2024 NC State Legislature Short Session Request for Veterans Home Replacement

2024 NC State Legislature Short Session Request for Priority State Veterans Home Replacement in Fayetteville Military Officers Association of America NC Council of Chapters State Advocacy 10 January 2024

Table of Contents Table of Contents Recommendations Situation State Home Funding & Budget State Home Trust Fund Current Authorized Uses Veteran Cemeteries Trust Fund State Home Trust Fund Changes 2023 (HB 259 PG 555) Additional Details NC State Veterans Home History State Veteran Home Overview Previous (2015) State Home Funding Verbiage (Federal CFR) State Legislative Guidance to DMVA ( 3 slides): Long Term Planning FY21-22 An Additional State Funding Option

Recommendations Recommendations State Legislature approve use of State Home Trust Funds for any cost adjustment for disabled veterans displaced with short notice closing of Fayetteville State Veterans Home. DMVA promised comparable nursing care (If needed G.S. 143C-6-4; G.S. 143C-6-1) Divert funds in the Cemetery Trust Fund BACK into the State Home Trust Fund with directed use to initiate a replacement home in Fayetteville. Perpetual veteran cemetery support not expected to be needed for at least another 19 years per DMVA. Approve the use of funds previously planned for a home in Raleigh to expedite the replacement of the Fayetteville State Veterans Home. Initiate a state review as requested in FY21-22 on partnership possibilities with private assisted care/nursing facilities around the state that would enable more veterans to access funds within the State Home Trust Fund for managed care in their NC city home of record. Initiate a review of the state engineering approval process of the closing Fayetteville State Veterans Home for lessons learned to prevent a repeat of its infrastructure failures.

Situation Situation The 150 bed Veterans State Home in Fayetteville, NC is scheduled to close on 1 February 2024 due to extensive infrastructure issues. This decision was made late November 2023 making a short notice requirement to re-home 85 nursing care Veterans. This short notice created hardship on disabled/aging veterans. It is not unusual for assisted living/nursing facilities to have wait lists over a year or two long. Maintenance issues have been previously known with one wing having been temporarily closed pending repairs reducing the home to 85 usable beds ( excess funds still moved to cemetery trust fund). As of 9 January, 30 veterans still needed rehoming in another comparable health care home.

State Home State Home Funding & Budget Funding & Budget 1. Funding & Maintenance a. Facility maintenance budget remains the responsibility of the State Legislature, delegated to the NC DMVA through annual and special state appropriations. b. Operating budget funded by Medicare, Medicaid, Insurance, Veterans Administration, private pay and donations. Contracted Third party operating management & staffing (Pruitt Health); billing is after services are provided c. All funds are to be maintained in the Veterans Home Trust Fund, G.S. 143B-1293 2. 2023 Conference Report on the Base, Capitial & Expansion Budget: Pg F206-7 Veterans Homes Trust Fund 1. FY 23-24 Requirements $72,166,291; Receipts $ 59,006,170; Net Appropriation from (increase to) Fund Balance $13,160,121; FTE 10,750 2. Legislative Changes: 1095 $5M to Veterans Cemeteries Trust Fund 3. Legislative Changes: 1096: Directed grant to Purple Heart Homes Inc. to support the Veterans Aging in Place & veterans home ownership programs for veterans and their families $3M FY23-24 & $3M FY 24-25. 4. Legislative Changes: 1097: Military Missions in Action Provides Funds from the cash balance for a directed grant to Military Missions in Action to assist disabled veterans $750,000 FY23-24. 5. Repairs & Renovation Reserve Fund: $1.5M Urgent & Unanticipated R&R needs will be covered under the authority in G.S. 143C6-4. 6. Adjusted state trust balance by increasing funds moved to cemetery fund due to FY21-22 receipts collected that exceeded the cost of nursing home operations in each state home so 10% was transferred to the cemetery fund pers GS 134B-1293(d). Total: $1,108,405 7. Revised budget Requirements: $73,524,696; Revised Receipts $59,006,170; Revised Net Appropriation from (increase to) Find Balance $14,518,526; Revised FTE 10,750 8. Fund Balance Availability Statement. Estimated Beginning Fund Balance $80,581,623; Less: Net Appropriation From (Increase to) Fund Balance $14,518,526; Estimated Year-End Fund Balance $66,063,097

