Important Update on VA Authorization Limits for Home Care Providers

Update as of 7/9: The VA has communicated that these changes are currently on hold. However, Paradigm has observed that some VAMCs have already implemented these changes. We will continue to update this article as new information becomes available.

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Since the introduction of the VA Community Care Network, many changes have taken place as the VA refines its processes, budgets, and implementation at local VA Medical Centers. One area of frequent adjustment is the duration of authorizations and weekly care limits for veteran clients. As of June 28th, another significant change has been implemented.

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Before delving deeper, let's clarify some essential terminology:

• Authorization/Referral: These interchangeable terms refer to VA Form 10-7080, which officially authorizes the care and services your agency will provide to a veteran client. ‍
• SEOC (Standardized Episode of Care): Predetermined bundles of care services, standardized across the VA system. The SEOC section in referrals specifies VA-authorized services for the client based on these packages. ‍
• Consult: Often part of the referral document but may be sent separately or found in HSRM. It contains specific service instructions and takes priority over other directives.

What's Changing?

The VA has announced modifications to the SEOCs, affecting both authorization duration and weekly limits. While these changes affect other VA home-based programs, we are focusing on Homemaker/Home Health Aid and Respite programs under the CCN. Key changes include:

• More variations of H/HHA & Respite SEOCs with smaller ranges of hours (typically 4-15 hours).
• Reduced authorization durations.
• Discontinuation of 30-, 90-, and 365-day SEOCs.
• Introduction of a 60-day SEOC.
• Retention of the 180-day authorization.
• Formal clarification that care should follow the consult order as written, rather than the SEOC range.

It's important to note that while this is a national change, implementation appears to be regional, with some VAMCs already adopting changes while others may be delayed.

Given the shortened SEOC durations, it's crucial to closely monitor authorization expiration dates. Submit RFS forms for service continuation 30 days before the expiration date to ensure uninterrupted care.

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Keeping an Eye Out

These changes are reportedly part of the VA's efforts to enhance care delivery and manage budgets more effectively. While the VA presents these adjustments as improvements to the system, it's crucial to remain vigilant. Home care providers should carefully monitor and document any instances where these changes negatively impact veteran care and notify state or national home care associations or Paradigm.

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In this evolving landscape, staying on top of authorizations is more critical than ever. Paradigm's authorization management tools can be invaluable in helping you navigate these changes. Our system can assist you in tracking authorization expiration dates, prompting timely submission of RFS forms, and ensuring compliance with new SEOC parameters. Fill out the form below to find out if this service is available in your area.