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End delay, VA is told

August 15, 2014
by Bob Gatty
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With all of the controversy over the difficulties of America’s veterans obtaining needed healthcare from Veterans Affairs (VA) hospitals around the country, it is especially timely that a group of lawmakers is putting the heat on the VA to make it easier for vets to obtain care from non-VA facilities.         

Yes, President Obama has just signed legislation to overhaul the VA, and it is supposed to make it possible for veterans to obtain outside healthcare, but according to industry experts, the legislation doesn’t really address long-term care. That’s why the effort by these lawmakers in both the House of Representatives and the Senate is so important.

Aug. 8, 109 members of the House sent a letter to VA Secretary Robert A. McDonald urging the release of final rule RIN 2000-AO15, which would allow for the use of alternative provider agreements for extended care services. The proposed rule was released on Feb. 13, 2013, and is still languishing at the VA. “Expanding veteran access to extended care services from local providers could not come at a better time,” the congress members said in their letter. “Veterans who need these extended care services deserve access to this critical care.”         

Under the VA provider agreement, the VA would be authorized to enter into agreements with additional long-term service and support providers, expanding the number available to veterans. “As a result,” the letter said, “veterans will be able to access quality healthcare providers who are eager to participate in the VA system. In addition, these providers will expand options for veterans who desire care closer to their homes or their support network of family and friends.”

The agreement covers nursing center care, geriatric evaluation, domiciliary services, adult day health care, respite care, palliative care, hospice care and home healthcare.

“In the release of the final rule, we believe it’s also essential for the VA to meet its obligation to our veterans by assessing and maintaining uniform quality standards,” the letter stressed. “The VA provider agreement must ensure that our veterans will have access to quality healthcare regardless of where they live, and we urge you to release the final VA provider agreement rule as soon as possible.”

The American Health Care Association (AHCA) and National Centers for Assisted Living applauded the effort, led by Reps. Tulsi Gabbard (D-HI) and Jackie Walorski (R-IN). The effort comes after a similar bipartisan effort by 43 U.S. senators in June.

“Members of the House and Senate have spoken,” said Mark Parkinson, AHCA/NCAL president and CEO. “Once enacted, this rule will bring needed care to veterans through a network of local care providers. We now urge the VA to release the final VA provider sgreement rule and give back to our veterans who have given so much to our country.”

The rule is important because it is long-standing policy that Medicare (Parts A and B) or Medicaid providers are not considered to be federal contractors. If a provider currently has VA patients, however, then he or she is considered to be a federal contractor.

Under the new VA provider agreement, providers would not be considered federal contractors and, therefore, would not have to follow complex federal contracting and reporting rules. Federal contracts come with extensive reporting requirements to the Department of Labor on the demographics of contractor employees and applicants, which have deterred providers, particularly smaller ones, from VA participation.

It is anticipated that when the final rule is in place, the number of providers serving veterans will increase in most markets, expanding the options among veterans for nursing center care and home- and community-based services.

Meanwhile, in a related development, Sen. Richard Blumenthal (D-CT) says Congress will focus on the renovation and rebuilding of long-term care (LTC) facilities when lawmakers return from their summer recess in September. Blumenthal serves on the Senate Armed Service, Veterans Affairs and Special Aging committees. 

The new VA reform law authorizes at least $17 billion to improve the VA healthcare system, which has been plagued with long patient wait times and falsified records covering up the delays. The agreement includes $10 billion in emergency spending to make it easier for veterans who cannot get prompt appointments with VA physicians to obtain outside care.        

Blumenthal said next on the agenda is renovating and rebuilding VA LTC facilities. The question, of course, is whether this politically fractured Congress, just a few weeks before the November elections, will be able to agree on any legislation that will require expenditures.

Most likely, any such initiative will have to wait until the new Congress that convenes in January, and, of course, the outcome will depend on the makeup of that Congress following the elections.

Related content: Long-term care next VA focus, senator says