Representatives from the Veterans Health Care Administration Central Office, Office of Geriatrics and Extended Care joined the Adult Day, HCBS, and Medicaid Waiver Network on September 22. They provided a presentation on the current state of Community Adult Day Health Care (CADHC) program.

The VA reported a large decline in the number of veterans served in their CADHC program currently. They shared that in 2019, 10,176 veterans were served by CADHC and now only 4,834 veterans are being served. Throughout the presentation, the VA was clear that they really want to work with LeadingAge to get those numbers up.

The VA reviewed the definition of criteria used for VA adult day. They also discussed that they are researching the difference between social and medical models for utilization in veterans. They also reviewed the codes that the VA uses for billing; though they noted that if you have a local contract, you are probably not using these codes.

For the 248 CADHCs with local contracts, the VA noted that you need to check whether your contact includes basic ordering agreements (BOA) or an indifferent delivery, indefinite quantity (IDIQ). If you have BOA and have not heard from your local adult day coordinator at the VA Medical Center, reach out. You will be given the choice of joining of the Community Care Network or negotiating a Veteran’s Care Agreement. Getting a Veteran’s Care Agreement in place is generally the faster of the two options.

To determine reimbursement, the VA uses the Minnesota Medicaid rates and then nationalize them, removing the wage index, and set it to the national average. They then apply local wage indices using the physician fee schedule. Used to base it based on the home county of the VA Medical Center. Now they have merged all those wage indices together; most states have a single rate.

The VA will reimburse for transportation under certain conditions. A primary care provider determines if transportation is clinically indicated and family and community resources must not be available. Importantly, the VA must be assured that the transportation is safe (e.g. vehicle passes inspection, is insured, the driver must be trained). Provision of transportation must be documented as part of CADHC center’s plan of care for the veteran. The VA through their third-party administrators (Optum and Tri-West) are going to credential an adult day center to provide transportation. An adult day provider can contract out the service, but would need to have a copy of the documents so that there is evidence of these safety concerns. If an adult day provider is using state or county transportation, they just need to report that. Important that it is part of the care and part of the package. The VA emphasized the importance of transportation in the provision of CADHC.

The biggest takeaway from the meeting was how much the VA wants to work with adult day providers to serve eligible veterans. They suggested going in groups, facilitated by LeadingAge and/or LeadingAge state partners, to meet with Veterans Integrated Service Networks (VISNs) regarding your presence in a broader community and how to get linked in to serving Veterans.

If you have any questions about the meeting, please email Mollie at mgurian@leadingage.orgmgurian@leadingage.org and join the network here.