The Department of Veterans Affairs (VA) has issued a final rule that amends its payment regulation for non-VA providers to include providers of home health and hospice services.
Effective November 15, 2013, non-Va home health and hospice providers that do not have a negotiated contract with the VA will be paid the lowest Medicare rate for the period in which the service was provided.
Additionally, these providers will also receive the lowest amount negotiated by a repricing agent, if the provider is participating within the repricing agent’s network and VA has a contract with that repricing agent.
In this section of the rule, VA defines “repricing agent” as a contractor that seeks to connect VA with discounted rates from non-VA providers as a result of existing contracts that these providers may have within the commercial health care industry.
Under the final rule, Non-VA home health and hospice providers can also expect to receive the lowest amount that the provider bills the general public for the same service.
On February 18, 2010, the VA issued its proposed rule to implement certain payment methodologies for all non-VA patient and outpatient health care professionals and providers.
When the final rule was published on December 17, 2010, the regulation included an exception for including home health and hospice services into its payment methodologies.
Because administrative and system problems prevented VA ability to implement the Medicare payment system for home health and hospice on such short notice, these newly included care services have been paid according to a payment rate structure outlined in the 2004 VA Handbook.
For home health providers, this payment structure pays for services on the Medicare low utilization payment adjustment rates.
For hospice services, the VA uses locally calculated Medicare hospice payment rates as the maximum reimbursement rates to purchase a package of bundled home hospice services.
Written by Jason Oliva