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lotter on DSK11XQN23PROD with RULES1

Federal Register / Vol. 86, No. 174 / Monday, September 13, 2021 / Rules and Regulations and resources are made available by national offices of the Veterans Health Administration VHA as compared to when they are made available by Veterans Integrated Service Networks VISN or by individual VHA medical facilities. In response to the commenters input in this regard, we note that VA currently uses a mix of organizational components and points of contact to make information relating to VAs implementation and use of VCAs available to entities and providers. Certain information, resources, and points of contact are made available at the national organizational level through the website of VHAs national Office of Community Care.1 For example, VA provides access to relevant provider educational and training resources e.g., webinars of the type incidentally mentioned in the same comment, and a related national point of contact, in this manner.2 However, VA also currently makes certain information, resources, and points of contact available only through the individual VHA medical facilities that enter into and administer the specific VCAs to which such information, resources, and points of contact relate.
Applications for certification under section 17.4110 of the interim final rule are processed, and VCAs are entered into and administered, by officials at local VHA medical facilities.
Consequently, those officials and the local facility staff are often the most reliable and efficient sources of relevant and accurate information for an entity or provider that is considering or is currently navigating the processes of applying for certification, entering into a VCA with that local facility, and/or furnishing hospital care, medical services, or extended care services pursuant to a VCA that the entity or provider previously entered into with that local facility. Moreover, even in instances where the responsible local officials lack certain information requested by an entity or provider regarding those matters, it is important that those local officials remain the applicable VA points of contact for such entities and providers regarding those matters. Local officials possess the authority and responsibility for many aspects of the implementation and use of VCAs at each local VHA medical facility, so ensuring that they are privy to and the source of communications to entities and providers regarding those 1 See https www.va.gov/communitycare/ last accessed 9/8/2021.
2 See https www.va.gov/communitycare/
providers/EDU_Training.asp last accessed 9/8/
2021.

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matters e.g., status of a providers certification, terms of a providers VCA, or issues pertaining to specific authorizations or claims promotes consistency and efficiency in VAs use and administration of VCAs and mitigates risk of conflicting communications from those lacking the authority and responsibility for those aspects of VAs implementation and use of the specific local VCAs and processes that are the subject of such communications. If the responsible officials at local VHA facilities lack certain information requested by an entity or provider regarding implementation and use of VCAs at that facility, those officials can and do utilize established internal communication channels to consult with VISN and national VHA offices, including the Office of Community Care, as appropriate, in identifying such information and formulating an appropriate response.
In its second comment, the same commenter noted that it wants to ensure that the Centers for Medicare &
Medicaid Services CMS and VA
communicate how CMS Patient Driven Payment Model PDPM, which became effective on October 1, 2019, and the VCA reimbursement structures will work together. As it pertains to VA, we interpret this comment as requesting that VA communicate whether and to what extent the rates that VA pays for care and services furnished by nursing facilities pursuant to VCAs are based upon or influenced by CMS PDPM
case-mix classification methodology for calculating Part A payments under Medicares skilled nursing facility prospective payment system SNF PPS.
As established in 17.4120 of the interim final rule, that information i.e., the nexus between CMS PDPM
methodologies and rates and VA
payment methodologies and rates, if any, when applicable, will be communicated by VA in the price terms set forth in the specific VCA pursuant to which VA obtains the care or services at issue. Specifically, as established in 17.4120 of the interim final rule, the rates paid by VA for hospital care, medical services, and extended care services furnished pursuant to a VCA
will be the rates set forth in the price terms of that specific VCA, and those price terms will be established in compliance with the general parameters set forth in 17.4120ae. One such parameter of particular relevance to this comment regarding CMS PDPM is contained in 17.4120a, which provides in pertinent part that, subject to the caveats and exceptions set forth
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in 17.4120be, payment rates for services furnished pursuant to VCAs will not exceed the applicable Medicare prospective payment system amount, if any, for the period in which the service was provided without any changes based on the subsequent development of information under Medicare authorities. Given that Medicares SNF
PPS is a prospective payment system within the meaning of the foregoing limitation, and given that CMS PDPM
currently governs how payment amounts are calculated under the SNF
PPS, the PDPM will necessarily be factored into VAs calculus when formulating certain VCA payment rates that are subject to the general limitation set forth in 17.4120a. However, while the general limitation in 17.4120a can affect how VA formulates pricing for care and services obtained pursuant to VCAs, we emphasize that it is subject to the caveats and exceptions set forth in 17.4120be and we note that the existence of that general limitation does not require or mean that the price terms set forth in any specific VCA for care and services furnished by nursing facilities will be the same as or based upon the payment rates, if any, for the same services under CMS PDPM.
Instead, as previously stated, the nexus between CMS PDPM methodologies and rates and VA payment methodologies and rates, if any, will be communicated by VA in the price terms set forth in the specific VCA pursuant to which VA obtains the care or services at issue.
In its third comment, the same commenter indicated that providers might be hesitant to enter into VCAs until the U.S. Department of Labors Office of Federal Contract Compliance Programs OFCCP issues a Notice of Proposed Rulemaking NPRM that would revise certain portions of 41 CFR
subtitle B, chapter 60 that concern the obligations of TRICARE and certain other health care providers, as federal contractors and/or subcontractors, under the nondiscrimination and affirmative action provisions of Executive Order E.O. 11246 as amended, section 503 of the Rehabilitation Act of 1973 as amended, and the Vietnam Era Veterans Readjustment Assistance Act of 1974 as amended. We interpret this comment as referring to the NPRM
subsequently published by OFCCP at 84
FR 59746 Nov. 6, 2019. That NPRM
culminated in a final rule, published by OFCCP at 85 FR 39834 Jul. 2, 2020, that revised certain definitions set forth in 41 CFR 601.3, 60300.2, and 60
741.2. Given that the rulemaking
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