Monthly Overview. Veteran Affairs Sharing Agreement Program with Indian Health Service (IHS) and Tribal Health Programs (THP)

Transcription

1 Monthly Overview Veteran Affairs Sharing Agreement Program with Indian Health Service (IHS) and Tribal Health Programs (THP)

2 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 2

3 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 ed 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 3

4 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 4

5 Implementation Timelines IHS Signed IHS Agreement 12/05/12 Phase 1 Kick Off Jan 2013 CBO & VAMC Approve Local Implementation Plans Site Readiness Finalize Phase 2 Sites VA and IHS negotiations 6 months CBO & VAMC Approve Local Implementation Plans Site Readiness Finalize Phase 1 Sites Phase 2 Kick Off June 2013 THP Signed 28 Agreements Over 25 tribes in process Revise THP Agreement Continue communication and in processing of Tribal Health Programs Update Program Documents

6 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 6

7 VA IHS & THP Program SharePoint Site to request access to this site. Templates and guidance documents for IHS and THP Standard Orientation Overview Brief Status of each tribe in the reimbursement agreement process organized by VISN 7

8 VA-IHS Memorandum of Understanding 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, 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: VA-IHS MOU: 8

9 VA-IHS MOU Work Group #6 Payment and Reimbursement 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: Status: 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. Held 1 st workgroup of 2013 on January 15 th and instituted monthly meetings Updated objectives and measures of performance for accomplishing goals 9

10 VA-IHS MOU Work Groups and Leaders (1 of 2) Workgroup Leader WORK GROUP 1: SERVICES AND BENEFITS Robert Reynolds WORK GROUP 2: COORDINATION OF CARE Nancy Quest WORK GROUP 3: HEALTH INFORMATION TECHNOLOGY Clayton Curtis WORK GROUP 4: NEW TECHNOLOGIES Jay Shore WORK GROUP 5: SYSTEM LEVEL Anthony Warner WORK GROUP 6: PAYMENT AND REIMBURSEMENT Cyndi Kindred WORK GROUP 7: SHARING OF CARE PROCESS, PROGRAMS AND SERVICES Chad Pomelow 10

11 VA-IHS MOU Work Groups and Leaders (2 of 2) Workgroup Leader WORK GROUP 8: CULTURAL COMPETENCY AND AWARENESS WORK GROUPs 9 and 10: TRAINING AND RECRUITMENT WORK GROUP 11: EMERGENCY AND DISASTER PREPAREDNESS LoRae (HoMana) Pawiki Richard Lussier Leroy Jazz Jasper LoRae.Pawiki@va.gov Richard.Lussier@va.gov Leroy.Jasper@va.gov WORK GROUP 12: JOINT IMPLEMENTATION TASK FORCE Anthony Warner Anthony.Warner@va.gov WORK GROUP 13: ALASKA Susan Yeager susan.yeager@va.gov 11

12 Questions For more information or if you have additional questions, please 12