Report 2012-119 Recommendation 1 Responses

Report 2012-119: California Department of Veterans Affairs: It Has Initiated Plans to Serve Veterans Better and More Cost-Efficiently, but Further Improvements Are Needed (Release Date: May 2013)

Recommendation #1 To: Veterans Affairs, Department of

To ensure that it maximizes its ability to generate revenue at all the veterans homes and better cover the costs of providing care to its members, CalVet should continue to implement standardized policies and procedures throughout the veterans homes to increase revenue, including its policies and procedures for identifying and enrolling eligible members into federal, state, and private insurance programs, such as the Medicare and Medi-Cal programs.

1-Year Agency Response

1. CalVet Homes Division led an effort at all eight veterans homes during Medicare Open Enrollment period in 2013. Residents who did not have Medicare coverage were identified and educated on the benefits they are eligible for. As a result 3 new residents were enrolled in Part B. Also, there were 583 residents enrolled in Medicare Part D and an additional 659 residents were enrolled this year taking it to a total of 1,242. CalVet's program to educate residents regarding plans for which they are eligible, as well as its tracking of new enrollees, are ongoing. 2. CalVet reached out to the Department of Health Care Services (DHCS) on the implementation of the Coordinated Care Initiative (CalMedi Connect) which caused residents to be passively enrolled in managed care. As a result, there are monthly data transmissions between CalVet and DHCS to ensure residents are not dis-enrolled from Medi-Cal. 3. CalVet Homes Division reached out to the Medi-Cal Benefits Division on the potential cost recovery of residents who are dual eligible under Medi-Cal and Medicare. As a result, CalVet confirmed that it can participate in the crossover claim process and recover more revenue from Medicare Part B, and the Department is doing this. 4. New revenue sources were identified in the areas of Respiratory, Pulmonary, Behavioral, Mental health, Audiology, and Optometry. CalVet will identify the top CPT/HCPS codes for those services and monitor the matrix of the increased revenue. 5. In order to maximize the revenue from the USDVA, CalVet has secured funding and position authority for all the homes to have Veteran Claim Representatives. The positions were approved on July 1, 2014, and the vacancies were posted. Those who already have civil service positions participated in a statewide County Veteran Service Officers four day conference for the first time where they will learn about claims process and getting additional revenue for residents.

California State Auditor's Assessment of 1-Year Status: Fully Implemented

6-Month Agency Response

HQ Homes Division Staff provided training on revenue types and insurance coverage to Fresno (June11th and 12th and Fresno July 18th and 19th). Remaining homes will be provided revenue training in the first quarter of calendar year 2014. Expanded pay source training in the new electronic health record system was provided to Yountville, Redding and Fresno staff on October 2nd. As a result of the upated charge master, CalVet was able to bill for 21 additional types of services. CalVet initiated a Medicare Open Enrollment campaign and letters were sent to residents who do not currently have Medicare Part B and D on November 1, 2013.

California State Auditor's Assessment of 6-Month Status: Pending

60-Day Agency Response

Within 60 days, CalVet will develop additional policies and procedures which specifically address identifying and enrolling eligible members into all insurance programs for which they are eligible. CalVet will use the expanded functionality of the new electronic health record system to maximizing the department's ability to recover its cost from multiple payers through coordination of benefits.

1) In June provided training to Fresno staff on health insurance plans. Redding Training scheduled for July. Remainder of homes will receive training by December.

2) Implemented a revised Charge Masters in Barstow as pilot home to capture more services in medical billing process. This will increase revenue and will be rolled out to all homes by December 2013.

3) Created policies on Corporate Compliance.

4) Amendments proposed to Insurance Coverage Policy to include post admissions insurance coverage. Will be finalized by December 2013.

California State Auditor's Assessment of 60-Day Status: Partially Implemented

All Recommendations in 2012-119

Agency responses received after June 2013 are posted verbatim.