VETERANS HEALTH ADMINISTRATION
Caregiver Support Program
MISSION ACT Implementation Update
August 27, 2020
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Phase 2 hiring has launched adding approximately 700 additional staff to the Caregiver Support Program.
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New Program of Comprehensive Assistance for Family Caregivers Stipend, Eligibility Frequently Asked
Questions (FAQ), and Final Rule FAQs are complete and available on the website. Spanish translation will also
be available.
•
Launched VA Suicide Prevention Toolkit for Caregivers. Provided training to field. Alerted field and external
partners of the toolkit. The toolkit is available on the website.
•
COVID-19 Caregiver tips developed and shared on website, listserv, social media, email blast to field and
others.
•
C
ollaborated with the Office of Rural Health to develop a video series to educate and aid Caregivers caring for
a loved one with dementia.
•
Collaborated with the Office of Connected Care and the VA Caregiver Center at Memphis to roll out the Annie
Caregiver Text Program. The program is designed to provide Caregivers helpful hints to manage stress via text
messaging.
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CARMA is entering final testing at the beginning of next week for all remaining functionality required for the
Secretary of VA’s certification of Information Technology (IT) systems
•
This includes integrations into over a half dozen backend IT systems, many of which are already completed and
fully deployed.
•
VA will assess establishing an official certification date at the conclusion of user acceptance testing which is
currently scheduled to end on September 18, 2020.
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All remaining features needed for the Secretary of VA’s certification are code
complete. User acceptance testing (UAT) will begin September 1, 2020.
UAT is planned through September 18, 2020
•
CARMA Phase 1 – Initial Implementation: Deployed Fall 2019
–
Replaced legacy system, modern scalable platform, new functionality
•
CARMA Phase 2 – Stipend Payments: Deployed February 2019
•
CARMA Phase 3 – Certification
–
On-line Application: Developed, tested and being used on a test basis
–
New Regulation: Developed and in test
–
Interfaces with other VA IT Systems
•
VA.gov, VHA CDW: Deployed
•
VA Profile, Enrollment System tested: Ready for deployment
•
Master Person Index / IAM, Benefits Gateway Service (BGS): In test
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VA will provide an update on certification status after
UAT is complete mid-September
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CARMA is the foundation for this effort.
–
As a workflow management tool, CARMA is designed to support improved oversight and
monitoring of the changes VA is making to improve and expand PCAFC.
–
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With a click of a button in CARMA, an electronic health record will be created for a Family
Caregiver where Caregiver Support Coordinators (CSC) will document their clinical
interactions.
–
Available today, through an integration with Enrollment Services, with a click of a button in
CARMA, the Veteran’s service-connected rating or dates of service displays.
–
Also available today, through an integration with the Financial Management System, payment
information flows from CARMA directly to the Financial Services Center/Treasury to support
processing of stipend payments to Primary Family Caregivers.
A separate system to calculate
stipend amounts was able to be retired.
–
CARMA will help guide consistency by systematically adjusting VA’s stipend payment
calculations to the GS pay table; alert users when annual reassessments of PCAFC
participants are due; and institute date rules to more accurately monitor the completion of
what will soon be referred to as Wellness Contacts, among other key functionality.
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VA is building reporting functionalities as new functionality is deployed.
–
These systems will allow us to track transitions, applications, and appeals timing by VA Medical Centers
(VAMC).
–
These reports allow VA to identify "hot spots" which may require additional resources in order to meet
timeliness metrics.
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Veterans and Caregivers can use the VA.gov platform to apply online.
–
The application flows into CARMA and is routed directly to the VA facility selected by the user, allowing
VA to receive the application instantaneously.
•
On August 20, 2020, VA began a phase of beta testing, testing the online submission process with
a small number of Veterans and Family Caregivers.
•
This very limited release allows VA to test the online submission process to ensure the functionality
works as intended before opening the aperture to a larger audience.
•
The goal is to ensure a positive experience and mitigate challenges in real time whenever
possible.
•
Following the completion of beta testing, VA will address and resolve feedback obtained during
testing and complete other technical requirements. Once confident of a seamless experience,
access to the online portal will increase incrementally. With continued positive outcomes, VA looks
forward to broadly announcing this exciting new feature and make it available nationwide.
