The Department of Veterans Affairs (VA) has issued a rule that delays the effective date for the billing methodology for non-VA providers of home health services and hospice care. In the May 6, 2013 Federal Register, the VA published a final rule which established a November 15, 2013 effective date to change the billing methodology for non-VA providers of home health services and hospice care that have not negotiated a rate with the VA. This announcement delays that effective date to April 1, 2014.
On February 18, 2010, the VA issued a proposed rule to implement certain payment methodologies for all non-VA inpatient and outpatient health care professionals and providers, which included paying according to Medicare fee schedules and prospective payment systems, as applicable. When the final rule was published on December 17, 2010, however, the regulation included an exception for implementing the payment methodologies for home health and hospice services.
The VA cited administrative and systems problems that prevented their ability to implement the Medicare payment system for home health and hospice services on such short notice.
Additionally, on May 6, 2013, the VA published a final rule that established an effective date of November 15, 2013 for the payment methodology for non-VA home health and hospice providers that do not have a negotiated contract with the VA.
Services provided by non-contracted home health and hospice agencies were to be paid the lowest of the following amounts:

  • The applicable Medicare fee schedule or prospective payment system amount (“Medicare rate”) for the period in which the service was provided;
  • The 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. For the purposes of this section, repricing agent means a contractor that seeks to connect VA with discounted rates from non-VA providers as a result of existing contracts that the non-VA provider may have within the commercial health care industry;
  • The amount that the provider bills the general public for the same service.

The VA has delayed the November 15, 2013 implementation date until April 1, 2014 due to unforeseen difficulties in contracting and information technology procedures required to apply the billing methodology to non-VA home health services and hospice care.

ABOUT HMS   |   SERVICES & SOLUTIONS   |   RESOURCES   |   CONTACT   |   BLOG

8 Research Parkway, Wallingford, CT 06492 | 203.269.4667 | Toll Free: 888.629.6664

Copyright © 2013. Healthcare Management Solutions, Inc. All rights reserved.