Congress has passed a comprehensive Veterans Affairs (VA) package (the VA Mission Act of 2018) that authorizes VA provider agreements for extended care providers, including nursing centers. Provisions in the VA Mission Act will help remove some of the existing red tape that may prevent providers from being able to provide care to veterans. Adoption of such changes has long been a priority of AHCA.

VA provider agreements will allow our nursing centers to care for veterans in their communities or in close proximity to their families and support system. These agreements are supported by the VA yet required new statutory authorization. The White House has signaled that President Trump will sign this legislation into law.

Nursing centers already meet very strict compliance guidelines under the Medicare and Medicaid programs. Adding more regulations on top of the existing Medicare and Medicaid regulation is inefficient, adds cost, and takes staff time away from caring for veterans at the bedside.  

It is long-standing policy that participation in Medicare or Medicaid does not make providers federal contractors. However, if a provider currently has VA patients, they are considered a federal contractor and therefore must comply with statutes such as the Service Contract Act. The Office of Federal Contracting Compliance Programs (OFCCP) has administered onerous reporting requirements and regulations, beyond those required by Medicare and Medicaid rules, which have dissuaded nursing care centers from admitting VA patients. The result has limited long term care options for veterans in their local communities. Our veterans should not have to choose between obtaining the long term care services they need and remaining near loved ones in their community.  Conversely, the same centers contracting with the Centers for Medicare and Medicaid Services are not subject to the OFCCP regulations.  

Provisions in the VA Mission Act will help remove some of the existing red tape that may prevent providers from being able to provide care to veterans. More specifically, and according to the U.S. Senate VA Committee’s section-by-section description of the bill :  “Section 102 would authorize VA to enter into Veterans Care Agreements (VCAs) that are not subject to competition or other requirements associated with federal contracts, so that they can more easily meet veterans’ demands for care in the community. Eligibility for care would be subject to the same terms as VA care itself and the rates paid under VCAs, to the extent practicable, would be in accordance with rates paid under the Veterans Community Care Program established in section 101 of this bill. The VA would be responsible for development of a certification process for VCAs and a system for monitoring the quality of care. Participating providers, while not considered federal contractors for the purposes of this section, would still be required to follow federal laws related to fraud, waste, and abuse, as well as employment law.”

It is important to note that “Section 107 would apply the same affirmative action moratorium on VCA contractors and subcontractors as is applied to TRICARE contractors and subcontractors in Directive 2014-01 of the Office of Federal Contract Compliance Programs of the Department of Labor [DOL].” Moreover, on May 18, 2018, DOL released an extension of the moratorium on enforcement of the affirmative obligations of TRICARE providers for another two years, expiring May 7, 2021. More details on this extension can be found on the DOL website here and here.   

The number of facilities able to serve veterans will increase in most areas once qualified providers are able to enter into VA Provider Agreements, broadening options for veterans who need both nursing center care and home and community-based services.  

We know that many members are eager to enter into VA provider agreements. VA staff estimates that it will take at least a year to implement these agreements, pending the issuance of regulations. AHCA will offer a webinar with officials from the VA in the near future to provide members an opportunity to ask questions about how these agreements might be structured. Once this webinar date and time is finalized, we will send information to you. In the meantime, please contact Dana Halvorson, AHCA’s Senior Director of Not for Profit & Constituent Services with questions or comments you’d like to see addressed on the webinar.

The combined efforts of many AHCA members have helped the association successfully advocate for this policy.