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Veterans Administration (VA) SNF Payment Policies Impacted by PDPM
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The Veterans Health Administration is America’s largest integrated health care system, providing care at 1,255 health care facilities, including 170 medical centers and 1,074 outpatient sites of care of varying complexity (VHA outpatient clinics), serving 9 million enrolled Veterans each year. Community providers are a vital part of VA’s high-performing health care network; making sure Veterans who have served our country and their families get the timely, high-quality health care they need. With community care, Veterans and their family members (dependents) can receive care from a local provider in their community depending on specific eligibility requirements, their medical needs and circumstances, care available at VA, and other factors.
Community-based skilled nursing providers may furnish short-term and long-term care to veterans under VA benefits under one of the three programs identified below:
- 1.Patient-Centered Community Care (PC3) is a nation-wide network of community providers VA uses to refer Veterans to community care under specific circumstances. PC3 is intended to provide eligible Veterans with access to medical care when services are not readily available or accessible at their local VA medical facility.
- 2.Community Care Network (CCN): In an effort to streamline VA’s community care programs, the president signed the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018, referred to as the “MISSION Act,” into legislation on June 6, 2018, providing more choices and robust care coordination for Veterans using one consolidated program instead of multiple programs. A significant component of having one method for Veterans to receive care from community providers, although not dependent on the legislation, are the Community Care Network (CCN) contracts to be awarded to as many as four contractors covering an established set of regional boundaries to ensure health care services and resources are available to our diverse Veteran population. To establish the new CCN, VA released a request for proposal for private sector companies to develop and administer regional networks of high-performing licensed health care providers who will work together with VA providers and practitioners to provide medical, dental, and pharmacy services to Veterans who are unable to receive care at local VA medical centers. The CCN contracts were developed with a focus on transparency, accountability, quality, and increased communications between VA and Veterans.
- 3.Veterans Care Agreements (VCA): VA may enter into agreements with certain community providers to care for Veterans when they are not part of VA’s contracted community care network. These agreements are known as Veterans Care Agreements (VCA), which are intended to be used in limited situations where contracted services through VA’s community care network are either not provided or not sufficient to ensure Veterans can get the care they need. VA may only purchase care for Veterans through these contract vehicles such as the Patient-Centered Community Care (PC3) network or the Community Care Network (CCN), or by establishing a VCA. Providers interested in establishing a VCA should contact their closest VA medical facility. In some cases, VA medical facilities may reach out to community providers to request they establish a VCA where there is a need for services not adequately covered through VA’s contracted network.
VA Relationship with PDPM: Historically, the VA program payments to SNFs have varied regionally, with many locations having based payments on the Medicare SNF PPS RUGs payment model. While certain parts of the VA system are transitioning to PDPM on October 1, 2019, other parts appear to be continuing to base payments to SNFs under the RUGs model, or under other previously established contracted rates with individual providers, for at least a short period. This toolkit contains the most current available information related to the VA SNF payment policies.