–
Veterans and Caregivers can continue to apply as they currently do:
•
Visit
www.caregiver.va.gov
.
Download VA Form 10-10CG and mail the completed form.
•
Apply in person through local VAMC CSCs.
6
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–
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–
Development of educational products that include recorded webinars, e-learning
tools, program manuals/guides, new staff orientation materials and a CSP Toolkit.
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Ongoing education and training to field-based staff on four standing calls a
month.
•
In fiscal year (FY) 2019, more than 7,000 cumulative staff participated in
these calls.
–
Specific education and training related to the expansion of the CSP under the
MISSION Act has been offered.
–
Clinical, Operational and Management guidance is regular and enduring and
offered in a way to fit all learning styles (visual/recorded/discussions).
•
This supports continuous improvement, assists with staff transitions and
supports standardization across the field.
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Approximately 750-1,000 staff to attend.
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14
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–
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reassessments, new applications and appeals to support expansion.
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–
Facility Based Clinical Staff (PCAFC) - 263
–
Facility Based Assessors (PCAFC) - 222
–
Facility Based Clinical Staff (PGCSS) - 65
–
Administrative Support - 81
–
VISN CEATs – 110
–
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26 additional staff will be hired to support the mission of the Caregiver Support Line.
Additional FTE will provide support, information and guidance to the increased volume of
callers as well expanding access via text messaging capabilities.
–
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45 additional staff will be hired to support processing of new applications (10-10CGs)
15
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–
CEATs consist of at least three clinical members including either a Physician or Nurse
Practitioner, a Psychologist and a Social Worker, Registered Nurse or Licensed
Mental Health Counselor.
–
Teams may also request an Occupational Therapist, Physical Therapist or other
clinical provider.
–
CEATs are aligned administratively under the VISN Chief Medical Officers.
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•
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•
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CEATs are moving towards full functioning.
‒
Case reviews, tabletop exercises, community of practice discussions and
training/education are underway to all participants.
Tremendous progress has been made in expanding the Caregiver Support Program under the VA MISSION Act of 2018. Key updates include hiring staff, launching Phase 2 hiring, providing training and education materials, launching the VA Suicide Prevention Toolkit for Caregivers, sharing COVID-19 caregiver tips, developing the Annie Caregiver Text Program, and updating the Caregiver Records Management Application (CARMA).
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VETERANS HEALTH ADMINISTRATION Caregiver Support Program MISSION ACT Implementation Update August 27, 2020
Bottom Line Up Front Tremendous progress has been made to expand the Caregiver Support Program under the VA MISSION Act of 2018. Hiring 93% of Phase 1 staff have been hired to fill key positions to provide strong leadership and infrastructure for program expansion. Phase 2 hiring has launched adding approximately 700 additional staff to the Caregiver Support Program. Training and Education New Program of Comprehensive Assistance for Family Caregivers Stipend, Eligibility Frequently Asked Questions (FAQ), and Final Rule FAQs are complete and available on the website. Spanish translation will also be available. Launched VA Suicide Prevention Toolkit for Caregivers. Provided training to field. Alerted field and external partners of the toolkit. The toolkit is available on the website. COVID-19 Caregiver tips developed and shared on website, listserv, social media, email blast to field and others. Collaborated with the Office of Rural Health to develop a video series to educate and aid Caregivers caring for a loved one with dementia. Collaborated with the Office of Connected Care and the VA Caregiver Center at Memphis to roll out the Annie Caregiver Text Program. The program is designed to provide Caregivers helpful hints to manage stress via text messaging. Caregiver Records Management Application (CARMA) CARMA is entering final testing at the beginning of next week for all remaining functionality required for the Secretary of VA s certification of Information Technology (IT) systems This includes integrations into over a half dozen backend IT systems, many of which are already completed and fully deployed. VA will assess establishing an official certification date at the conclusion of user acceptance testing which is currently scheduled to end on September 18, 2020. Final Rule Published July 31, 2020 2
