The American Orthotic and Prosthetic Association (AOPA) published a document with responses from the Department of Veterans Affairs (VA) regarding changes the VA made to the purchase and delivery of O&P services for community-based providers. Community-based care allows veterans to receive healthcare outside of VA facilities in some circumstances.
The VA published a document in June that created new payment policies for community-based O&P services, including those described by not otherwise classified (NOC) codes, pedorthic services, and some products described by Healthcare Common Procedure Coding System codes that the VA acknowledged are not adequately reimbursed under the current Medicare fee schedule, according to AOPA.
The updated payment policies for NOC codes and outlier products are based on a sliding scale that includes the manufacturer’s invoice and a designated mark-up fee. AOPA said the VA’s response indicated that it will reimburse community providers at 100 percent of the Medicare fee schedule, eliminating the need for negotiated discounts.
The frequently asked questions (FAQ) document also included the following:
- Vendors will have the option to terminate any existing VA contracts early to participate in the new community-based provider program, including the revised nondiscounted reimbursement rates and NOC code reimbursement policy.
- Contracted vendors can elect to continue to operate under the terms of their existing contracts for the remainder of the contract term.
- Community-based providers must meet the revised standards to continue to serve veterans.
- The community-based care model will replace all contracts and blanket purchase agreements moving forward.
“The VA community-based provider standard represents a strong effort by VA leadership to continue to build collaborative relationships with O&P providers based in the community and creates consistent policy across the entirety of the Veterans Integrated Services Networks (VISNs),” AOPA said. “AOPA remains hopeful that this new standard will contribute to the provision of the best clinical care available to veterans and significantly less administrative burden for O&P providers and VA officials. Additionally, AOPA staff will continue to work with our VISN liaisons to monitor the impacts of these changes as well as others and welcomes feedback from members at any time.”
To read the FAQ document, visit AOPA’s website.
