Elected Official UpdateElizabeth Joyce Freeman, Director

December 16, 2014

Update Agenda• Veterans Choice Act (Special Briefing)• Wait Times• Upcoming Events

Background

Veterans Choice Act is a major

element of Public Law 113-

146, passed Aug. 7, 2014

Funded at $10 billion

nationally

Temporary (up to 3-year)

program to bridge gap while

VA expands capacity, access

Veterans choice increases access

to care in the community, not a requirement

Background

9 million enrolled

Veterans to receive a

Choice Card

Program to be run by a

contracted third party

administrator - Triwest

Implementation began

Nov. 5

Scheduling staff play an integral role

in this implementati

on

• Veteran must be enrolled in VA Health Care on or before August 1, 2014 or be a combat Veteran within 5 years of post-deployment

• AND

• Veteran who lives more than 40 miles away from a VA Point of Care (VAMC, CBOC) or faces unusual burden to travel due to geographical challenges

• 40 mile calculated using a straight line distance

Eligibility – 40+ Miles

• Veteran must be enrolled in VA Health Care on or before August 1, 2014 or be a combat Veteran within 5 years of post-deployment

AND

• VA Facility is unable to schedule an appointment within 30 days of the Veteran’s preferred date or the date determined to be clinically appropriate by the provider for a particular service

Eligibility - 30 + days

Choice Card

By January 2015 all eligible veterans will be provided with a Choice Card

8

Determine Veteran eligibility for Choice Program

Managing call center to answer Veteran question1-866-606-8198

Coordinate appointments for care

Mailing of cards

Coordinate care with VA staff

Contact VA facility to cancel scheduled appointment when Veteran elects to use this program

Role of the Third Party Administrator - Triwest

Bene travel available for these appointmentsCo-payments still apply

Veterans are required to provide private insurance information for this programPrescriptions written by Choice provider needs to be paid from money authorized through PL 113-146 (same for Prosthetics)Pharmacy and Prosthetics benefit: utilizing current in-house process (same as other non-VA medical care prescriptions)

Veterans Choice Program

Other Health Insurance (OHI)

Veteran Choice Program

• Veteran must provide any OHI coverage information to use program; however Veteran is not required to have other health insurance.

• Non-VA provider will bill the Veteran’s OHI for treatment of non-service connected conditions.

• Veteran may be responsible for cost shares and deductibles owed by the Veteran’s health insurance policy.

• Date deemed clinically appropriate by a VA health care provider

• If a time range is indicated (2-3 months) than the latest clinically appropriate date will be used to determine eligibility (desired date field)

• Most often used for established patients

• Clinically indicated date supersedes the patient’s preferred date when determining eligibility for this program

Clinically Appropriate Date

• If no clinically indicated date is available, then use patient preferred date

• For new patients will be determined in the following manner “What is the first date that you would like to be seen?”

• For Established patients the scheduler indicates when the provider would like to see them back and then asks the patient “When they would like to be seen?”

– This is the preferred/desired date

Veterans Preferred Date/Desired Date

• When scheduling staff an appointment 30 days beyond the clinically appropriate date or preferred date than they will populate the Veterans Choice List (VCL) to indicate eligibility for this appointment

• Scheduling staff are responsible for notifying Veteran that they are eligible for this program

• If the Veteran indicates that he is not interested in the program, we still need to make a VCL entry

• Implementation is currently underway

Eligible for 30+ Days

Total to Receive Card = 1380 EWL: 463 Veterans VCL: 917 Veterans

30+ Days Choice Card Recipients

Veteran Questions 1-866-606-8198

VA intranet web site for Veterans http://vaww.va.gov/choice/ VA internet web site for staff http://www.va.gov/opa/choiceact/Facility leadership and “Choice Champions”

Important Resources

VA is posting regular data updates showing progress on its efforts to accelerate access to quality health care for Veterans who have been waiting for appointments. These access data updates will be posted at the middle and end of each month at the following website:

http://www.va.gov/health/access-audit.asp

Current Wait Time Data

Upcoming Events• Second Quarter Veterans Town Hall:

• Calaveras County

Questions/DiscussionNext Scheduled Update: March 2014