State Home Trust Fund State Home Trust Fund Current Statute Authorized Uses Current Statute Authorized Uses 143B-1293. North Carolina Veterans Home Trust Fund. (a) Establishment. A trust fund shall be established in the State treasury, for the Department of Military and Veterans Affairs, to be known as the North Carolina Veterans Home Trust Fund. (b) Composition. The trust fund shall consist of all funds and monies received by the Veterans' Affairs Commission or the Department of Military and Veterans Affairs from the United States, any federal agency or institution, and any other source, whether as a grant, appropriation, gift, contribution, devise, or individual reimbursement, for the care and support of veterans who have been admitted to a State veterans home. (c) Use of Fund. The trust fund created in subsection (a) of this section shall be used by the Department of Military and Veterans Affairs to do the following: (1) To pay for the care of veterans in said State veterans homes; (2) To pay the general operating expenses of the State veterans homes, including the payment of salaries and wages of officials and employees of said homes; and (3) To remodel, repair, construct, modernize, or add improvements to buildings and facilities at the homes. (d) Miscellaneous. The following provisions apply to the trust fund created in subsection (a) of this section: (1) All funds deposited and all income earned on the investment or reinvestment of such funds shall be credited to the trust fund. (1a) The Department of Military and Veterans Affairs shall transfer ten percent (10%) of the unspent receipts collected in each fiscal year from the trust fund to the North Carolina Veterans Cemeteries Trust Fund on or before June 30 of each fiscal year. (2) Except as provided in subdivision (1a) of this subsection, monies remaining in the trust fund at the end of each fiscal year shall remain on deposit in the State treasury to the credit of the North Carolina Veterans Home Trust Fund. (3) Nothing contained herein shall prohibit the establishment and utilization of special agency accounts by the Department of Military and Veterans Affairs or by the Veterans' Affairs Commission, for the receipt and disbursement of personal funds of the State veterans homes' residents or for receipt and disbursement of charitable contributions for use by and for residents. (1995, c. 346, s. 1; 2011-284, s. 127; 2015-241, s.24.1(k),(pp);2015-268, s. 7.3(a),(b); 2021-180, s. 33.5(b).)

Veteran Cemeteries Trust Fund Veteran Cemeteries Trust Fund 1. In the last couple of state budgets, money has been taken out of the Veteran State Home Trust Fund and redirected into the Veteran State Cemetery Fund (perpetual care). DMVA can t touch it and it can only be used for veteran cemeteries that are closed to accepting new burials. No Veteran Cemetery is expected to be closed for at least 19 years into the future as forecast by the DMVA. The Veteran Cemetery Trust s projected value at the end of current FY is $21,473,589. a. In the Committee Report: 1094. Fund Code 2401 moved $5,000,000 NR from the Veterans Homes Trust Fund to the Veterans Cemeteries Trust b. In the Committee Report: 1094 FY 2021-22 Receipts Fund Code 2401 Adjusts reflect the transfer of excess receipts collected in the State Veterans Homes Trust Fund during FY 2021-22 in accordance with G.S. 143B- 1293(d)(1a) $1,108,405 NR to the Veterans Cemeteries Trust 2. Wouldn t these funds be better used to support a replacement state veteran home in Fayetteville diverting these funds back into the State Home Trust Fund and authorizing the initiation of a replacement Home in Fayetteville outside of the largest military installation in NC? 3. Can a long-term strategic plan be developed that enables veterans access to funds within the State Veterans Trust Fund while getting assisted living or nursing care at private or semi-private facilities in their cities/towns around the state close to families and friends? Wouldn t this be a better use of Medicare & VA managed care funds than transferring those funds to a perpetual cemetery trust fund?

State Home Trust Funding Changes 2023 HB 259 PG 555 (1a) The Of the funds deposited in the trust fund each fiscal year, the Department of Military and Veterans Affairs shall transfer ten percent (10%) of the unspent receipts collected in each fiscal year from the trust fund to the North Carolina Veterans Cemeteries Trust Fund on or before June 30 of each fiscal year. ." VETERANS HOME TRUST FUND/ROUTINE REPAIRS TO STATE VETERANS HOMES SECTION 33.2. Of the funds appropriated in this act to the Department of Military and Veterans Affairs for the 2023-2024 fiscal year, the Department shall reserve the sum of one million five hundred thousand dollars ($1,500,000) to be used to make routine repairs and renovations to buildings and facilities at State veteran homes. Funds held in reserve as required by this section shall not be used for "unforeseen circumstances," as that term is defined in G.S. 143C-6-4(b)(3). Funds for unforeseen circumstances shall be spent only as authorized by G.S. 143C-6-4. VETERANS HOME TRUST FUND/TRANSFER TO VETERANS CEMETERY TRUST FUND SECTION 33.1. G.S. 143B-1293 reads as rewritten: " 143B-1293. North Carolina Veterans Home Trust Fund. (d) Miscellaneous. The following provisions apply to the trust fund created in subsection (a) of this section:

