Are You Prepared for These VA Changes in 2023?

Posted January 24, 2023 by Jason Smartt, Esq., CRCR

With 2022 officially behind us and New Year’s resolutions in full effect (or already fallen off), and everyone back in the saddle for 2023, the VA continues to alter their operating landscape. With the passage of the MISSION Act in 2018 and the PACT Act in 2022, Veterans sought care from Community Providers in record numbers. The Department of Defense decided it was time for some changes in 2024 for their West region. The VA decided to delay the roll out of their fee schedule until February . Finally, there is significant interest with the new Omnibus Budget and the reporting requirements for the benefit of Community Providers.

First, let’s start with the MISSION Act and how Veteran engagement outside the Veteran Administration changed in the past three years. As previously discussed, the MISSION Act combined the best of the Veteran Choice Program and the Patient-Centered Community Care network as it came to easing eligibility rules.

With the altered set of rules:

  • In 2020, 17% of Veterans received care outside the VA .
  • In 2021, that number increased to 26% of Veterans receiving care outside the VA Health System.
  • Finally, in 2022, the VA reported that this number would round out at 33%.

This means that Community Providers would see 1 in every 3 Veterans that needed care. During Congressional testimony last summer, the Secretary of the Veteran Administration forecasted that this number would climb to 40% for 2023. This translates to Community Providers possibly seeing every 2 out of 5 Veterans for their healthcare needs. With roughly 9 million Veterans that qualify for care, Community Providers will see an estimated 3.6 million Veterans this year.

Second, the PACT Act (The Sergeant First Class Heath Robinson Honoring our Promise to Address Comprehensive Toxics Act) is in full force as of January 1, 2023. This piece of legislation added significant diseases and cancers due to toxic exposure to the covered disease list that a Veteran can receive treatment. The VA performed nearly 900,000 toxic screens finding that nearly 400,000 Veterans qualified for immediate benefits. Normally, adding 400,000 Veterans to the rolls for coverage is a significant ask, but the severe nature of the diseases covered utilizes considerable resources to render care. The VA did not publish an anticipated impact to Community Providers, but this additional group will impact those Community Providers that cover those respiratory diseases and cancers.

Third, the Department of Defense reviewed their Tricare network and decided to make some changes that will take place in 2024. The Department of Defense took bids for a new administrator to handle Tricare West claims processing. TriWest received confirmation that Tricare awarded the new contract to them. At the same time, the Department of Defense decided it was time to migrate six states from the East Region to the West Region. Specifically, Arkansas, Illinois, Louisiana, Oklahoma, Texas, and Wisconsin, will move from the East Region to the West Region. This move is meant to reduce the number of states in Tricare East and even the coverage map. The Department of Defense scheduled for these changes to take place around January 1, 2024.

Finally, there are some interesting reports and timeline changes that will affect Community Providers in the coming year. The VA changed their Fee Schedule publication date from January 1, 2023 to February 1, 2023. This allows the VA time to review the Medicare changes for the year and alter their schedule where appropriate. VA claims utilize Medicare rates as their primary source of reimbursement. However, if Medicare rates do not apply, the VA utilizes their own fee schedule to price. If the code in question does not receive coverage on either schedule, the VA utilizes a third fair and reasonable equation to price the services in question. At the same time these changes occurred, Congress delivered $33 Billion to the VA to purchase outside care this year with a condition. Within 90 days of the budget enactment, the VA must produce a report to Congress showing how potential reimbursement may affect rural provider recruitment as it concerns mental care. The hope is that this report will spur a bigger debate as to how the VA purchases care with all Community Care providers, which is generally below Medicare rates. Hopefully, the report will show that increasing payment size would lead to better recruitment and retention. We will keep an eye out for that report to drop in April.

While the VA continues to evolve, EnableComp remains on top of all the changes while utilizing our proprietary technology and trained staff to handle these adjustments. Changes to fee schedules, coverage, providers, covered codes, and continually training our staff affords us the ability to seamlessly roll with all of the changes the VA implements and envisions. If you have any questions or concerns about your VA claims, please contact us.