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2010 Winter Conference2010 Winter ConferenceNational Association of State Veterans National Association of State Veterans

Home Home February 26 - March 4, 2010February 26 - March 4, 2010

Washington, DCWashington, DCTheresa HayesState Home Per Diem ProgramVeterans Health Administration

Per Diem for SVHs from 2002-2009Per Diem for SVHs from 2002-2009

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VA State Home Basic Per Diem RatesVA State Home Basic Per Diem Rates

NHC/HOSP NHC/HOSP DOM DOM ADHCADHC20002000 $46.49$46.49 $20.36$20.36 N/AN/A20012001 $51.38 $51.38 $22.03 $22.03 N/AN/A20022002 $53.17 $53.17 $23.74$23.74 N/AN/A20032003 $56.24$56.24 $26.95$26.95 N/AN/A20042004 $57.78$57.78 $27.19$27.19 N/AN/A20052005 $59.36$59.36 $27.44$27.44 N/AN/A20062006 $63.40$63.40 $29.31$29.31 $37.91$37.9120072007 $67.71$67.71 $31.30$31.30 $40.48$40.4820082008 $71.42 $71.42 $33.01 $33.01 $64.13$64.1320092009 $74.42$74.42 $34.40 $34.40 $66.82$66.8220102010 $77.53$77.53 $35.84 $35.84 $69.63$69.6320112011 $94.59$94.59 $38.90$38.90 TBATBA

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Number of State Veterans Nursing Homes, Number of State Veterans Nursing Homes, Domicilaries, and ADHC’s for Domicilaries, and ADHC’s for

FY 2000 – 2009FY 2000 – 2009

96

50

102

50

103

51

111

49

112

53

114

53

119

54

121

53

125

52

131

53

0

20

40

60

80

100

120

140

2000 2001 2002 2003 2004 2005 2006 2007 2008 2009

NHC

DOM

ADHC

5555

Total Number of Authorized Beds Total Number of Authorized Beds for FY 2009for FY 2009

Total State Home programs: 137 in 50 Total State Home programs: 137 in 50 states and Puerto Ricostates and Puerto Rico

Total State Veteran Nursing Homes: 131 in Total State Veteran Nursing Homes: 131 in 50 states and Puerto Rico (24,302 beds)50 states and Puerto Rico (24,302 beds)

Total State Domiciliary facilities: 53 in 33 Total State Domiciliary facilities: 53 in 33 states and Puerto Rico (6,086 beds)states and Puerto Rico (6,086 beds)

Total State ADHC programs: 1 state (50 Total State ADHC programs: 1 state (50 slots)slots)

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FY 2009 FY 2009 Annual ADC, Percentage of VA CostAnnual ADC, Percentage of VA Cost

Average Per Diem Cost & Occupancy RatesAverage Per Diem Cost & Occupancy Rates

Average Daily CensusAverage Daily Census Average Percentage of Cost PaidAverage Percentage of Cost Paid by by VAVA

Nursing Home: 19,027Nursing Home: 19,027 32%32% Domiciliary Care: 2,837 Domiciliary Care: 2,837 25%25% Hospital Care: 62 Hospital Care: 62 (Hospital Closed 3(Hospital Closed 3rdrd QTR) QTR) 14% 14% Adult Day Health Care: 14 Adult Day Health Care: 14 40%40%

Average Per Diem CostAverage Per Diem Cost Occupancy RatesOccupancy Rates Nursing Home: $238.91 Nursing Home: $238.91 75% Vet-----85%Total 75% Vet-----85%Total Hospital Care: $991.48 Hospital Care: $991.48 100%Vet---- 48%Total100%Vet---- 48%Total Domiciliary Care: $140.52 Domiciliary Care: $140.52 93% Vet ---68%Total 93% Vet ---68%Total Adult Day Health Care: $165.22 Adult Day Health Care: $165.22 32% Vet----73%Total 32% Vet----73%Total

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38 U.S.C. 1745(Implementation date May 29, 2009)

Requires VA to begin paying States higher rate for SNF to certain veterans in State nursing homes with SC disability rated 70% or higher and those requiring nursing home care for a SC disability.