Additional Details

NC State Veteran Home History NC State Veteran Home History 1891-1938 NC Legislature established the NC Soldiers Home on the Civil War training camp land off New Bern/Rock Quarry Roads, across from the National Cemetery. Funding provided by subscribers and the General Assembly. Provided domiciliary & health care. Closed in 1938 due to decline in number of residents. 1990-1999 VA run nursing home wards at the 4 NC Veterans Medical Centers were phased out. Legislature feasibility studies showed Veterans from NC were receiving care at the SC state Veterans Nursing Home & private facilities, costing increased NC spending of Medicare funds Fayetteville Home History: 1. 1994 State portion of funding approved for building of Fayetteville Veteran Nursing Home. 2. 1996 Federal grant funding approved. (Construction funding begun. 3. 1999--Building opened to 150 veterans requiring skilled nursing care, only. 4. Request for Information: when wing closed and reduced to 85 beds Still pending from both DMVA & Fayetteville Home Administrator. 5. The Fayetteville facility is located adjacent to the Fayetteville Veterans Affairs Medical Center (VAMC). It is a one-story building (82,000 ) comprised of 150 beds with ancillary support and mechanical space. There are three wings with fifty beds in each unit. One of the wings includes a Memory care 20 bed unit and 30 bed unit for a total of 50 beds in the wing. (Construction funding 1/3 state, 2/3 VA 1/3 state, 2/3 VA). State bidding process and construction permitting

State Veteran Home Overview: State Veteran Home Overview: The US Department of Veterans Affairs (USDVA) is authorized to make certain grants to states for construction and acquisition of state home facilities. In 2015, the North Carolina General Assembly enacted legislation (NCGS 143B-1291) that authorizes the NCDMVA to construct, acquire, and operate veterans homes. The Department of Military & Veterans Affairs has State Management Authority over a total of 5 State Veteran Homes for a total of 569 beds; Without the Fayetteville Home the bed total is 419: Salisbury (99 beds) November 1998 Fayetteville (150 Beds) May 1999 with semi-private rooms Kinston (100 beds) April 2013 (mirrors Black Mountain facility) Black Mountain (100 Beds) opened October 2012 with private rooms Kernesville ( 120 Beds) opened October 2023 with private rooms Raleigh (there was a planned home to be completed by 2024 but it has been on hold and has not been initiated). Department of Administration, Office of Fiscal Management Purchasing Section contracted for the operation and management of licensed nursing care using a single 5-year proposal for the DMVA s State Veteran Homes Current operational management is contracted to Pruitt Health; Department of Health & Human Services Inspects each home for proper staffing and nursing standards of care It has been said that NC has the third highest number of veterans in the nation with over 760,000 within its borders.

Previous (2015) Statute State Home Funding Verbiage Gives Insight to original funding intent and origins prior to it be diverted to cemetery fund and other grants: 143B-1294. Funding. (a) The Department of Military and Veterans Affairs may apply for and receive federal aid and assistance from the United States Department of Veterans Affairs or any other agency of the United States Government authorized to pay federal aid to states for the construction and acquisition of veterans homes under Title 38, United States Code, section 8131 et seq., or for the care or support of disabled veterans in State veterans homes under Title 38, United Stated Code, section 1741 et seq., or from any other federal law for said purposes. (b) The Department may receive from any source any gift, contribution, devise, or individual reimbursement, the receipt of which does not exclude any other source of revenue. (c) All funds received by the Department shall be deposited in the North Carolina Veterans Home Trust Fund, except for any funds deposited into special agency accounts established pursuant to G.S. 143B-1293(d)(3). The Veterans' Affairs Commission shall authorize the expenditure of all funds from the North Carolina Veterans Home Trust Fund. The Veterans' Affairs Commission may delegate authority to the Assistant Secretary of Veterans Affairs for the expenditure of funds from the North Carolina Veterans Home Trust Fund for operations of the State Veterans Nursing Homes. (1995, c. 346, s. 1; 2001-117, s. 1; 2011-284, s. 128; 2015-241, ss. 24.1(k), (qq); 2015-268, s. 7.3(a).)

