The National Association for Home Care and Hospice (NAHC) has recently received reports of home care and hospice providers facing challenges in working with the Veterans Health Administration (VA) following their transition of third-party administrator (TPA) from TriWest to Optum.
As background, following the passage of the VA Mission Act, Optum was named the TPA for the VA Community Care Network for Regions 1-3. The operational transition to Optum began in July of 2019 for region 1 and ended on December 10th. Region 2 began in October of this year and will continue in phases into March of 2020.
Reports received by NAHC detail various administrative steps faced by home care and hospice providers that upon successful completion have not resulted in a proper outcome. These steps include credentialing, service and rate negotiation through a contractual agreement, and finally being “loaded” into the VA software system. Reports to NAHC indicate that upon completion of credentialing and the contractual agreement, providers are not being loaded into the VA’s software. Predictable results have been realized: physicians are not able to refer to providers they trust and patients are not receiving the care they need. In situations where care commenced under TriWest’s oversight and continued under Optum, providers are being forced to decide between discharging a patient in need of care or providing that care with no guarantee of payment.
NAHC quickly engaged with bipartisan and bicameral congressional leadership in search of a timely and equitable resolution to ensure that patients maintain access to these valuable services and receive the care they need. Congressional leadership expressed their concern about these unnecessary administrative barriers and will be working to address these blockages.
It is estimated that over 100,000 veterans use of home care and hospice services each year and as NAHC Report has written, veterans often have special needs that make quality health care in the home even more important for them.
NAHC urges any providers who become aware of such problems to notify us as quickly as possible by sending an email to firstname.lastname@example.org. NAHC Report will continue to follow this important story and report any new developments.
Home Care Regulatory & Policy Mgr.
Texas Association for Home Care & Hospice