What Hospices Need to Know to do What Hospices Need to Know to do Business with VABusiness with VA

Christine Cody, RCN, MSNDepartment of Veterans Affairs (114), 810 Vermont Ave. NW, Washington, DC 20420

Christine.Cody@va.gov, 202-273-8537

Diane Jones, Project Administrator, HVP ProgramPO Box 844, Moorestown, NJ 08057

djones@ethosconsult.com, 856-234-5878

Doing Business with the Doing Business with the Federal GovernmentFederal Government

• Get a Data Universal Numbering Get a Data Universal Numbering System (DUNS) number from System (DUNS) number from Dun & BradstreetDun & Bradstreet

• Register with Central Contractor Register with Central Contractor Registration (CCR)Registration (CCR)

DUNS NUMBERDUNS NUMBER

• Unique 9-digit identification number provided Unique 9-digit identification number provided by Dun & Bradstreetby Dun & Bradstreet

• Free for all businesses required to register Free for all businesses required to register with the federal government for contracts or with the federal government for contracts or grantsgrants

• Each hospice location must have a separate Each hospice location must have a separate DUNS numberDUNS number

How to request a DUNS How to request a DUNS numbernumber

• On-line applicationOn-line application– D&B DUNS Numbers for US Government D&B DUNS Numbers for US Government

Contractors & GranteesContractors & Grantees– http://fedgov.dnb.com/webformhttp://fedgov.dnb.com/webform

• Call (866) 705-5711 Call (866) 705-5711

Central Contractor Registration Central Contractor Registration (CCR)(CCR)

• What is CCRWhat is CCR– Central vendor database for the federal Central vendor database for the federal

governmentgovernment– Maintains electronic payment informationMaintains electronic payment information– Allows VA to pay contractors and vendors Allows VA to pay contractors and vendors

such as hospice agenciessuch as hospice agencies– Registration is free to vendorsRegistration is free to vendors– Annual renewal is requiredAnnual renewal is required

Central Contractor Registration Central Contractor Registration (CCR)(CCR)

• Why do hospices have register?Why do hospices have register?– Federal regulationFederal regulation– Prerequisite to contracting with the Prerequisite to contracting with the

governmentgovernment

• How do hospices register?How do hospices register?– Online registration at Online registration at www.ccr.govwww.ccr.gov– You must have your DUNS number to You must have your DUNS number to

register register

General information you need General information you need to registerto register

• DUNS numberDUNS number• CAGE (Commercial and Government CAGE (Commercial and Government

Entity) code Entity) code – If you do not have a CAGE code, one will If you do not have a CAGE code, one will

be assigned to you after you register with be assigned to you after you register with CCRCCR

– There is no fee to get a CAGE codeThere is no fee to get a CAGE code

http://www.dlis.dla.mil/CAGESearch/cage_faq.asphttp://www.dlis.dla.mil/CAGESearch/cage_faq.asp

General information you need General information you need to registerto register

• Company nameCompany name• Federal Tax Identification NumberFederal Tax Identification Number• LocationLocation• ReceiptsReceipts• Website addressWebsite address

Other information you need to Other information you need to registerregister

• Organization or business typeOrganization or business type• Small Business Administration defined Small Business Administration defined

socioeconomic characteristicssocioeconomic characteristics• NAICS (North American Industry NAICS (North American Industry

Classification System) codeClassification System) code– 62160 (hospice care services, in home)62160 (hospice care services, in home)– 623110 (hospice, inpatient care)623110 (hospice, inpatient care)

Other information you need to Other information you need to registerregister

• SIC (Standard Industrial Classification) SIC (Standard Industrial Classification) codecode– 8059990580599905 Personal care home, with health carePersonal care home, with health care– 8059990680599906 Rest home, with health careRest home, with health care– 8082000080820000 Home health care servicesHome health care services

• Product Service codeProduct Service code– Service codeService code Q – Medical servicesQ – Medical services

• FSC (Federal Supply Classification) codeFSC (Federal Supply Classification) code

Other information you need to Other information you need to registerregister

• Financial InformationFinancial Information– Financial institutionFinancial institution– American Banking Association (ABA) routing American Banking Association (ABA) routing

numbernumber– Account numberAccount number– Remittance addressRemittance address– Lock box numberLock box number– Automated clearing house (ACH) informationAutomated clearing house (ACH) information– Credit card informationCredit card information

Other information you need to Other information you need to registerregister

• Point of Contact informationPoint of Contact information– Principal and alternate points of contactPrincipal and alternate points of contact– Electronic business, past performance, and Electronic business, past performance, and

government points of contactgovernment points of contact

• Electronic Data Interchange (EDI) informationElectronic Data Interchange (EDI) information– EDI point of contact and contact informationEDI point of contact and contact information– Optional – for businesses interested in conducting Optional – for businesses interested in conducting

transactions through EDItransactions through EDI

Doing Business with the Doing Business with the GovernmentGovernment

• Getting started can be very Getting started can be very emotional!emotional!

