Veteran Directed Home and Community Based Services (VD-HCBS) Program

Beginning in 2008, the Administration on Aging, now the U.S. Administration on Community Living (ACL) as of April 2012, began a close collaboration with the Veterans Health Administration (VHA) to provide an additional opportunity to SUAs and AAAs to serve Veterans of all ages at risk of nursing home placement. The Veteran Directed Home and Community Based Service Program (VD-HCBS) is a package of services that the VA purchases from AAAs and/or SUAs on behalf of eligible Veterans. The VD-HCBS program will provide veterans the opportunity to self-direct their long-term supports and services that enable them to avoid institutionalization and continue to live independently at home. Veterans enrolled in VD-HCBS have the opportunity to manage their own flexible budgets, to decide for themselves what mix of goods and services best meet their needs, and to hire and supervise their own workers. The Aging Network provides facilitated assessment and care/service planning, arranges fiscal management services, and provides ongoing options counseling and support to Veterans.

Are You New to VD-HCBS?

State and/or local level aging network entities can begin to plan for implementation of the Veteran Directed Home and Community-Based Services program with their local VA Medical Center partners. Suggested steps include:

1. Find the right people.
The VD-HCBS program requires partnership between VA and Aging Network officials. Contact ACL, your SUA, and other AAAs that may be involved in moving forward. ACL can work with Dan Schoeps at VA Central Office to identify the right contacts at your local VAMC, if needed.

2. Do your homework.
Review the resources for VD-HCBS and consumer direction at www.adrc-tae.org and at www.participantdirection.org. Talk to your colleagues in other states about their experiences with VD-HCBS. Contact your Technical Assistance Lead with questions or for help connecting with your peers. The Readiness Review (see below) can also be used as a planning tool.

3. Establish mutual buy-in for VD-HCBS.
Discuss the project with your partners at the VAMC and establish a shared understanding of the program before moving forward. Your VAMC partners may already be excited to start a new program, but they may also want to check with their contacts at other medical centers or at VA Central Office.

4. Work with federal partners.
Your federal partners are available to assist you and the VAMC as you plan for implementation. Visit the VD-HCBS Contacts page to identify your state's point of contact at ACL.

5. Determine reimbursement rates.
Generally, VA Central Office gives the local VAMC a range to fall within, but there is a lot of local flexibility. Sufficient, sustainable payment rates from the VAMC will be essential to supporting the program.

6. Pass a readiness review.
The Readiness Review document is completed by the AAA/ADRC, and verification of readiness is made by the National Resource Center for Participant-Directed Services (NRCPDS). Points of contact for this process are Merle Edwards-Orr (merle.edwards-orr@bc.edu) and Sandy Barrett (sandragbarrett@sbcglobal.net). The document is also a great opportunity for self-assessment for AAA/ADRCs early in the development process.

7. Execute a provider agreement.
A Provider Agreement with the VAMC is required for services that the AAA/ADRC will provide. It can be executed between a VAMC and AAA/ADRC or a VAMC and SUA.

Key Resources for Getting Started

Procedures for Implementing Veteran Directed Home and Community Based Services (PDF)
Source: Veterans Health Administration
The VD-HCBS program provides Veterans the opportunity to receive home and community based services that enable them to avoid institutionalization and continue to live in their homes and communities. This document describes requirements and procedures for implementing VD-HCBS locally.

VD-HCBS Flow Chart (PDF)
Source: Technical Assistance Exchange and Administration for Community Living
This flow chart describes the process by which an eligible veteran may be screened and enrolled in the Veteran Directed Home and Community Based Services program, including the roles of the VAMC and CLP grantee agencies.

Readiness Review to Deliver Veteran Directed Home and Community-Based Services (PDF) or (Word)
Readiness Review to Deliver Veteran Directed Home and Community-Based Services relating to Financial Management Services (FMS) (PDF) or (Word)
Source: National Resource Center for Participant-Directed Services
This document describes the criteria sites must meet in order to be approved to deliver Veteran Directed Home and Community-Based Services. The purpose of the review is to determine whether essential participant-directed program components are in place and to identify areas where assistance may still be needed.

Example Flowchart for Readiness Review Submission (PDF)
Source: National Resource Center for Participant-Directed Services
This document provides an example of the flowchart which is to be submitted as part of the Readiness Review. The flowchart may also be used as an example of a veteran's movement through VD-HCBS.

VD-HCBS Implementation Training Series
Source: Technical Assistance Exchange
From December 2011 through February 2012, the Administration for Community Living (ACL) hosted a training series on VD-HCBS program development/implementation. Each training is tailored to a specific topic within VD-HCBS such as provider agreements, programmatic & FMS readiness reviews, billing & invoicing, cash flow management, quality assurance monitoring, and identifying a business model. You can view the recorded webinars in a Windows Media Player or read through the presentation slides in PowerPoint.

Overview of VD-HCBS Program (PDF)
Source: Disabled American Veteran's Magazine
Magazine article about VD-HCBS: "A program for VA patients who need long-term care but choose to remain at home is expected to be available in 28 states this year. This alternative to nursing home care allows veterans to live independently in their community with a greater choice over the services they receive."

TAE Issue Brief: How ADRCs Can Effectively Assist Veterans (PDF)
Source: Technical Assistance Exchange
The TAE Issue Brief "How ADRCs Can Effectively Assist Veterans” details programs and benefits relevant to help ADRCs best serve older veterans and veterans with disabilities. The brief also contains details of the newly created Veterans Directed Home and Community Based Supports Program, which helps Veterans Administration Medical Centers provide home and community supports to veterans. The report also contains brief case studies of ADRCs that have successfully collaborated with veterans services. Finally, the brief provides advice for how ADRCs can effectively build relationships with veterans services and provide the best service possible to older veterans and veterans with disabilities.

Helpful links elsewhere on this website

Resources by Topic > VD-HCBS Materials
The TAE Resources are organized by topic and sub-topic to assist users in locating needed information. Visit the page dedicated to resources that relate to the VD-HCBS program.

Resources by Population Served > Veterans
Many of the TAE Resources are relevant to specific service populations, such as veterans, caregivers, people with disabilities, et cetera. View the page dedicated to resources that pertain to serving veterans.

Calendar of TAE Events
This calendar, updated regularly, provides details about regularly scheduled all-grantee monthly calls, TAE Trainings, conferences of interest to grantees, and other events.

Technical Assistance Exchange Issue Briefs
The Technical Assistance Exchange and our partners regularly publish Issue Briefs on specific topics of interest to grantees. Recent examples have included Leadership Transitions, Coordinating with Transportation, Assessing the Fiscal Impact of ADRCs, and many others.

How to Contact ACL and Technical Assistance Teams
Each state is assigned a Technical Assistance "lead" at The Lewin Group to coordinate any requests for information and aid. Each grantee is also assigned a project officer at the Administration for Community Living. View contact information for the TAE team and our Federal partners at the link above.

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