Transcript Tribal Health Program (THP)

VA-Indian Health Service(IHS)/Tribal Health Program (THP)
Reimbursement Agreements Program
Agenda
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Milestones
Benefits
Direct Care Services
Payment Methodologies
Reimbursement Agreements vs. MOUs
Status of IHS and THP Agreements
IHS and THP Signed Agreements
THP Agreement Implementation Process
Eligibility and Enrollment
VHA Health Eligibility Center Training
VA Office of Tribal Government Relations
Local Implementation Plans
Questions/ Points of Contact
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Indian Health Service &
Tribal Health Reimbursement
Milestones
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October 1, 2010: the VA Under Secretary for Health, Dr. Petzel,
The MOU and
and the IHS Director, Dr. Roubideaux, signed a Memorandum of
Agreements:
Understanding (MOU).
 Promotes quality
March – May 2012: VA and IHS and Tribal Health Programs (THP)
health care through
initiated tribal consultation on a draft national agreement.
collaborative
June 2012: Confirmed approach: one National Agreement with
relationships and
agreements
IHS and individual sharing agreements under 38 USC 8153 for
Tribal Health Programs due to their sovereign nature.
 Focuses on increasing
August 24, 2012: Dr. Petzel signed and distributed the Dear Tribal
coordination,
Leader Letter with program guidance.
collaboration, and
resource-sharing for
December 5, 2012: VA-IHS National Agreement signed.
eligible American Indian
Ongoing coordination in onboarding THPs.
and Alaska Native
Veterans
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Benefits
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Medical Benefits Package – VA will reimburse for direct care services provided under the Medical
Benefits package available to eligible AI/AN Veterans under 38 CFR § 17.38.
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Choice of care provider – Eligible AI/AN Veterans can choose to receive their health care from the
IHS/THP facility and/or VA Medical Center (VAMC). No pre-authorization by VA will be required for
direct care services provided to eligible AI/AN Veterans if care is received at the IHS/THP facility.
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Pharmacy Options – IHS/THP health care facilities will be reimbursed when providing outpatient
medications to eligible AI/AN Veterans.
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No Copayment – Pursuant to section 405(c) of the Indian Health Care Improvement Act (IHCIA), VA
copayments do not apply to direct care services provided by the IHS/THP facility to eligible AI/AN
Veterans under the National Agreement or local reimbursement agreements.
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Third Party Billing – Pursuant to section 405(c) of IHCIA, IHS/THP health care facilities will bill all
third party payers, as permissible by law, prior to billing VA.
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Direct Care Services
• Direct Care Services are defined as any health service that is provided
directly by IHS/THP. This does not include Contract Health Services, unless
those services are provided within the walls of the IHS or THP facility.
• VA will not reimburse for any services that are excluded from the Medical
Benefits package or for which the eligible AI/AN Veteran does not meet
qualifying criteria.
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Payment Methodologies and Fees
• Inpatient hospital services are based on Medicare Inpatient Prospective
Patient System (IPPS).
• Outpatient services will be based on the IHS All Inclusive Rate published 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.
• Administrative fees will be applied to the following claims:
 Paper claims will incur a $15 fee for the duration of agreements
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Reimbursement Agreements vs. MOUs
• Reimbursement agreements:
– Only apply to AI/AN Veterans receiving direct care services
– Do not relate to existing MOUs or sharing agreements in place, or being
negotiated with VA
– Program guidance and authorities for these agreements do not apply to
other agreements or MOUs you may have in progress and/or in place
– While some VAMC staff involved with Reimbursement Agreements
might also be the points of contact for other MOU development efforts,
the efforts should be considered separate and distinct
VETERANS HEALTH ADMINISTRATION
Status of IHS and THP Agreements
• IHS: 83 Implementation plans signed, for a total of 108 IHS facilities.
• THP: Currently 92 signed agreements, with 42 tribes in progress.
• To date, VA has reimbursed over $37 million in direct care services for over
6,700 eligible AI/AN Veterans under both Reimbursement Agreements.
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Tribal Health Programs with Signed Agreements
ALASKA
Kodiak Area Native Association Medical Clinic
Alaska Native Tribal Med Ctr
Maniilaq Association
Aleutian Pribilof Islands Association
Mount Sandford Tribal Consortium
Annette Island Service Unit (Metlakatla)
Native Village of Eklutna
Arctic Slope Native Association Limited
Native Village of Tanana
Athabascan Tribal Government
Ninilchik Community Clinic
Bristol Bay Area Health Corporation
Norton Sound Health Corporation
Chickaloon Village Traditional Council
Seldovia Village Tribe
Chugachmuit
Southcentral Foundation
Eastern Aleutian Tribes, Inc.
Southeast Alaska Regional Health Consortium
Gulkana and Gakona Clinics (Copper River Native Association)
Tanana Chiefs Conference
Ilanka Community Health Center (Native Village of Eyak)
Yakutat Tlingit Tribe
Kenaitze Indian Tribe
Yukon-Kuskokwim Health Corporation
KIC Tribal Health - Ketchikan Indian Community
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Tribal Health Programs with Signed Agreements
ARIZONA
Tuba City Regional Health Corporation (Navajo Nation)
Wassaja Memorial Health Center (Fort McDowell)
Winslow Indian Health Care Center (WIHCC)
CALIFORNIA
Central Valley Indian Health, Inc.
Consolidated Tribal Health Project
Greenville Rancheria THP
Indian Health Council, Inc.
