Serving America's Veterans: How Louisiana’s Health Centers Can Answer the Call September 23, 2015
Presentation Topics Topic 1. Veterans Healthcare Overview- Gina Capra 2. Veteran Services in Health Centers- Kelly Engstrom 3. Veterans Choice Program Overview- Gina Capra 4. How the Veterans Choice Program Works- Hal Blair 5. Making Yourself Known as a VCP Provider and Key Resources- Kelly Engstrom Organization Presenter Veterans Health Administration Gina Capra, Office of Rural Health Ward Circle Strategies Kelly Engstrom, Managing Director TriWest Healthcare Alliance Hal Blair, Deputy Program Manager 2
1. Veterans Health Care Overview 3
Overview: Which Veterans Use VA Healthcare? ~22 Million US Veterans ~9 Million Enrolled in VA Healthcare ~6 Million VA Patients Not every VA-enrolled veteran receives VA In order to receive VA Healthcare health care services in a given year. Some benefits, a veteran must be eligible veterans may opt not to seek care, and others for care (usually determined by the may receive care outside the VA system, paying presence of a service-connected for care using private health insurance, disability, period of military service, Medicare, Medicaid, TRICARE or other means. or income level). 4
Overview: DoD vs. VA Health Care Department of Defense Department of Veterans Affairs Military Health System (MHS) Veterans Health Administration (VHA) • • Provides care to those who serve in Provides care to those who served in uniform (plus families and retirees) uniform • through the TRICARE program 144 hospitals, 14 health care centers, • 57 hospitals and ~400 clinics and, 754 community-based outpatient worldwide clinics across US • • FY 2015 Budget = $47.4 B FY2015 Budget = $59.5 B ~1 million dual-eligibles ~10 million MHS beneficiaries ~9 million VHA enrollees 5
Overview: Department of Veterans Affairs (VA) • Established in 1930 • Elevated to Cabinet level in 1989 • Federal government’s 2 nd largest department after the Department of Defense • Goal 1: Empower Veterans to Improve their Well-Being – Giving Veterans more information and Veterans Health choices for health care Administration • Goal 2: Enhance and Develop Trusted Partnerships – Creating relationships between VA and community partners to provide care for Veterans National Benefits Cemetery Veterans Administration Administration • Goal 3: Manage and Improve VA Operations to Deliver Seamless and VA Mission: To fulfill President Lincoln's Integrated Support promise "To care for him who shall have – Improving the coordination of care borne the battle, and for his widow, and his between VA and community providers orphan" by serving and honoring the men and women who are America's veterans. 6
VA Efforts to Engage Health Centers February 1995 January 2014 November 2014 VA begins to establish VA establishes Patient VA launches Veterans Community Based Centered Community Choice Program (VCP) Outpatient Clinics Care (PC3) Contracts (CBOCs) • The VCP • Lack of access • Barriers to • CBOCs for Veterans provides greater established to accessing care improve Veterans’ seeking access to due to long wait community specialist care geographic access times and • PC3 established health care for geographic to and use of eligible Veterans to expand care distance primary care • Choice Act • Choice Act options for services • Shifts focus of care Veterans specifically established the mentions FQHCs from inpatient to VCP to increase as providers accessibility to outpatient setting • Coordinated • Most CBOCs care for eligible Care owned and staffed Veterans • Choice by VA, but some Improvement Act contracted to private sector 7
2. Veterans Services in Health Centers 8
Veteran Services in Health Centers: NACHC’s Role Advocacy Communication Assistance • • • Choice Act Fact Sheets Targeted technical assistance • • 2015 Amendments Toolkits • to Choice Act Education • Conference Calls Sessions • Implementing Regulations • Policies 9
Veteran Services in Health Centers: A Natural Fit Provides a venue In line with health for connecting with center mission for Veterans in the the underserved community Community impact Additional source and opportunity for of revenue partnership with community VSOs and nonprofits 10
Veteran Services in Health Centers: Key Statistics Approximate number of Veterans 300,000 served by health centers according to the 2014 Uniform Data System Number of Health Center sites 739 currently signed up as VCP/PC3 providers, representing over 250 Health Center grantees 95% Percent of VCP claims paid within 30 days 11
3. Veterans Choice Program Overview 12
Veterans Choice Program (VCP) Provisions Definitions • • VA to furnish hospital care and For purposes of the Veterans Choice Program, a VA medical facility is medical services to eligible Veterans through agreements* with eligible defined as a: • VA Community Based Outpatient Clinic entities or other laws administered by (excludes mobile clinics) the Secretary • VA health care center • $ 10 billion for a “Veterans Choice • VA hospital Fund” to pay for community care • Outpatient Clinic on VA Medical Center authorized under the Veterans Choice campus Program • Authority sunsets in three years, or Note: VA operates when the Veterans Choice Fund is other outpatient service sites, exhausted community living • Pre-existing programs and initiatives centers, and were unchanged rehabilitation facilities, but these sites are excluded from *Agreements include contracts, provider VCP driving distance calculations agreements and intergovernmental agreements 13
Veterans Choice Program (VCP) Veteran Eligibility • *Veterans who were enrolled for VA medical care as of August 1, 2014 OR recently discharged combat Veterans (within the five-year enrollment window) And one of the following: • Live >40 miles driving distance from nearest VA Medical Facility, • Wait time for an appointment is greater than Other Recent Updates** the wait time goal set by VA (currently 30 • No longer a 60 day limit on episode of days) or clinically necessary time** care • Reside in state without VA Medical facility, • VA Secretary can establish criteria to OR • Unusual or excessive burden for travel to expand provider base nearest health care facility • Change in requirement for distance from CBOCs related to full time * In p ro cess o f ch an g e d u e to n ew leg islatio n physician availability 14
Veteran Health coverage in Louisiana • 9 F Q H C s a re C h o ic e re g iste red • 6 F Q H C s a re P C 3 c o n tra c ted
Veterans Choice Program: Third Party Administrators • Role • Geographic Coverage – Health Net (yellow) and TriWest (blue) 16
Veterans Choice Program: Third Party Administrators • TriWest Contact Information – Provider Services Contracting Phone: 1-866-284-3743 – Email: TriWestDirectContracting@triwest.com – Website: https://joinournetwork.triwest.com/ – Point of Contact: Hal Blair, Deputy Program Manager, TriWest Healthcare Alliance, hblair@triwest.com 17
4. How the Veterans Choice Program Works 18
Veterans Choice Program: How it Works Completes Provider Accepts Returns medical Registration form Provides Health Center appointment documentation, Receives on TPA Website care to request from along with a Payment and accept terms of Veteran TPA claim, to the TPA participation Determines eligibility, Adds Health Sends relevant provides 60-day Processes Third Party Center to medical authorization, makes Clean Claim Administrator database of documentation to appointment with a w/in 30 days** VCP providers Health Center participating VCP provider Exercises Choice Option by calling Receives care phone TPA phone number on the at Health Veteran Veteran Choice Card; Requests VCP Center provider and preferred appointment time **Clean claims that are not processed within 30 days will be paid interest in addition to the payable amount 19
Veterans Choice Program: Requirements for Providers Accept Medicare rates and meet all Medicare conditions of participation 1 and conditions for coverage Be in full compliance with federal and state regulatory 2 requirements Have unrestricted license in state where services are 3 delivered 20
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