• Once you have a DUNS Once you have a DUNS numbernumber– Update only if there are Update only if there are

changes in your business changes in your business

• Once you are registered Once you are registered with CCRwith CCR– Annual on-line re-certificationAnnual on-line re-certification

VA PolicyVA Policy

Hospice and palliative care is a covered benefit for Hospice and palliative care is a covered benefit for all enrolled veterans, all settings all enrolled veterans, all settings

"VA must offer to provide or purchase hospice & "VA must offer to provide or purchase hospice & palliative care that VA determines an enrolled palliative care that VA determines an enrolled veteran needs." 38 CFR 17.36 and 17.38veteran needs." 38 CFR 17.36 and 17.38

VA Paid and VA Referred Hospice

VA Inpatient

VA Hospice and Palliative Care Mission

To Honor Veterans’ Preferences for Care at the End of Life . . .

. . . in all settings

16

VA Paid Hospice CareVA Paid Hospice Care

Average Daily Census FY04 – FY07

VA Purchasing Hospice CareVA Purchasing Hospice Care

• Purchased Home Health Care Services Purchased Home Health Care Services HandbookHandbook– Contract and clinical staff at facility and VISN Contract and clinical staff at facility and VISN

level jointly develop processeslevel jointly develop processes– Broad array of home and community based care Broad array of home and community based care

options options – Veteran’s preference for specific resourcesVeteran’s preference for specific resources

Purchasing (cont’d)Purchasing (cont’d)

• Services purchased from hospices that are Services purchased from hospices that are licensed or otherwise state approved or licensed or otherwise state approved or certified by Medicare/Medicaidcertified by Medicare/Medicaid

• Purchasing optionsPurchasing options– Basic Ordering Agreement – geographical area Basic Ordering Agreement – geographical area

or low frequency of useor low frequency of use– Bid ContractBid Contract

• best value approachbest value approach• price, quality, service area coverageprice, quality, service area coverage

• Written agreements at facility, VISN, multi-Written agreements at facility, VISN, multi-VISN levelVISN level

Statement of WorkStatement of Work

• Purpose – purchase comprehensive Purpose – purchase comprehensive package of bundled services at a per diem package of bundled services at a per diem rate for eligible veteransrate for eligible veterans

• Pricing – locally calculated Medicare Pricing – locally calculated Medicare Hospice Benefit rates as maximumHospice Benefit rates as maximum– $2/day for physician services beyond scope of $2/day for physician services beyond scope of

routine hospice careroutine hospice care– Negotiated rates reflect fair market value for Negotiated rates reflect fair market value for

services services

Statement of Work (cont’d)Statement of Work (cont’d)

• Hospice responsibilitiesHospice responsibilities– ServicesServices– Hospice manages care planHospice manages care plan– Request level of care changesRequest level of care changes– Contact VA to preauthorize inpatient Contact VA to preauthorize inpatient

admissions admissions

Statement of Work (cont’d)Statement of Work (cont’d)

• VAMC ProceduresVAMC Procedures– Approve referralApprove referral– VA physician certifies prognosis, VA physician certifies prognosis,

encouraged to act as attendingencouraged to act as attending– VA sets recertification time frame and VA sets recertification time frame and

processesprocesses– Treatment issues identified and Treatment issues identified and

coordinatedcoordinated

Statement of Work (cont’d)Statement of Work (cont’d)

• Communication/CoordinationCommunication/Coordination– Liaisons – facilitate collaborative efforts, Liaisons – facilitate collaborative efforts,

streamline communication, promote streamline communication, promote coordination of servicescoordination of services

– Communication process – referrals, general Communication process – referrals, general information, physician, patient discharge, deathinformation, physician, patient discharge, death

• Quality ImprovementQuality Improvement– joint review of quality and appropriateness of joint review of quality and appropriateness of

servicesservices