To amend title 38, United States Code, to modify the rate of pay for care or services provided under the Community Care Program of the Department of Veterans Affairs based on the location at which such care or services were provided, and for other purposes.
This bill would change how the Department of Veterans Affairs pays for care or services provided under the Community Care Program (CCP). Instead of basing payment rates on the provider’s headquarters location, the Secretary of Veterans Affairs would establish location-specific rates tied to where the care or services are actually delivered (e.g., inpatient hospital, on-campus or off-campus hospital outpatient departments, ambulatory surgical centers, or a physician’s office). The bill also requires claims to include a geographically specific national provider identifier that identifies the service location, and it directs that when multiple rates could apply, the lowest rate must be paid. The new rate framework would take effect January 1, 2026. The aim appears to be to better reflect geographic differences in care costs and improve payment accuracy, though it would also entail new data and administrative requirements for the VA and community providers.
Key Points
- 1The Secretary must establish location-specific payment rates for CCP care based on where the care is provided, not where the provider’s headquarters is located. The defined locations include: inpatient hospital, on-campus hospital outpatient department, off-campus hospital outpatient department, ambulatory surgical center, and the office of a physician.
- 2Claims must include a unique, geographically specific national provider identifier code that identifies the care location as described above.
- 3If more than one rate could apply for a given care episode, the Secretary must pay the lowest applicable rate.
- 4The new location-based rates apply to care or services furnished under the Community Care Program.
- 5Effective date for these amendments is January 1, 2026.