HCAOA VA Council Meets with VA Leadership in D.C.

During Advocacy Day in Washington last week, the HCAOA VA Services Advisory Council met with the leadership of the VA Community Care Network at the U.S. Department of Veteran Affairs headquarters. The VA appreciated the time to learn about what providers are experiencing in the field.

The Council presented a survey of over 30,000 authorizations and consults that revealed diverse numbers of hours of home care prescribed for veterans. Many of the consults were for under 10 hours per week, even though veterans in the program have to be eligible for nursing home level care. VA leadership explained that each VA Medical Center has a budget they are responsible for, and with the higher reimbursement amounts in many parts of the country, medical centers are becoming more budget conscious. While consults indicate lower amounts of hours, the VA tracks claims paid, and the average paid claim has increased from nine to 13 hours/week, and the VA is spending $700 million above their appropriation for home care programs. There are also 14% more authorizations for care issued.

The VA believes the growing average in paid claims may be driven by home care agencies billing based on the authorization instead of the consult, which is incorrect. This is prompting the VA to conduct a linear study of authorizations, consults, and actual number of hours of care provided and claims paid. Having a clear understanding of the usage of hours and actual costs would enable the VA to submit more reliable budgets to Congress.

The additional expenditures and the need for VA medical centers to manage budgets have led the VA to review the fee schedule this summer. The VA Council urged the Department to take into account economic factors in various areas of the country that the Council provided to the VA in January. The VA found the information very helpful and will take it into consideration. The VA suggested that some of the higher rates for home health aide may be decreased in the coming years. The fee schedule is not expected to change in the near term. The Council also suggested that while homemaker hours may often have a lower reimbursement more friendly to VA Medical Center budgets, homemaker services will not reduce nursing home usage.

The Council addressed providers being referred to audit and fraud investigations by the Milwaukee VA even though documentation in authorizations and training manuals are confusing and audits commenced without warning and without opportunity for remedy. The VA agreed that the response by Milwaukee was inconsiderate. The Council will continue to address the issues in Milwaukee with VA leadership.

The Council also asked to work with leadership on creating a clear pathway for home health agencies licensed to provide skilled care but are not Medicare-certified to obtain unbundled authorizations. The VA leadership was agreeable to connecting the Council with the Integrated Veterans Care team which has responsibility for credentialing and the provider directories.

The Council also asked for clarity on using respite code S.9124. VA leadership suggested using a 15-minute G code for now. The VA acknowledged this remains an unresolved issue.

The Council will continue to represent the home care industry before the VA and advocate for policies that ensure veterans have the care they need.

Pictured Above
Virtually On Screen: Daniel Schoeps, Director, Purchased Long Term Services and Supports, Geriatrics and Extended Care
Pictured Left to right:
Eric Reinerman, Vice President, Government Affairs, HCAOA
Rick Mabe, National Director of Business Development and Managed Care Operations, Visiting Angels
Yossi Stern, Chief Operating Officer, Paradigm Senior Services
Jason Lee, CEO of HCAOA
Cheryl Stanton, Chief Legal and Government Affairs Officer, BrightStar Care
Dorrie Emmerich, Director, Sales & Opportunity National Accounts, BrightStar Care
Doug Robertson, HCAOA VA Advisory Council Chair, Right at Home
Cheryl Schmitz, Deputy Executive Director, Office of Geriatrics and Extended Care
Matthew Walker, Co-Owner, Village Caregiving
Carmen Perry-Tevaga, Strategic Partnerships, Patriot Home Care
(taking the picture) JD Hagedorn, BrightStar Care Franchisee