The new per diem rate is the lesser of the following:

•The applicable or prevailing rate payable in the geographic area in which the State home is located.

•A rate not to exceed the daily cost of care in the SNF.

The law thus requires VA to use the actual cost of care in State homes based on a report from the home in determining the higher per diem, and the home will receive its actual cost if LESS than the applicable or prevailing rate.

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Effect on Per Diem for Veterans Effect on Per Diem for Veterans Without a SC DisabilityWithout a SC Disability

Other Veterans on whose behalf VA pays per Other Veterans on whose behalf VA pays per diem to State homes (but do not require nursing diem to State homes (but do not require nursing home care because of SC disabilities) will still home care because of SC disabilities) will still receive the basic per diem rate from VA. Current receive the basic per diem rate from VA. Current basic per diem rate for NHC is $77.53.basic per diem rate for NHC is $77.53.

This rate is adjusted each fiscal year.This rate is adjusted each fiscal year.

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38 U.S. C. 174538 U.S. C. 1745

The new law requires VA to furnish medications The new law requires VA to furnish medications needed to treat a SC disability. Aid and Attendance needed to treat a SC disability. Aid and Attendance rules also applyrules also apply..

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National Estimated Higher Per National Estimated Higher Per Diem RatesDiem Rates

for Nursing Home Carefor Nursing Home Care

FY 2007: $258.64FY 2007: $258.64FY 2008: $268.80FY 2008: $268.80FY 2009: $278.39FY 2009: $278.39

FY 2010: $275.53FY 2010: $275.53

(Includes Drug Costs)(Includes Drug Costs)

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The Importance of Form 10-5588 Per Diem The Importance of Form 10-5588 Per Diem CostCost

– The VA Form 10-5588 is a tool for communicating The VA Form 10-5588 is a tool for communicating with the VA the SVH’s cost and request for with the VA the SVH’s cost and request for federal aid.federal aid.

– Complete and accurate reporting of per diem Complete and accurate reporting of per diem costs is the only way the VA can determine the costs is the only way the VA can determine the per diem amount to pay per 38 U.S.C. 1745.per diem amount to pay per 38 U.S.C. 1745.

– Must enter monthly reporting data in Citrix Must enter monthly reporting data in Citrix CORRECTLYCORRECTLY and and ON TIMEON TIME. .

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VA Form 10-5588 Consists of Several PartsVA Form 10-5588 Consists of Several Parts

Gains and LossesGains and Losses Days of CareDays of Care Average Daily CensusAverage Daily Census Total Per Diem Cost (Daily Cost of Care for the Total Per Diem Cost (Daily Cost of Care for the

Month)Month) Per Diem ClaimedPer Diem Claimed Total Amount Claimed Total Amount Claimed For Hospital, Nursing Home, Domiciliary and Adult For Hospital, Nursing Home, Domiciliary and Adult

Day Health Care.Day Health Care.

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The State home should submit the 10-5588 to VA Medical Center of Jurisdiction by the end of the 5th workday after the close of each monthly report period.

VA medical center of jurisdiction staff will review each monthly 10-5588 for accuracy, resolve any discrepancies with the State home, make payment by electronic fund transfer and file the report. A report should not be accepted if the report is incomplete, calculations not accurate, or missing the authorized signature of the SVH.

15151515

For additional information, please contact:For additional information, please contact:

Theresa Hayes @ (202) 461-6771Theresa Hayes @ (202) 461-6771

theresa.hayes@va.govtheresa.hayes@va.gov

oror

Brenda Wiggins @ (202) 461-6757Brenda Wiggins @ (202) 461-6757

brenda.wiggins3@va.govbrenda.wiggins3@va.gov