Caregiver Support Program (CSP) Overview Our mission is to promote the health and well-being of Family Caregivers who care for our nation s Veterans, through education, resources, supportive services and service excellence. 3
CARMA Status All remaining features needed for the Secretary of VA s certification are code complete. User acceptance testing (UAT) will begin September 1, 2020. UAT is planned through September 18, 2020 CARMA Phase 1 Initial Implementation: Deployed Fall 2019 Replaced legacy system, modern scalable platform, new functionality CARMA Phase 2 Stipend Payments: Deployed February 2019 CARMA Phase 3 Certification On-line Application: Developed, tested and being used on a test basis New Regulation: Developed and in test Interfaces with other VA IT Systems VA.gov, VHA CDW: Deployed VA Profile, Enrollment System tested: Ready for deployment Master Person Index / IAM, Benefits Gateway Service (BGS): In test VA will provide an update on certification status after UAT is complete mid-September 4
CARMA Automations and Integrations The CSP has modernized the IT system and achieved system integrations with other VA systems. CARMA is the foundation for this effort. As a workflow management tool, CARMA is designed to support improved oversight and monitoring of the changes VA is making to improve and expand PCAFC. Results are increased efficiencies and effectiveness for VA staff but more importantly, increased ease for Veterans and Caregivers. System automations and integrations will replace several manual processes. With a click of a button in CARMA, an electronic health record will be created for a Family Caregiver where Caregiver Support Coordinators (CSC) will document their clinical interactions. Available today, through an integration with Enrollment Services, with a click of a button in CARMA, the Veteran s service-connected rating or dates of service displays. Also available today, through an integration with the Financial Management System, payment information flows from CARMA directly to the Financial Services Center/Treasury to support processing of stipend payments to Primary Family Caregivers. A separate system to calculate stipend amounts was able to be retired. CARMA will help guide consistency by systematically adjusting VA s stipend payment calculations to the GS pay table; alert users when annual reassessments of PCAFC participants are due; and institute date rules to more accurately monitor the completion of what will soon be referred to as Wellness Contacts, among other key functionality. 5
CARMA Automations and Integrations Program management and monitoring will occur using dashboards and key metrics. VA is building reporting functionalities as new functionality is deployed. These systems will allow us to track transitions, applications, and appeals timing by VA Medical Centers (VAMC). These reports allow VA to identify "hot spots" which may require additional resources in order to meet timeliness metrics. On-Line Application processing (10-10CG) in addition to traditional processing will be available. Veterans and Caregivers can use the VA.gov platform to apply online. The application flows into CARMA and is routed directly to the VA facility selected by the user, allowing VA to receive the application instantaneously. On August 20, 2020, VA began a phase of beta testing, testing the online submission process with a small number of Veterans and Family Caregivers. This very limited release allows VA to test the online submission process to ensure the functionality works as intended before opening the aperture to a larger audience. The goal is to ensure a positive experience and mitigate challenges in real time whenever possible. Following the completion of beta testing, VA will address and resolve feedback obtained during testing and complete other technical requirements. Once confident of a seamless experience, access to the online portal will increase incrementally. With continued positive outcomes, VA looks forward to broadly announcing this exciting new feature and make it available nationwide. Veterans and Caregivers can continue to apply as they currently do: Visit www.caregiver.va.gov. Download VA Form 10-10CG and mail the completed form. Apply in person through local VAMC CSCs. 6
CSP Education and Training A broad training plan encompassing continuous training and enhanced education was implemented - ensuring a well-trained workforce. Live trainings on four standing CSP monthly education calls focused on training. Targeted weekly community of practice calls. Development of educational products that include recorded webinars, e-learning tools, program manuals/guides, new staff orientation materials and a CSP Toolkit. Field-based staff receive continuous education and training through various modalities on a variety of topics, including expansion. Ongoing education and training to field-based staff on four standing calls a month. In fiscal year (FY) 2019, more than 7,000 cumulative staff participated in these calls. Specific education and training related to the expansion of the CSP under the MISSION Act has been offered. Clinical, Operational and Management guidance is regular and enduring and offered in a way to fit all learning styles (visual/recorded/discussions). This supports continuous improvement, assists with staff transitions and supports standardization across the field. 7
