Comment on AO57-Interim Final Rule-Reeves, Randy C.

We (MS Veterans Affairs Board) wish to address: Part A. GENERAL “8. All Veterans for whom VA pays for care under this agreement and who require hospital care will be referred to an appropriate VA facility when the following criteria are met: the Veteran, when able, agrees to be referred, the VA facility can provide the needed care, and transportation of the Veteran to the VA facility would be consistent with patient safety.”We believe there needs to be a strong statement, so there is no question, that eligible veterans covered by the Provider Agreement do not forfeit their eligibility for VA benefits and programs. That is to say, that VAintends to honor the commitment to the eligible veterans covered by this Provider Agreement to pay for services, prosthetic devices and specialty care that are not routinely provided at the Nursing Home Care level. Additionally there is another aspect of the Agreement which are of concern: High Drug Costs: Since the implementation of the 70% Program on May 29, 2009, some State Veterans Homes report that they have experienced extraordinarily high drug costs for some service-connected disabled veterans enrolled under the 70% Program. Pursuant to 38 U.S.C. §1745(b), such extraordinarily high drug costs are not reimbursable separately from the all-inclusive payment made to State Veterans Homes under 38 U.S.C. §§1745(a)(3) and 1745(b). The question of extraordinarily high drug costs for certain service-connected disabled veterans enrolled under the Provider Agreement must be addressed because the cost of these medications are not routine and the prevailing rate payable to a State Veterans Home may be insufficient to cover the cost. Regardless of how the reimbursement of extraordinarily high drug costs could be authorized to be made by VA, it is important that there be a specific methodology included in the Final Rule which would stipulate a method for negotiating the issue on a case by case method at the local VAMC level.