1 “Making the Program Work” VD-HCBS Provider Agreements Patrick Brady VHA CO, Geriatrics & Extended Care (GEC) 24 February 2009

2 VA Provider Agreements Pilot Provider Agreement Program –Pub Law , 38 U.S.C 1720(a) –Began test phase in 2006 as an alternative to VA Contracts for purchasing community nursing home care services Provider Agreements v. Contracts –Contracts put a heavy administrative burden upon Providers due to DOL audits –Rates established and not negotiated

3 ProVA Pilot Program Before setting policy, VHA needed to ensure: –Manageable, if any, cost increases –Same Veteran and Governmental protections between Contracts and ProVAs –Wide-range testing of various geographic markets and program conditions Findings: –Flexible, responsive –Minimal cost increase –More attractive to higher quality providers –Improved access & choice for veterans

4 Provider Agreements tested in: –Nursing Home Care –Home Care –Adult Day Health Care –Hospice Care –Veteran Directed H&CBS ProVA Pilot Program

5 6 Months in 15 Minutes… What are Provider Agreements? Provider defined as an Area Agency on Aging (OAA, Sec. 305 (a)(2)(A)) or a single planning and service area State Agency on Aging (OAA, Sec. 305(b)(5)(A)) An Agreement is formed when a VAMC agrees to purchase VD-HCBS from a Provider

6 VD-HCBS ProVA (3 Parts) PART I Provider Agreement Template: –Provider Agreements must be annually renewed –General outline of terms and conditions: Section A: Criteria Section B: Rate Structure & Reimbursement Section C-H: Other Administrative Issues…

7 PART II Provider Agreement Addendum –Individualizes ProVA for VAMCs and local Providers Outline the package of services and goods that will be provided to Veterans Other local administrative issues that need to be addressed VD-HCBS ProVA (3 Parts)

8 Part III VA Form –OMB Approved form for furnishing LTC Services to Veterans (NH, HC, Hospice, VD-HCBS) –Signature binds the Provider Agreement Template and Addendum between VAMC and Provider –Some portions not applicable for Providers VD-HCBS ProVA (3 Parts)

9 General Provider Information Initial Schedule of Services and Price

10 Final Schedule of Services and Price Final Signatures & Effective Date of Agreement

11 Success!?! First VD-HCBS Provider Agreement signed 17 February 2009 –Battle Creek VAMC –Area Agency on Aging of Western Michigan

12 Questions Daniel Schoeps, Director of Purchased LTC Programs Patrick Brady, Coordinator, Purchased LTC Reimbursement