Wednesday, March 5, 2014

Community Nursing Home (CNH) Agreements and the VA


Dianne De La Mare

The Veterans Health Administration (VHA) has just begun notification to nursing facilities that its pilot Provider Agreements to purchase nursing home care are no longer acceptable. VA Provider Agreements, hammered out with significant input from AHCA, have been tested in a handful of states across the country over the past few years to ensure that the VA proposed rule on the Provider Agreements released in February 2013 is workable. AHCA was informed that this notice is due to the possibility that the final VA Provider Agreement rule might be released this year. According to an email from the VHA, in order “to maintain patient care it is imperative that nursing homes are transitioned from provider agreements to basic ordering agreements (BOAs) that are awarded by warranted Contracting Officers. This must be accomplished as expeditiously possible. VHA’s procurement organization is read in to this requirement and will be prepared to support this transition.” Below are additional points from the VHA email notification.

All Veterans Integrated Service Networks (VISNs) are requested to develop a listing by nursing facility where services are provided through provider agreements. The listing shall include the nursing facility name, address, point of contact for the nursing facility, current rates, expiration date of provider agreement, and identify a Contracting Officer Representative (COR) that will be working with your Network Contracting Office to establish BOAs. This listing needs to be forwarded to the Director of Contracting in the Network Contracting Office no later than Thursday, March 6, 2014. Priority will be given to provider agreements with the earliest expiration dates to protect the continuum of patient care.
  • It is envisioned that the Network Contracting Offices will establish short-term 90 day BOAs to each holder of provider agreements for signature with proposed rates. In determining the rate that will be initially offered the contractor the Contracting Officer and COR will consider current rates being paid under the provider agreements, but not exceed authorized contract rates. This is being done to expedite the process due to the volume of contracts, but it is anticipated that some nursing facilities will want to negotiate. The BOAs will contain a continuation of services clause that will permit extending the agreement when necessary. Due to the urgency of this transition facility inspections and contract reviews will be waived for the short-term BOAs. This short-term measure will allow time for longer-term BOAs to be established. The long-term agreements will be in executed in accordance with all regulatory and policy requirements. 
  • Network Contracting Offices will be provided approved templates and additional guidance for this effort. In situations where nursing facilities do not agree to required contract terms; plans must then be made to move patients as soon as practical. Close coordination with the Network Contracting Offices is critical for the success of this initiative. 
If you have one of these pilot VA Provider Agreements, it is important that you read the agreement closely as it may contain wording or a clause that says the VA has the right to terminate the agreement at any point. That being said, as soon as AHCA received alert of this notification, AHCA staff immediately contacted the VA and expressed opposition to this action due to the impact it will have on our member nursing care centers and those VA patients they serve. AHCA members impacted by this notice are encouraged to contact their members of Congress and Congressional staff to express the problems this notice will create -- and to ask your elected officials to contact the VA directly about this matter.


Finally, AHCA continues its support for the VA’s proposed rule on Provider Agreements, which, among other things, increases the opportunity for veterans to obtain non-VA extended care serves from local providers that furnish vital and often life-sustaining medical services. AHCA is currently awaiting the final rule.

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