This interim final rule will not implement section 101 of the Mission Act, which creates a new VA community care program to provide eligible veterans through non-VA providers. The VA Community Care Program is implemented within a separate rules framework (2900-QT46), but here is a brief explanation of the need to implement section 1703A authorized agreements prior to the Community Care Program itself. Under section 101(c)(1) of the Mission Act, VA is required to issue regulations to conduct the Veteran Community Care Program by June 6, 2019. Along with this legal deadline, section 143 of the Mission Act amended section 101(p) of the Veterans Access, Choice, and Accountability Act of 2014 (the Choice Act) to stipulate that VA may no longer use the Choice Act to provide care and services after June 6, 2019. As a result, VA is established after the 6th. June 2019 will no longer be able to use agreements with Veterans Choice program providers. The agreements approved by this rule-making establishment will essentially replace agreements with Veterans Choice Program providers as a method of purchasing community care with instruments other than conventional procurement contracts, which are subject to the Federal Procurement Regulations (FAR) and all other federal procurement legislation. VA requires that the provisions of these new agreements be legally in force by June 6, 2019 so that VA has time to establish new purchasing relationships with Community Suppliers, as the contractual network of VA Community Suppliers required by new Section 1703(h) as amended by Section 101(a) of the MISSION Act may not be fully covered by June 6. 2019.
In addition, based on VA`s experience, some care and services (e.B. home health services) from sources that are unwilling or unable to enter into conventional supply contracts subject to far, and VA expects this to continue to be the case after June 6, 2019. If the agreements promulgated by this rule-making establishment are not in effect and do not have sufficient time to allow VAs and community providers to deviate from current agreements with Veterans Choice Program providers by June 6, 2019, there is a risk of disruption to Veterans receiving community care (see section on the Administrative Procedure Act, for more specific information on the interruption of care). To ensure that the transition from the current Veterans Choice Program to the Veterans Community Care Program is seamless, VA needs this preliminary final rule to establish the parameters of the agreements and other related authorities so that VA can legally order the care and services contained therein by June 6, 2019. Paragraph d) of § 17.4120 states that the VA may deviate from the parameters set out in § 17.4120 (a) — (c) if VA determines that it is not possible to limit payments as required under Article 17.4120 (a) — (c) due to patient needs, market analyses, qualifications of healthcare providers or other factors. This general exception is consistent with the provision of Section 1703(i)(1) which allows VA to pay at rates not exceeding the Medicare rate «to the extent possible.» Paragraph (d) will give VA the flexibility to ensure that it can reach an agreement with companies or suppliers on the provision of required services when the factors causing costs may change faster than Medicare`s established rates. This flexibility is not a guarantee of payments in excess of the applicable health insurance rates, as the chapeau of § 17.4120 states that payment rates are ultimately set out in the terms of the agreement under which care and services are provided. Such agreements provide for appropriate procedures and review process for all payments that could use the exception in paragraph 17.4120(d) to ensure a consistent level of VA oversight. Using dental services as an example, HCVs are required to ensure that there is no failure in the provision of medically necessary dental care provided under agreements with Choice providers. Without proper oral hygiene and dental care, bacteria in the mouth can reach levels that can lead to oral infections such as tooth decay and gum disease.
In addition, certain medications – such as decongestants, antihistamines, painkillers, diuretics and antidepressants – can reduce salivation, with saliva chasing food and neutralizing acids produced by bacteria in the mouth and protecting against microbial invasion or proliferation that could lead to gum disease. Dental Start Printed Page 21676care is essential for monitoring or treating inflammation or oral infection that may be associated with an overgrowth of oral bacteria, when such inflammation or infection can negatively affect a person`s overall health and has been linked to certain diseases….