CSP Topic-Specific Training CARMA Training Purpose: To ensure CSP staff are trained in the use of CARMA for existing and planned functionality. Delivery Method: Training is provided through multiple modalities including a planned CARMA Training Environment for practice of key functionality, Talent Management System (TMS) training modules, Quick Reference Guides (QRGs), Support Sessions and Office Hours. Audience: All CARMA Users including VISN Leads, Program Office Staff, Program Managers, All CSP Field Staff, CSCs/VA Admins Staff; however, not all functionality is relevant to all users. SOP and Template/Consult Training Purpose: To educate, train and ready CSP staff on new standard operating procedures developed for expansion and enhancement of the CSP. In addition, this training provides a deep dive into the newly developed templates and consults. Delivery Method: This training consists of 7 distinct sessions, each delivered as live and interactive sessions. The 7 sessions are repeated in the morning and afternoon to allow for greatest attendance. Sessions are recorded and housed on VA s educational and training platform. Audience: CSC Staff, CSC Program Managers, Centralized Eligibility and Appeals Teams (CEAT) members, VISN Leads. Veteran Functional Assessment Instrument Purpose: To educate, train and ready CSP staff on the standardized use of the assessment instrument using a Veteran-centric approach. The training is designed to provide CSP staff with an understanding of what the instrument is, how to perform the instrument and understand how the instrument will assist in making eligibility determinations. The Veteran Functional Assessment Instrument is one piece of an overall assessment process that informs the CEATs when making eligibility determinations for the PCAFC. Delivery Method: Training is provided through 8 recorded sessions housed on VA s educational and training platform. Case reviews and live, virtual Q&A sessions are conducted. Audience: CSC Staff, CEAT members, CSC Assessors, VISN Leads. Caregiver Support Training Program Expansion 101/201 Purpose: To educate and ready VA staff for the program s expansion. Delivery Method: Training is provided though self study on VA s educational and training platform. Audience: All VHA Staff. 8
CSP Information Sharing and Education for Stakeholders and Partners Core Curriculum for Caregivers Purpose: A comprehensive Family Caregiver Training Program for Caregivers of Veterans participating in the PCAFC. Delivery Method: Training is provided through self-study via workbook/CD/DVD, web-based online training with CD/DVD for reference, and face-to-face. Audience: CSC Staff, PCAFC eligible Caregivers. Veteran Stakeholder Education Purpose: To educate Veterans, Veterans Service Organizations (VSO), Stakeholders and the General Public on CSP program expansion. Deliver Method: FAQs released on new eligibility criteria, stipend changes, and impact of new regulation on current participants. Live, interactive briefings will be offered. Audience: Stakeholders, VSOs, Partners. Various FAQs Purpose: To provide an organized collection of information about CSP and expansion that have been frequently asked by Veterans, Caregivers, stakeholders and partners. Delivery Method: FAQs are available on www.caregiver.va.gov and were distributed via the listserv. Audience: All VHA staff, Caregivers, Stakeholders, VSOs, Partners. 9
CSP Clinical and Operational Consultations Hands On Workflow Reviews Purpose: Practice the step-by-step workflow, transition points and decision-making criteria required to implement the new regulations and new business processes. Delivery Method: Users will walk Veteran/Caregiver scenarios through the process and interact with the new consults and templates. This workflow review is an opportunity for all staff involved in the CSP business process to apply the knowledge learned during offered trainings and professional development calls. Audience: CSP Program Office Staff, CSP Field Staff, CEAT. Scenario-based Training for CEATs Purpose: CEAT members walk through real Veteran/Caregiver cases and discuss how they will make eligibility and appeals determinations using the new eligibility criteria. Delivery Method: Cases presented each week by different CEATs for discussion. Subject matter experts are available to answer questions on assessment tools and clinical appeals requirements. Audience: CEAT Members. CSP Tabletop Exercises Purpose: To provide a near real experience of the Veteran/Caregiver eligibility/admission process to identify gaps or other weaknesses in this process. Identify where the intended process flow and transition points work smoothly and where gaps exist. Review scripts for five scenarios: Approved Application Submission; Reassessments; Appeals; Wellness Contacts; and Stipend Calculations Delivery Method: Five live, interactive tabletop sessions were conducted. Audience: CSP Program Office Staff, Representatives from each staff/leadership group involved in the business process from nine VISNs. 10
