promotes legislative and related initiatives in the best interest of the veterans of the US and SVH Program • Serves as the liaison to the USDVA • Implements and upholds the MOU between the USDVA and the NASVH • Communicates and meets with State and Federal officials, USDVA and Congress, to present and pursue related goals and objectives of the NASVH • Implements, recommends, and encourages support of USDVA initiatives when those initiatives are in concert with NASVH objectives; analyzes proposed legislation to determine probable impact on the SVH Program, and educates concerned parties relative to this legislation’s effects Kelley Kash, Chair Maine

National Association of State Directors of Veterans Affairs - (NASDVA) Liaison Committee Composed of the President of the Association (Chair), immediate Past President, and two other Past Presidents Serves as a liaison between the National Association of State Veterans Homes (NASVH) and the National Association of State Directors of Veterans Affairs (NASDVA) Works with NASDVA to develop and implement activities and programs which are mutually beneficial to both organizations The Chair or designee shall represent the Association at appropriate meetings or proceedings conducted by or in concert with NASDVA

Networking Committee • Responsible for facilitating communications within the Association and with related external parties • Develops, implements and maintains communication networks including web site, email and directory Tracy Schaner, Chair Idaho

Nominating Committee • Develops and presents a slate of officers for the Association. The Committee shall prepare and present its recommendations to the membership for approval at the Association’s Summer Conference • This Committee shall make every effort to select recommended officers on a regional and rotational basis • Composed of the Immediate Past President (Chair), and three other past presidents appointed by the standing President Kelley Kash, Chair Maine

Quality Enhancement Committee • Responsible for introducing new programs to the membership to enhance the quality of life of Veterans in SVH • Develops and implements initiatives with other related organizations to conduct joint programs which are mutually beneficial to both organizations • Identify and analyze changes in longterm care as they apply to the SVH Program • Promote best practices in SVH Program Ed Harries, Chair Tennessee Veterans Homes

Summer Conference Committee • With NASVH’s Conference Director, plans the Association’s Summer Conference; locates conference meeting sites; coordinates the event with the host state • Establishes, plans, and negotiates the Conference including date, time, hotel location and activities, up to three years in advance. • Committee shall make every effort to select hosts states and sites on a regional and rotating basis, preferably within 30 minutes drive from an airport Sharon Murphy, Chair Maryland State Veterans Home

VA Resources VA Staff SHPDP Calls Bi-monthly Training Contact Information https: //www. va. gov/COMMUNITY CARE/providers/info_Other. Care. a sp#SVH

State Veterans Homes Programs VA Oversight Office of Geriatrics and Extended Care • Operations, Surveys, Reporting, Appeals • Lisa Minor Director Facility Based Programs, Jo. Anne Parker, National Program Manager, Valerie Delanko SVH Quality & Survey Oversight VAMC of Jurisdiction and VISN (Map Slides) VHA Office of Community Care • State Home Per Diem Program • Colette Alvarez, Chief, State Home Per Diem Program • Brenda Wiggins, Program Analyst Office of Capital Asset Management & Support • State Home Construction Grant Program • Anna Gaug, Deputy Director/Program Manager Office of Construction & Facility Management • State Home Design and Construction Consultant

VA Reimbursement Basics (Grant Per Diem) VHA DIRECTIVE 1601 SH. 01 Basic Per Diem – (also known as the lower per diem, or per diem) 38 CFR 51. 40 Will pay the lessor of (1) (Onehalf of the cost of care for each day the veteran is in the facility; or (2) the basic per diem rate for the Fiscal Year established by VA in accordance with 38 U. S. C. 1741(c) ($112. 36 currently). Increases yearly Prevailing Per Diem Rate – also called Full cost of Care (misnomer), higher per diem, 70%, 100%. . . (VT) $427. 28/day, all inclusive per diem. Currently RUGS Based (more to come on that during the conference) Domiciliary Per Diem Rate- $48. 50

Fiscal Check VA 1010 EZ Application for Health Benefits VA 1010 SH Form State Home Program Application for Veteran Care Medical Certification (online system) VA 10 -5588 State Home Report and Statement of Federal Aid Claimed (key to basic per diem payments and improper payments 10 -10 SH forms must be completed timely & properly in order to receive payment. Form must be submitted to the VA in 10 calendar days from the date of veteran’s admission, if not you can only receive per diem for those eligible days after it is submitted. Poor Process = Lost Revenue $$$ Do you have an active tracking system in place ?

VA Construction Grant Program § Construction grant program may provide 65% matching federal funds for building new State Veterans Homes that are approved through the grant application process § Grant process also allows for the same match for a variety of projects § Please make sure you attend the State Veterans Home Construction Grant Program presentation led by Deputy Director Anna Gaug or stop by her and see her at the VA support table during the conference § Hoping for $250 million in funding § Going forward we want to eliminate any future backlogs

REMINDERS • Quarterly Calls with the SVH and VAMCs are held on the second Wednesday of every October, January, April and July at 3 pm 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

ADDITIONAL INFORMATION • NEXT SHPDP NATIONAL CALL – August 14 th at 3 pm EST/11 am 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 26 th, 2019 – VHA 10 D 1 B 3 State. Home. Per. Diem. Inquiries@va. gov

VA Pharmacy Directives (VHA DIRECTIVE 2011 -035) 1. OPTION 1. The VA medical centers into a sharing agreement with a SVNH that has a pharmacy located in the SVNH for this pharmacy to fill prescriptions for residents in the SVNH using Federal Supply Schedule (FSS) contracts. 2. OPTION 2. The VA medical facility enters into a sharing agreement with a SVNH that has a pharmacy located in the SVNH, for this pharmacy to fill prescriptions for residents in the SVNH using VA to procure medications at the "ceiling" prices. 3. OPTION 3. The SVNH enters into a sharing agreement with VA for VA to provide medications and pharmaceutical care services for the residents in the SVNH. 4. OPTION 4. VA only fills prescriptions for SVNH Veterans listed in subparagraph 4 a(2) of this Directive. Contract Pharmacy, In House Contract? ? Just remember if use a institutional contract pharmacy ensure a process for A&A drug reimbursement

Sentinel Events Know what a sentinel event is and how to report it. Nasvh. org, training, SVH Sentinel Events 2018

Nursing Retention Grant Opportunities Grant funding opportunities for approved retention/recruiting projects (ask your peers who has obtained a grant)

Survival Tips Know the key players at VA Central Office and your VA of jurisdiction. VA website for State Homes. – www. va. gov. communitycare Get to know your US Senate & House Representatives as well as State elected officials: • Know their staff and develop relationships. • Invite them to your Home often. • Keep them informed! Know your regulations. All of them. • (Federal, State, & local)

Last, but most importantly, What do you need from us to be successful and engaged? Please feel free to offer suggestions to improve this session or any other. We encourage you to get to know the Executive Committee, Committee Chairs and fellow members. Seek out your counterpart at other SVH’s to share unique experiences, successes and issues. Why “reinvent the wheel”. Please get involved in Committee work. I can’t reinforce how critical communications and relationships with the regional directors are. Our regional directors represent extremely knowledgeable, professional providers and operations that want to help you succeed.