Friday February 1, 2013

NEAL P. GOSWAMI

Staff Writer

BENNINGTON -- The Vermont Veterans Home is facing a shortfall of more than $2 million in its 2014 fiscal year budget because of a low census, increased costs and stagnant reimbursements rates from federal care health programs.

The home is running a deficit in the current fiscal year that could approach $3 million, according to officials. The 2014 fiscal year budget deficit is projected to be about $2.5 million before a $400,000 contribution from the state’s Global Commitment fund.

The current budget of $19.1 million will rise to $20.2 million in the 2014 fiscal year. The salary line item is set to decrease by about $240,000. However, a budget narrative provided to lawmakers this week indicates that overtime, temporary employees and shift differential pay have not been budgeted.

Benefits will increase about $96,000, mostly due to an increase in the employers’ share of the Federal Insurance Contributions Act tax, which funds Social Security.

Supply cost up $626,000

Non-salary increases are listed at more than $1 million, an increase of about 27 percent. The largest factor is a $626,000 increased cost for various supplies.

Most of the home’s funding comes from the Centers for Medicaid and Medicare Services and other insurance programs. But flat reimbursements are not keeping up with costs, according to officials.

Board of Trustees President Joseph L. Krawczyk Jr. said the projected deficit in the next budget is based on a variety of factors. Perhaps the biggest factor is that the home’s census, or number of residents living at the state-run home, has dwindled.

The home, which can accommodate almost 170 residents, has a current average of 120 residents. The facility’s census was purposely reduced following a near-loss in September of its provider agreement with Centers for Medicaid and Medicare Services. The federal funding from CMS was in jeopardy unless the home could correct several deficiencies identified by state inspectors. The home passed a last chance inspection in September but remains under closer scrutiny.

However, the census dropped to 118 residents as the home focused on correcting the deficiencies and training staff. That drastically reduced revenues.

According to the home’s budget plan, officials counting on an average daily census of 140 residents in the next fiscal year. That would still be down from the 150 residents in the current budget.

Krawczyk said the home is already making progress. "We’re moving on it," he said. "We’ve increased it already a few this week. It’s a goal. It’s a benchmark out there. We hope to be able to do that."

There are factors making it more difficult, however. New York passed a law in 2011 that requires the home to contact all New York nursing homes within a 50 to 75 mile radius of a New York resident that wishes to live at the Vermont home. Krawczyk said New York residents cannot live at the home if a New York facility will accept them.

The law was passed "in order to try to make it more difficult for (New York veterans) to go (out-of-state), Krawczyk said. "They’ve got a money problem, too," he said.

The home often cares for residents for months without guarantee of payment, and sometimes with no payment at all. According to a VVH budget narrative presented to lawmakers, it can take three months for a Vermont resident’s Medicaid application to be approved. Approval for a New York resident can take longer.

Krawczyk said if an application is not properly filled out, the home may not receive any payment.

"We raised that with the Legislature and they were very concerned with that," he said.

Bennington County also has the second-lowest occupancy rate of nursing home beds in Vermont, according to VVH officials. With just 80.1 percent of beds utilized, there are many options available for veterans.

The home will raise the rate for semi-private rooms by 4.7 percent, and the rate for a private room by 8.1 percent. Federal reimbursement rates will remain flat, though.

Krawczyk said the current daily stipend for a resident from the Veterans Administration will remain $97.07. The daily Vermont Medicaid rate for a resident will be flat at $245 and the daily New York Medicaid will also remain stagnant at $228, Krawczyk said.

About 60 percent of the home’s total budget is made up of salaries and benefits for employees, Krawczyk said. Those are contractual and cannot be reduced or cut. The home faces a host of additional budget pressures, too, including a $120,000 increase in fuel and a $200,000 jump in the state-levied provider tax, he said.

"It’s $50,000, $60,0000 here, there, and everywhere else. It adds up," Krawczyk said.

Meanwhile, the home is seeking $1 million in the state’s capital budget to remove mold from the basement of the facility. Lawmakers are discussing whether to spread that cost of one or two fiscal years.

"Even though the mold is contained down there and no risk to patients, we’ve got to get on that down there," Krawczyk said.

Mold was discovered in a room in the facility’s dementia wing last August, as well as the basement, according to Krawczyk. Patients were moved and the mold was removed as quickly as possible form living areas, he said.

"We took immediate action right away," he said. "We have it contained. It’s in the basement only now. The trouble is, it’s where we store our records and stuff."

Contact Neal P. Goswami at ngoswami@benningtonbanner.com, or on Twitter @nealgoswami