veteran affairs sharing agreement program with indian ... · ihs & thp reimbursement agreement...
TRANSCRIPT
Monthly Overview
Veteran Affairs Sharing Agreement Program with Indian Health Service (IHS) and Tribal Health Programs (THP)
VETERANS HEALTH ADMINISTRATION
Agenda
• Program Update
• Payment Methodologies
• Timeline
• Reimbursement Agreement Status
• IHS THP SharePoint Site
• VA-IHS MOU
• VA-IHS MOU Work Group #6
• VA-IHS MOU Work Group Points of Contact
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VETERANS HEALTH ADMINISTRATION
IHS & THP Reimbursement Agreement Program Update
IHS
• On December 5, 2012, VA and IHS signed a National Agreement on reimbursement covering all IHS sites
• IHS has 10 Phase 1 sites identified
• CBO Purchased Care emailed each VISN with a Phase 1 site for coordination of a Joint VA and IHS Phase 1 Kick-Off Meeting for later this month
THP
• While the IHS National Agreement involves a phased approach, Tribal Health Program (THP) sites are not subject to this requirement.
• All THP sites can continue discussion with their local VAMC and the CBO office.
Claims Processing Update
• CBO Purchased Care continues to evaluate whether to consolidate claims processing to a VISN for all IHS and THP reimbursement claims or have each VAMC process locally
• These claims are different than the typical Non-VA Care program; some differences include the payment rates and administrative fees
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VETERANS HEALTH ADMINISTRATION
Reimbursement Agreement Payment Methodologies
• Direct Care Services will be reimbursed according to the following payment methods and rates:
– Inpatient hospital services are based on Medicare Inpatient Prospective Patient System.
– Outpatient services will be based on the IHS All Inclusive Rate posted in the Federal Register.
– Critical Access Hospitals will be reimbursed at the established rate as determined by Medicare.
– Ambulatory Surgical Services will be reimbursed at Medicare rates.
• VA is responsible only for the balance remaining after other third party reimbursements.
• Additionally, claims will be reduced by $15 on outpatient claims and paper claims will be reduced by $15. This helps cover the administrative processing costs of these unique claims
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VETERANS HEALTH ADMINISTRATION
Implementation Timelines
Signed IHS
Agreement
12/05/12
Finalize
Phase 1
Sites
Phase 1 Kick Off
Jan 2013
6 months
Finalize
Phase 2
Sites CBO & VAMC Approve
• Local Implementation Plans
• Site Readiness
Phase 2
Kick Off
June 2013
CBO & VAMC Approve
• Local Implementation Plans
• Site Readiness
IHS
THP
VA and IHS negotiations
Signed 28 Agreements
Over 25 tribes in process
Revise
THP
Agreement
Update Program
Documents
Continue communication and in processing of Tribal Health Programs
VETERANS HEALTH ADMINISTRATION
Reimbursement Agreement Status
• Tribal Health Program – Signed 28 Tribal Health Program Agreements and another 30 tribes across
11 VISNs are in the process of developing THP Agreements.
– Completed 21 tailored briefings to the VISNs and individual VAMCs
• Indian Health Service – Signed 1 VA-IHS National Agreement to cover all IHS facilities
– Creating a Local Implementation Plan for the ten Phase 1 IHS facility sites
– Planning Phase 2 for all remaining IHS facility sites
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VETERANS HEALTH ADMINISTRATION
VA IHS & THP Program SharePoint Site
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Templates and guidance documents for IHS and THP
to request access to this
site.
Standard Orientation Overview Brief
Status of each tribe in the reimbursement agreement process organized by VISN
VETERANS HEALTH ADMINISTRATION
VA-IHS Memorandum of Understanding
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• The Memorandum of Understanding (MOU) was signed between Department of Veterans Affairs (VA) and Department of Health and Human Services (HHS)/Indian Health Service (IHS) on October 1, 2010.
– It builds upon decades of successful collaboration and achievements from the 2003 VA-IHS MOU.
– VA Office of Rural Health is managing implementation of the MOU and all related work groups.
– For more information: http://vaww.vha.vaco.portal.va.gov/sites/RuralHealth/qdrive/va-ihs_mou/default.aspx
2010 VA-IHS MOU:
VETERANS HEALTH ADMINISTRATION
VA-IHS MOU Work Group #6 Payment and Reimbursement
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Workgroup 6 Scope and Goals:
• To increase availability of services, in accordance with law, by the development of payment and reimbursement policies and mechanisms to:
• Support care delivered to eligible AI/AN Veterans served at VA and IHS.
• Facilitate the sharing and coordination of services, training, contracts, and sharing agreements, sharing of staff, and development of health information technology and improved coordination of care as specified elsewhere in this agreement.
Status:
• Held 1st workgroup of 2013 on January 15th and instituted monthly meetings
• Updated objectives and measures of performance for accomplishing goals
VETERANS HEALTH ADMINISTRATION
VA-IHS MOU Work Groups and Leaders (1 of 2)
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Workgroup Leader Email
WORK GROUP 1: SERVICES AND BENEFITS
Robert Reynolds [email protected]
WORK GROUP 2: COORDINATION OF CARE
Nancy Quest [email protected]
WORK GROUP 3: HEALTH INFORMATION TECHNOLOGY
Clayton Curtis [email protected]
WORK GROUP 4: NEW TECHNOLOGIES
Jay Shore [email protected]
WORK GROUP 5: SYSTEM LEVEL
Anthony Warner [email protected]
WORK GROUP 6: PAYMENT AND REIMBURSEMENT
Cyndi Kindred [email protected]
WORK GROUP 7: SHARING OF CARE PROCESS, PROGRAMS AND SERVICES
Chad Pomelow [email protected]
VETERANS HEALTH ADMINISTRATION
VA-IHS MOU Work Groups and Leaders (2 of 2)
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Workgroup Leader Email
WORK GROUP 8: CULTURAL COMPETENCY AND AWARENESS
LoRae (HoMana) Pawiki
WORK GROUPs 9 and 10: TRAINING AND RECRUITMENT
Richard Lussier
WORK GROUP 11: EMERGENCY AND DISASTER PREPAREDNESS
Leroy Jazz Jasper
WORK GROUP 12: JOINT IMPLEMENTATION TASK FORCE
Anthony Warner [email protected]
WORK GROUP 13: ALASKA Susan Yeager
VETERANS HEALTH ADMINISTRATION
Questions
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