Serving America's Veterans: How Florida Health Centers Can Answer the Call

Florida Association of Community Health CentersWebinar

08/19/20153pm, EST

Discussion Topics

Topic Area PresenterVeterans Health Administration Lelia Jackson, Director, Office of Community

Engagement

Health Net Federal Services Jim Jones, Director, Provider Network Management

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• Provides care to those who serve in uniform (plus families and retirees) through the TRICARE program

• 57 hospitals and ~400 clinics worldwide• Fiscal year 2015 budget = $47.4 B

Department of DefenseMilitary Health System (MHS)

Department of Veterans Affairs Veterans Health Administration (VHA)

• Provides care to those who served in uniform

• 144 hospitals, 14 health care centers, and, 754 Community Based Outpatient Clinics across the United States

• Fiscal year 2015 budget = $59.5 B

A Quick Primer

~10 million MHS beneficiaries ~9 million VHA enrollees

~1 million dual-eligibles

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November 2014Veterans Choice Program (VCP)

launched

February 1995VA begins to establish

Community Based Outpatient Clinics (CBOC)

• CBOCs established to improve Veterans’ geographic access to and use of primary care services

• Shift in focus of care from inpatient to outpatient setting

• Most CBOCs owned and staffed by VA, but some contracted to private sector

• Lack of access for Veterans seeking specialist care

• PC3 established to expand care options for Veterans

• Barriers to accessing care due to long wait times and geographic distance

• Choice Act established the VCP to increase accessibility to care for eligible Veterans

January 2014VA establishes Patient Centered Community Care (PC3) Contracts

• The VCP provides greater access to non-VA health care services for eligible Veterans

• Choice Act specifically mentions FQHCs as a potential group of providers

VA Efforts to Engage Health Centers

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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:• Live >40 miles driving distance,• Wait time >30 days from medically

appropriate date,• Reside in state without VA Medical

facility, OR• Unusual or excessive burden for travel

to nearest health care facility

VCP allows eligible Veterans the choice to receive pre-authorized health care in their communities from non-VA providers participating in the VCP, rather than waiting an extended time for a VA appointment or traveling a significant distance to a VA medical facility.

In order to be a VCP provider, you must be an approved provider through a third party administrator.

Veterans Choice Act

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HR 3236 - Surface Transportation and Veterans Health Care Choice Improvement Act of 2015

• Sec. 4005. modifications of Veterans Choice Program• Includes five provisions to enhance the Choice Act:

– Removes 60 day limit on episode of care

– Removes requirement for enrollment prior to 8/1/2014; Veteran must be

enrolled in the system of patient enrollment

– Expands provider base by allowing VA Secretary to establish criteria • Most likely requires regulations to implement

– Amends the wait time language that allows care at a non-department facility

if Veteran cannot get care in VA within the:• Wait time goals set by VA (currently 30 days)• Or within the clinically necessary time if shorter than wait time

– Changes requirement for distance from CBOCs related to full time

physician availability• Most likely requires regulations to implement• Under review by OGC to determine exact interpretation 6

In line with health center mission for the underserved

Provides a venue for connecting with

Veterans in the community

Additional source of revenue

Community impact and opportunity for

partnership with community VSOs

and nonprofits

What VCP Means For Community Health Centers

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Florida Health Care Delivery Sites Orientation

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Accept Medicare rates and meet all Medicare conditions of participation and conditions for coverage

Be in full compliance with federal and state regulatory requirements

Have unrestricted license in state where services are delivered

Requirements for VCP Providers

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•Complete Information on Health Net Website

•Receive Authorization Package from Health Net

•Return Medical Documentation to Health Net

•Claims Payment

How to Become a VCP Provider

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How to Become a VCP Provider (continued)

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How to Become a VCP Provider (continued)

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How to Become a VCP Provider (continued)

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Veterans referred from VA Medical Centers for PC3

Patient-Centered Community Care (PC3) is a contracted provider vehicle with the VA that was established before VCP, but is the foundation upon which VCP was established

Care is available through PC3 when the local VA Medical Center cannot readily provide the needed care to Veterans due to lack of available specialists, long wait times, geographic inaccessibility or other factors

PC3 providers are automatically eligible to participate as VCP providers through Health Net – no additional steps are required

PC3 established before VCP

PC3 and VCP administered by Health Net

PC3: An Additional Option for Health Centers

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• Clean Claims will be paid within 30 days of receipt• Clean Claims that are not processed within 30 days will be paid interest in

addition to the payable amount

Community Health Center

Claims Funding

Reimbursement

How to Be Paid as a VCP Provider

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Engage with Veteran Community

Marketing and Outreach

Partner with Community VSOs

Provide Fact Sheets

Partner with Local VA

How to Be Known as a VCP Provider

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• Tom Grahek, Chief, Non-VA Purchased Care, Chief Business Office, VHA: Tom.Grahek@va.gov or 804-878-2754

• Veterans Choice Program overview: http://www.va.gov/opa/choiceact/factsheets_and_details.asp

• "How to Become a Veterans Choice Program and/or Patient-Centered Community Provider" fact sheet: http://www.va.gov/opa/choiceact/documents/FactSheets/VACAA_Provider_Fact_Sheet_Choice_Program_508c_Internet.pdf

• VHA Choice Locator PC3 Provider Map: http://www.va.gov/opa/apps/locator/

Key Resources

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Military Culture Training Course Training for community providers on treating the unique Veteran patient community

http://deploymentpsych.org/military-culture-course-modules

PTSD Consultation ProgramPost-traumatic stress disorder training offered for health care professionals who treat Veterans

www.ptsd.va.gov/professional/consult/index.asp

Veterans Choice Program ToolkitOutreach materials (e.g., fact sheets, FAQs) designed to make it easy to share information and spread awareness about VCP

http://www.va.gov/opa/toolkit/index.asp

Key Resources (continued)

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Lelia JacksonDirector, Office of Community Engagement, VHA202-461-5758 Lelia.Jackson@va.gov

Jim JonesDirector, Provider Network Management,Health Net Federal Services571-227-6545James.A.Jones@healthnet.com

Contact Information

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