Challenge
The Veterans Health Administration (VHA) delivers a wide array of Long-Term Services and Supports (LTSS) that constitute a growing portion of VHA’s total medical care budget. In FY2014, VHA spent approximately $6.8 billion on LTSS through the delivery of institutional and non-institutional care programs. LTSS is projected to grow by nearly 10 percent, to total $7.5 billion, in FY2016. Since FY2004, VHA has grown its investment in Home and Community-Based Services (HCBS) by over 600 percent (from $275 million in 2004 to $1.7 billion in 2014) and reduced its overall market share of nursing facility costs to 77 percent of total LTSS spending (91.5 percent in FY2014).
Solution
To increase access to HCBS, continue to rebalance VHA’s LTSS system, and provide Veterans with greater choice and control in how HCBS are delivered, Atlas and partner the Lewin Group are supporting VHA in implementing the Veterans Directed Home and Community Based Services (VD-HCBS) program in partnership with the Administration for Community Living (ACL). The VD-HCBS program is a consumer-directed model of care where the Veteran uses a flexible budget to purchase home care and other goods and services, primarily by hiring family and friends. Veterans enrolled in VD-HCBS are supported by 1) a person-centered counselor within the Aging & Disability (A&D) Network to help make informed decisions, and 2) the Financial Management Service (FMS) to process workers’ payroll and associated taxes and manage Veterans’ budget funds.
Result
As of late October 2015, the VD-HCBS program is operational in 31 states, the District of Columbia and Puerto Rico, 19 Veterans Integrated Service Networks (VISNs), 57 VA Medical Centers (VAMCs), and 116 A&D Network sites. A&D Network sites with VD-HCBS programs reported serving 1,361 Veterans in VD-HCBS and have cumulatively served 3,411 Veterans since the start of the program. To support VHA with the roll-out of a national VD-HCBS program by 2018, the Atlas Team is providing subject matter experts to assess the A&D Network sites’ readiness to implement VD-HCBS. This will provide VHA assurance that the Veteran will receive high-quality, patient-centered, and self-directed care. Additionally, the team’s work in the areas of LTSS, self-direction, and nationwide rollout of health care programs will assist VHA with Technical Assistance (TA) and training to support VISNs and VAMCs with the successful, effective, and sustainable implementation of VD-HCBS.