Karuk Tribal Health and Human Service Program
Kimaw Medical Center (Hoopa Valley Tribe)
Lake County Tribal Health Consortium
Pit River Health Service
Riverside-San Bernardino County Indian Health
Santa Ynez Tribal Health Clinic
Sonoma County Indian Health Project (SCIHP)
Southern Indian Health Council, Inc.
Toiyabe Indian Health Clinic
United Indian Health Services, Inc.
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COLORADO
Southern Ute Indian Tribe Health Center
IDAHO
Benewah Medical Wellness Center (Coeur d' Alene)
Nimiipuu Health (Nez Perce Tribe)
IOWA
Meskwaki Tribal Health (Sac and Fox Tribe of the Mississippi
in Iowa)
KANSAS
Prairie Band Potawatomi Health Center (Prairie Band
Potawatomi)
LOUISIANA
Chitimacha Health Clinic (Chitimacha Tribe of Louisiana)
MAINE
Maliseet Health and Wellness Center
Passamaquoddy Health Center
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Tribal Health Programs with Signed Agreements
MICHIGAN
Hannahville Potawatomi Indian Community Health
Lac Vieux Desert Health Clinic and Pharmacy (Lac Vieux Desert (LVD) Band of Lake Superior Chippewa Indians)
Little Traverse Bay Band Health Department (LTBB of Odawa Indians)
MINNESOTA
Fond du Lac Reservation
MISSISSIPPI
Choctaw Health Center (Mississippi Band of Choctaw)
MONTANA
CSKT Tribal Health & Human Services (Confederated Salish and Kootenai Tribes)
Rocky Boy Health Center (Chippewa Cree Tribe in Montana)
NEBRASKA
Ponca of Nebraska
NEVADA
Newe Medical Clinic (Ely Shoshone)
Owyhee Community Health Facility
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Tribal Health Programs with Signed Agreements
NEW MEXICO
Isleta Health Center
Jemez Health Center (Pueblo of Jemez)
Santo Domingo Health Center (Kewa Pueblo Health Corp)
NEW YORK
St. Regis Mohawk Health Services
OKLAHOMA
Absentee Shawnee Tribal Health Authority, Inc. (Absentee Shawnee Tribe)
Black Hawk Health Center
Citizen Potawatomi Nation Health Clinic
Chickasaw Nation Division of Health
Choctaw Nation Health Care Center (Choctaw Nation)
Health Centers & Hospitals of Cherokee Nation
Kanza Health Center (Kaw Nation)
Muscogee (Creek) Nation Health System (Muscogee (Creek) Nation of Oklahoma)
Northeastern Tribal Health System (NTHS)
White Eagle Health Center (White Eagle - Ponca Tribe of Oklahoma)
Wyandotte Bearskin Health Center
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Tribal Health Programs with Signed Agreements
OREGON
Confederated Tribes of Grand Ronde Health and Wellness Center
Cow Creek Health and Wellness Center (Cow Creek Band of Umpqua Tribe of Indians)
Siletz Community Health Clinic
Yellowhawk Tribal Health Center (Umatilla)
SOUTH DAKOTA
Flandreau Santee Sioux Tribe (FSST)
UTAH
Utah Navajo Health System, Inc.
WASHINGTON
Lake Roosevelt Community Health (Colville)
Lummi Tribal Health Center
Port Gamble S’Klallam Health Center
WISCONSIN
Lac Courte Oreilles
Red Cliff Community Health Center
Stockbridge-Munsee Health and Wellness Center
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Basic THP Process for Establishing Agreements
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Using the agreement template, the VAMC, THP, and Contracting Officer work together to complete the draft reimbursement agreement.
The national template shall always be used.
Concurrently, the THP works to satisfy local implementation criteria.
Once the draft is complete, it will be reviewed by CBO, Network Contracting Office and Regional Counsel, respectively.
After final signatures, reimbursement for direct care can commence.
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Eligibility and Enrollment
• VA and IHS are responsible for determining eligibility for health care
services within their respective programs.
• The eligible Veteran must also meet IHS eligibility requirements and be
eligible for services in accordance with 42 C.F.R. Part 136.
• Veterans must be enrolled in the VA system before a claim can be
processed and reimbursed.
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Electronic Health Care Claims Submissions
• VA is accepting electronic health care claims submission
• Claims submission must satisfy the criteria established in the Health
Insurance Portability and Accountability Act of 1996 (HIPAA)
• IHS/THP providers or facilities must register or establish connection with
the VA’s clearinghouse, Emdeon, to enable the processing of electronic
health care claims
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Local Implementation Plan
The Local Implementation Plan
serves as a document to aid in the
onboarding process and enable
knowledge sharing regarding facility
services and points of contact.
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VHA Health Eligibility Center Training
Training
• The VHA Health Eligibility Center (HEC) provides monthly training focused
on eligibility, the medical benefits package, and enrollment.
Current Schedule:
– Every third Tuesday Monthly
– 2pm – 3pm (EST)
– Please email
[email protected]
to receive a calendar invite.
• Additional information on VA Health Benefits:
http://www.va.gov/healthbenefits/
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Further Information
Information on how to establish
agreements, templates, forms and
guides about the program are
housed at VA Chief Business Office
Purchased Care:
http://www.va.gov/PURCHASEDCA
RE/programs/veterans/nonvacare/
ihs/index.asp
For more information on getting
started with Tribal Health Program
agreements, send an e-mail to
[email protected]
VETERANS HEALTH ADMINISTRATION
Questions / Points of Contact
VA
Kristin Cunningham
Director, Business Policy
VHA
[email protected]
IHS
Terri Schmidt
[email protected]
Majed Ibrahim
Program Mgr, IHS/THP
Reimbursement Agreements
VHA
[email protected]
Organizational email
[email protected]
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