President Barack Obama signed a bill this summer that provides the VA $10 billion to contract out care for vets who can't get an appointment in 30 days at VA hospitals or clinics. Also covered are veterans who live more than 40 miles from a VA facility.
The VA Tuesday released an interim rule (PDF) that laid out and reiterated guidelines for covered services, eligibility requirements, reimbursement rates and criteria that non-VA providers must meet to participate. The proposed rule will be effective Nov. 5. The CMS will accept comments through March 5.
The AHA quickly expressed its concern that the VA may be slow to reimburse its members for the care they provide veterans. Qualifying vets must be enrolled in the VA health system as of Aug. 1, 2014, or within five years of post-combat separation.
The rule has no timeline regarding when providers can expect to be paid, only what they can expect to be paid, which “will not exceed the applicable Medicare rate.” To qualify to see veterans, healthcare providers must already participate in the Medicare program.
“We had hoped to see a more detailed plan to ensure that care provided to veterans is reimbursed in a timely manner,” Richard Umbdenstock, CEO of the American Hospital Association, said in a statement.
The VA is known to be a slow payer, sometimes taking more than a year to reimburse for a claim, and even then, paying less than expected.
Paying no more than Medicare rates in the new plan may concern some hospital administrators.
“Imposing Medicare rates, especially for complex cases, will likely not create open doors for veterans at many hospitals,” said Colette Lasack, vice president of revenue cycle at Kansas City-based University of Kansas Hospital earlier this summer. “Adding capacity to accommodate an influx of patients from the VA system requires financial investment in people, technology and facilities, (which is) something that is not likely to happen with Medicare rates.”
Others hospitals have said they will be happy to treat veterans regardless of reimbursement rates.
The VA will pay more to a provider in a highly rural area where there are few to no other options, the new rule specifies. Other clinicians who could see a higher rate include OB-GYNs because Medicare rates do not exist for the services these providers offer, the rule says.
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