CSP Conferences CSP Conferences FY 2020 Three (3) CSP conferences are available in FY 2020 in collaboration with the Employee Education System. VISN Lead Training March 3-5, 2020; Face-to-Face Conference All newly hired VISN Leads attended a face-to-face conference in Washington, DC to learn roles and responsibilities as new VISN Leads. Eighty-nine (89) staff attended. Centralized Eligibility and Appeals Teams July 14-16, 2020; Virtual Conference CEAT members and VISN Leads from each VISN were trained on initial/ongoing PCAFC eligibility and appeal processes related to the new CEAT. Over 100 staff attended. CSP MISSION Act Expansion: September 16-17, 2020 and September 23-24, 2020; Virtual Conference CSP field staff to be trained on CSP and changes under the MISSION Act of 2018 expansion. Primary staff to be trained: CSCs, PGCSS Staff, CSP Program Managers and VISN Leads. Approximately 750-1,000 staff to attend. 11
CSP Webinars CSP Webinars: Training plan developed to identify topics to create enduring webinars on TMS available for all VA staff. Currently eight webinars are complete, and more than nine webinars are underway. Completed Webinars Available on TMS Course Title FY 2020 Course Completions Course Title FY 2020 Course Completions VA Caregiver Center, Memphis Overview of Programs. Overview of available supports and services available to Caregivers and how staff can refer and enroll Caregivers 118 Caregiver Support Program (CSP) MISSION Act Toolkit, a staff resource on available products available to inform others on CSP Mission Act 537 Implementation of Purple Heart and Disabled Veterans Equal Access Act of 2018 113 Program of Comprehensive Assistance for Family Caregivers (PCAFC): Veterans Eligibility Criteria 350 Program of Comprehensive Assistance for Family Caregivers (PCAFC): Veterans Eligibility Criteria for Providers 874 Caregiver Support Program (CSP) VHA Directive 1152(1) Overview 405 PCAFC SOP Changes in Functional Status & Continued Eligibility 816 VHA Caregiver Support Program Overview 493 Course completion data is from October 1, 2019 thru August 20, 2020 12
CSP - Hiring CSP Phase 1 Hiring Status* The first phase of the hiring initiative commenced in the Fall of 2019. The goal of this phase was to proactively begin optimizing baseline staffing in preparation for expansion and establish a strong facility and VISN level infrastructure. 638 of 684 (93%) new staff have been hired to fill key positions to provide strong leadership and infrastructure for program expansion, including: Veterans Integrated Service Network (VISN) Leads: 100% Program of Comprehensive Assistance for Family Caregivers (PCAFC) Facility Program Managers/Supervisors: 93% Program of General Caregiver Support Services (PGCSS) Facility Coordinators: 90% *Note: CSP hiring data is reported as of July 31, 2020. 13
CSP - Hiring CSP Phase 2 Hiring Initiative The second phase of the hiring initiative is underway. The goal of this phase is to expand and enhance the field and VISN based staff to manage reassessments, new applications and appeals to support expansion. Phase 2 will expand: Caregiver Support Program Field Strength 741 additional facility and VISN staff are estimated to be hired Facility Based Clinical Staff (PCAFC) - 263 Facility Based Assessors (PCAFC) - 222 Facility Based Clinical Staff (PGCSS) - 65 Administrative Support - 81 VISN CEATs 110 Caregiver Support Line Staff 26 additional staff will be hired to support the mission of the Caregiver Support Line. Additional FTE will provide support, information and guidance to the increased volume of callers as well expanding access via text messaging capabilities. Health Eligibility Center Staff 45 additional staff will be hired to support processing of new applications (10-10CGs) 14
CSP - CEAT Hiring CEAT Composition CEATs consist of at least three clinical members including either a Physician or Nurse Practitioner, a Psychologist and a Social Worker, Registered Nurse or Licensed Mental Health Counselor. Teams may also request an Occupational Therapist, Physical Therapist or other clinical provider. CEATs are aligned administratively under the VISN Chief Medical Officers. CEAT Hiring Status (as of July 31, 2020) CEAT staff: 91% hired/selected The remaining positions are actively in the hiring process. All VISNs have most of their CEAT members selected or in place. Fifteen (15) VISNs have fully staffed CEATs CEAT Roll-out CEATs are moving towards full functioning. Case reviews, tabletop exercises, community of practice discussions and training/education are underway to all participants. 15