STATE LEGISLATURE GUIDANCE TO DMVA STATE LEGISLATURE GUIDANCE TO DMVA ASSESSMENT OF AND LONG-TERM CARE PLANNING FOR VETERANS See specifics below pages 500-501 SB 105 21-22 session. SECTION 33.1.(a) Notwithstanding the provisions of G.S. 143B-1293, of the funds appropriated in this act to the Department of Military and Veterans Affairs (Department), the sum of two hundred fifty thousand dollars ($250,000) in nonrecurring funds for the 2021-2022 fiscal year shall be used by the Department, in consultation with the Department of Health and Human Services (DHHS), to assess the long-term care needs of veterans across the State for the purpose of developing a plan to guide the State in enhancing long-term care and other services for veterans. The assessment and plan shall incorporate the following principles and objectives: (1) Use State-specific veterans' demographic information, including the geographical distribution of veterans across the State. (2) Allow for the fact that the needs of veterans are complex and broader than the traditional, institutional-based system of care. (3) Take into account the needs of pre- and post-Gulf War veterans in planning services and support. (4) Incorporate the presence and location of current State Veterans Homes, and the services they provide, in a larger long-term system of care to meet the needs of veterans in both rural and urban areas. (5) Enhance and develop new partnerships, including with the existing nursing home industry, to encourage and promote the location and certification of nursing homes in target areas so that those facilities can qualify for reimbursement from the U.S. Department of Veterans Affairs. 6) Explore partnerships with a broader system of nursing homes across the State to expand State resources. (7) Encourage partnerships of home- and community-based services with existing providers and the U.S. Department of Veterans Affairs for enhanced services. (8) Evaluate State planning to explore financially feasible and sustainable options for meeting veterans' needs. (9) Evaluate current resources by determining programmatic approaches to avoid new construction of State veterans' homes. (10) Consider alternate models of care prior to expanding veterans nursing homes.

State Legislature Guidance to DMVA State Legislature Guidance to DMVA SECTION 33.1.(b) To lead the assessment and develop the plan required by this section, the Department shall issue a request for proposals for an independent consultant with subject matter expertise in the field of long-term care planning for veterans. The provisions of Article 3 of Chapter 143 of the General Statutes shall apply to this subsection. SECTION 33.1.(c) The Department, in consultation with DHHS, shall issue a progress report on the implementation of this section no later than December 1, 2021, and April 1, 2022, and a final report, including the results of the assessment and the plan required by this section, no later than October 1, 2022, to the Joint Legislative Oversight Committee on General Government, the Senate Appropriations Committee on General Government and Information Technology, the House of Representatives Appropriations Committee on General Government, and the Fiscal Research Division. REPORT ON STATE VETERANS HOMES SECTION 33.2. Part 10 of Article 14 of Chapter 143B of the General Statutes is amended by adding a new section to read: " 143B-1301. Detailed annual report. By March 1 of odd-numbered years and September 1 of even-numbered years, the Department of Military and Veterans Affairs shall report to the Joint Legislative Oversight Committee on General Government, the Senate Appropriations Committee on General Government and Information Technology, the House of Representatives Appropriations Committee on General Government, and the Fiscal Research Division on the status of the State Veterans Homes program by providing a general overview of the State Veterans Homes and a specific description of each facility which shall include, at a minimum, all of the following: (details on next page)

STATE LEGISLATURE GUIDANCE TO DMVA STATE LEGISLATURE GUIDANCE TO DMVA REPORT ON STATE VETERANS HOMES REPORT ON STATE VETERANS HOMES Will Include at a minimum: (1) Facility location and date opened, which shall be included in the first report only, unless the information has changed. (2) Services available, including specialty services offered. (3) Staffing levels, including resident-to-nursing ratios. (4) Partnerships with outside organizations and governments in delivery of services. (5) Average daily census. (6) Number of beds, by type. (7) Admission eligibility, admission by type, such as long-term care and rehabilitation, and admissions by referral. (8) Description of residents, including: a. Demographics by age, race, ethnicity, and gender. b. Resident's home county where domiciled prior to admission to facility. c. Number of admissions, discharges, and deaths. (9) Results of resident and family satisfaction surveys. (10) Waiting list data, including average length of wait time and priority for admission. (11) Certification and quality rating by independent organizations and State and federal government. (12) Daily rate by payor, including Medicare, Medicaid, Veterans Affairs, private pay, or any other source. (13) Average out-of-pocket payment per resident. (14) State administrative costs, sorted by type, including staffing, fixed costs, facility operation, and maintenance. (15) Total receipts collected, by source, including Medicare, Medicaid, Veterans Affairs, private pay, or any other source."

An Additional State Funding Option An Additional State Funding Option Any lapse in using State Capital funds goes to the Capitial & Infrastructure Fund Created by G.S. 143 4.3.1 143C-4-3.1. State Capital and Infrastructure Fund. (a) Legislative Intent. The General Assembly recognizes the need to establish and maintain a sufficient funding source to address the ongoing capital and infrastructure needs of the State. The General Assembly further recognizes the need to protect the State's substantial improvements in existing public facilities while providing a stable funding source to pay for new facilities to meet the needs of a growing population The following amounts transferred from the General Fund at the beginning of the applicable fiscal year: a. For the 2021-2022 fiscal year, the sum of one billion three hundred million dollars ($1,300,000,000). b. For the 2022-2023 fiscal year, the sum of one billion three hundred sixty-five million five hundred thousand dollars ($1,365,500,000). c. For the 2023-2024 fiscal year, the sum of one billion four hundred twelve million five hundred ninety- two thousand five hundred dollars ($1,412,592,500).