SIMONE HOGAN, LICSWCNH POINT OF CONTACT

MINNEAPOLIS VA HEALTH CARE SYSTEM

Contract Nursing Home Program

VA medical system consists of integrated networks of care (VISNs) that

are focused on pooling and aligning resources to better meet local health

care needs and provide greater access to care.

VA Health Care System

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ELIGIBILITY…

In order to be eligible for the Contract Nursing Home Program or any other home and community care services – a veteran should be enrolled in the Minneapolis VA Health Care System

You can contact the Patient Access Center at 612-467-2071 to review eligibility and enrollment criteria/process

DETAILS REGARDING THE PROGRAM

Contract Nursing Home Program

Types of Contracts

Mill Bill (aka Millenium Bill or Long-Term)For Veterans rated 70% service connected or

greater through the Veteran's Benefits Administration

For Veterans rated 60% service connected or less if the reason for placement at a contract nursing home is related to the service connection disability

VA Contract Nursing Home team makes the determination if the reason for SC is related to the reason for the CNH placement.

Types of Contracts

Hospice For Veterans who are currently enrolled for

care at the Minneapolis VA Health Care System, have updated eligibility paperwork, and are enrolled in a hospice service (VA Primary Care Provider not req.)

VA is responsible for room and board at a VA contract facility

Hospice service is billed to either Medicare or VA, depending on patient preference and Medicare enrollment

Types of Contracts

Respite: Veterans must be enrolled for care at the

Minneapolis VA HCS, have Primary Care established, and have updated eligibility paperwork completed including LTC co-pay test if needed

Eligible for 30 days of respite care in a contract nursing home each calendar year

We prefer that Veterans use this benefit in increments of one-two weeks

Most respites are coordinated by Primary Care SW

Types of Contracts

Other:Veterans can be admitted from a private

hospital, with Medicare as the appropriate payer source (usually 20 days) and then transfer to a VA contract when pre-authorized

Veteran cannot go from a VA contract to Medicare, unless there is a qualifying stay that interrupts the placement

When the service-connected veteran admits from a VA facility, VA is the required payer from day one

Types of Contracts

Other: Other contracts may be available periodically

depending on other factors affecting the medical center

These contracts will be announced by VA leadership for temporary periods of time

Example: most recently, short-term 28-day contracts were being offered due to construction in our Community Living Center (CLC)

VA RELATIONSHIP: BENEFITS AND CHALLENGES

Contract Nursing Home Program

Benefits with VA relationship

• Broadens the pool of available funding • Higher daily funding than MA provides• Increased opportunities to serve America’s

veterans• Increases the gender mix/more male referrals• May contribute to Culture Transformation• Unique geographic offering• Access to increased VA clinics for support• VA RN and SW visits to veterans on contract

Reasons a facility may not want…

• Paperwork & accountability• Perceived too few referrals for the effort• NH is not geographically required by the VA• NH too small to offer unique options to the

VA• NH occupancy is generally already 100%• NH is not 100% fire sprinkled• Therapy VA pre-authorization

Current Numbers:

Counties represented in MN 22Counties represented in WI 9

Total CNH Facilities Currently 58

Total # of Veterans in CNH Program 294

CLINICAL OVERSIGHT – MONTHLY/QUARTERLY AND

SENTINEL EVENTS

Contract Nursing Home Program

The Minneapolis CNH Staff

CNH Point of ContactCNH Coordinator TeamClinical Social WorkersNurse CoordinatorsConsulting PharmacistMedical DirectorFee Basis Claims AssistantContracting Officer Life Safety InspectorsProgram Support Assistant

VA Personnel Visits to CNH

While Veterans are on contract in CNHs, authorized VA Social Workers and Nurses regularly visit veterans to provide follow-up and support. Monthly or quarterly visits occur – depending on

geography

These Social Workers and Nurses should be your main point of contract regarding Veteran issues.

VA Personnel Visits

Purpose of visits: to assist in the Veteran’s CNH adjustment and

the continuity of care; consult with staff address business office questions identify eligibility concerns; assist with VA

appointments assist with care coordination with the Veteran,

family, CNH, and the VAVA contract stipulates that VA personnel will have

access to the veteran's CNH medical record

Sentinel Events

A Sentinel Event may include but is not limited to the following:

falls resulting in death or injury elopement resulting in a missing Veteran Veteran abuse confirmed or under investigation medication error resulting in Veteran illness/injury death or injury secondary to restraint usage, and all deaths related to unconfirmed or suspicious

nature.

