The VA Master Agreement for 2019: What You Need to Know
The Department of Veterans Affairs (VA) has updated its Master Agreement for 2019, which outlines the policies and procedures for third-party administrators (TPAs) participating in the VA`s Veterans Choice Program. The program allows eligible veterans to receive medical care from private providers if they are unable to receive timely care from the VA or live more than 40 miles from a VA facility.
The 2019 Master Agreement includes several changes from the previous version, including new requirements for TPAs and updated language to clarify existing policies. Here are some of the key changes to be aware of:
– More comprehensive data reporting: TPAs are now required to provide more detailed data on the veterans they serve, including demographic information such as age and gender, as well as information on the types of medical services provided and any complications or adverse events that occur. This data will be used to monitor the quality of care provided through the Veterans Choice Program and identify areas for improvement.
– Increased oversight and accountability: The 2019 Master Agreement includes several provisions aimed at improving oversight and accountability for TPAs participating in the Veterans Choice Program. Among other things, TPAs must now maintain a compliance program to ensure they are following all applicable laws and regulations, and must undergo annual compliance audits. The VA also reserves the right to terminate agreements with TPAs that fail to meet performance standards or violate program requirements.
– Updated payment policies: The new Master Agreement includes updated payment policies for TPAs, including new guidelines for billing and reimbursement. For example, TPAs are now required to submit claims for payment within 60 days of service, and must provide clear documentation of the services provided and the amount charged. The VA will also be implementing a new payment system that will allow TPAs to receive payment more quickly and efficiently.
– Clarification of eligibility criteria: The 2019 Master Agreement includes updated language to clarify the eligibility criteria for veterans seeking care through the Veterans Choice Program. For example, veterans who live within 40 miles of a VA facility but face a long wait time for an appointment may now be eligible for care through the program, as long as they meet certain other criteria. The new language is intended to make it easier for veterans to understand whether they are eligible for care through the program.
Overall, the 2019 Master Agreement represents an important step forward in ensuring high-quality, timely medical care for eligible veterans through the Veterans Choice Program. By increasing oversight, clarifying policies, and improving data reporting and payment systems, the VA is working to make the program more effective and efficient for both veterans and TPAs. As always, it is important for TPAs and other stakeholders to stay up-to-date on the latest policies and procedures to ensure they are in compliance and providing the best possible care for veterans.