Proposed Rule Expands Access to Home Health Care and Hospice Services for Veterans

The Veterans Administration has issued a proposed regulation to that will ease cumbersome requirements so that veterans can have greater access to extended care services though non-VA providers. The proposed rule includes home health care, palliative care, and non-institutional hospice care services as extended care services when provided as an alternative to nursing home care.

Contracts between VA and non-VA providers are currently negotiated under federal contract statutes and regulations that include onerous and often confusing federal reporting requirements. To addresses the barriers these federal requirements have in securing arrangements with non-VA providers, the new VA rule proposes to allow arrangements with non-VA providers through provider agreements. The proposed rule would permit the VA to enter into provider agreements for extended care services with non-VA providers who have an existing Medicare provider agreement with CMS or for extended care services with non-VA providers who do not have a Medicare provider agreement with CMS if the provider is participating in a State Medicaid plan.

In addition to streamlining arrangements with non-VA providers, the rates of a provider’s agreement with the VA would be the same as the terms and rates of the provider’s Medicare provider agreement with CMS or agreement under a State Medicaid plan. If a provider has agreements with both Medicare and Medicaid, the terms and rates would be the same as the agreement with the highest rates. VA’s payment under the agreement with the highest rates is intended to encourage providers to enter into agreements with VA for the care of veterans.

The rule stipulated that a provider may voluntarily terminate an agreement but would be required to notify the VA at least 15 days in advance of the planned termination. Conversely, the VA may terminate an agreement with a provider, and would also be required to give at least 15 days notice before terminating an agreement. If, however, VA finds that the health of the veteran is in immediate jeopardy, VA would be authorized to terminate the agreement with only 2 days notice.

Finally, the proposed rule establishes procedures for appeal of the VA’s decision not to enter into a provider agreement or to terminate an agreement with a non-VA provider.

Comments on the proposed rule are due on or before March 15, 2013. To view the proposed rule click here.

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