Sentinel Events

If you are reporting an occurrence regarding this Veteran to the common entry point (CEP) or Department of Health, you’ll need also to report the occurrence to VA

Oversight

Currently we have a CNH Coordinator Team that meets weekly to review the CNH program, sentinel events, Veteran/family complaints and process improvement.

CNH Coordinator Team members are SW Simone Hogan, HCC Director Shawna Clausen, CNH Program Support Assistant Gordon Hofman and SW Supervisor Deb Smith Wagner

Simone Hogan (612-467-4527) is our new CNH Point of Contact and can be contacted for any questions or issues

NEW CONTRACTS AND RENEWAL OF CONTRACTS

Contract Nursing Home Program

VA Renewal of Contracts

“To be considered for a first-time VA contract, or to annually renew an existing contract,

VA takes the approach that a broad review of all available data is

essential”

VA contract renewal and quality oversight

The Minneapolis VA CNH staff annually reviews:the 2567 NH Compare Quality improvement plans Complaint reports Ombudsman activity All medical records of Veterans served at the

CNHComplaints from Veterans

VA contract renewal and quality oversight

We also review the following information:• NH Compare • quality measures • staffing reports

• Minnesota Health Facilities Complaint Office• Department of Health Information

• Number of State Deficiencies

• Minnesota Nursing Home Report Card • Review of VA medical record and documentation

from VA staff oversight visits

VA contract renewal and quality oversight

Coordination with the following agencies:• Veterans Benefit Administration • Guardians, conservators, fiduciaries

• Nursing Home Ombudsman• Hx of complaints, trends• Amenableness to complaint resolution• Evidence of consultation efforts by the NH• Staffing/turnover issues• Integration of resident/family council process• Support of cultural transformation• General view of care provided

VA contract renewal and quality oversight

Seven VA Standards:Are there three level “G” or higher deficiencies in the current

survey?In the current survey, are the total number of health requirement

deficiencies twice the state average?In the current survey, is there a level ‘E’ or higher deficiency in

any of the following areas:

• Restraints (F221 or F222) • Abuse (F223) • Staff treatment of patients (F225 or F226)• Dignity (F241) • Licensure (F491)

VA contract renewal and quality oversight

Seven VA Standards (cont.):In the NH Compare review are the RN hours per resident day

below the state average? In the NH Compare review are the total nursing staff hours

per resident below the state average?Are six or more of the MDS quality measures from NH

compare above the state average?In the current survey is there a level “E” or higher deficiency

in any of the following areas: Nursing services (F353) Nursing aide training (F494, F495, or F496) Regular in-service training (F497) Proficiency of nursing aides (F498) Staff Qualifications (F499)

VA contract renewal and quality oversight

To consider the contract, we apply the 7 VA standards and review all other relevant performance information in the determination process

If a newly proposed contract, proceed or declineRenewal of existing contract (most common)Renewal with added clinical oversightRenewal with additional stipulationsSuspension of placementsSuspension/termination of contract

New Contracts?

Needs Assessment is Completed:

Current availability of VA funding,

Implications for growth/decline in the current contract facilities,

Density/proximity of existing contract facilities,

Tendency for openings within the existing pool of contracted facilities,

Unique facilities that serve specialized needs,

The desire to providing ample business to existing contract facilities to warrant their continued affiliation.

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In summary, through the contract program, VA believes that enhancing the NH care for veterans within the CNH further enhances the care for all residents.

CONTACTS:

GORDON HOFMAN – CNH PSA@ 612-467-5202SIMONE HOGAN, LICSW – CNH POINT OF CONTACT

@ 612-467-4527 OR SIMONE.HOGAN@VA.GOV

SHAWNA CLAUSEN, MS, RN – HCC DIRECTOR @ 612-467-1658

DEB SMITH-WAGNER, LICSW – EC&R SW SUPERVISOR @ 612-467-1561

Contract Nursing Home Program

Questions?