1. VA-Indian Health Service(IHS)/Tribal Health Program (THP) Reimbursement Agreements Program

2. VETERANS HEALTH ADMINISTRATION Agenda 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 2

3. VETERANS HEALTH ADMINISTRATION Indian Health Service & Tribal Health Reimbursement Milestones 3 October 1, 2010: the VA Under Secretary for Health, Dr. Petzel, and the IHS Director, Dr. Roubideaux, signed a Memorandum of Understanding (MOU). March – May 2012: VA and IHS and Tribal Health Programs (THP) initiated tribal consultation on a draft national agreement. June 2012: Confirmed approach: one National Agreement with IHS and individual sharing agreements under 38 USC 8153 for Tribal Health Programs due to their sovereign nature. August 24, 2012: Dr. Petzel signed and distributed the Dear Tribal Leader Letter with program guidance. December 5, 2012: VA-IHS National Agreement signed. Ongoing coordination in onboarding THPs. 3 The MOU and Agreements: Promotes quality health care through collaborative relationships and agreements Focuses on increasing coordination, collaboration, and resource-sharing for eligible American Indian and Alaska Native Veterans The MOU and Agreements: Promotes quality health care through collaborative relationships and agreements Focuses on increasing coordination, collaboration, and resource-sharing for eligible American Indian and Alaska Native Veterans

4. VETERANS HEALTH ADMINISTRATION Benefits 4 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. 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. Pharmacy Options – IHS/THP health care facilities will be reimbursed when providing outpatient medications to eligible AI/AN Veterans. 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. 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.

5. VETERANS HEALTH ADMINISTRATION Direct Care Services 5 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.

6. VETERANS HEALTH ADMINISTRATION 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 6

7. VETERANS HEALTH ADMINISTRATION 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

8. 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.

9. VETERANS HEALTH ADMINISTRATION Tribal Health Programs with Signed Agreements 9 ALASKA Alaska Native Tribal Med Ctr Aleutian Pribilof Islands Association Annette Island Service Unit (Metlakatla) Arctic Slope Native Association Limited Athabascan Tribal Government Bristol Bay Area Health Corporation Chickaloon Village Traditional Council Chugachmuit Eastern Aleutian Tribes, Inc. Gulkana and Gakona Clinics (Copper River Native Association) Ilanka Community Health Center (Native Village of Eyak) Kenaitze Indian Tribe KIC Tribal Health - Ketchikan Indian Community Kodiak Area Native Association Medical Clinic Maniilaq Association Mount Sandford Tribal Consortium Native Village of Eklutna Native Village of Tanana Ninilchik Community Clinic Norton Sound Health Corporation Seldovia Village Tribe Southcentral Foundation Southeast Alaska Regional Health Consortium Tanana Chiefs Conference Yakutat Tlingit Tribe Yukon-Kuskokwim Health Corporation

10. VETERANS HEALTH ADMINISTRATION Tribal Health Programs with Signed Agreements 10 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. 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

11. VETERANS HEALTH ADMINISTRATION Tribal Health Programs with Signed Agreements 11 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 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)

12. VETERANS HEALTH ADMINISTRATION Tribal Health Programs with Signed Agreements 12 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 NEW YORK St. Regis Mohawk Health Services NEW MEXICO Isleta Health Center Jemez Health Center (Pueblo of Jemez) Santo Domingo Health Center (Kewa Pueblo Health Corp)

13. VETERANS HEALTH ADMINISTRATION Tribal Health Programs with Signed Agreements 13 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 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)

14. VETERANS HEALTH ADMINISTRATION Basic THP Process for Establishing Agreements 14 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.

15. VETERANS HEALTH ADMINISTRATION 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. 15

16. VETERANS HEALTH ADMINISTRATION 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 16

17. VETERANS HEALTH ADMINISTRATION Local Implementation Plan 17 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.

18. VETERANS HEALTH ADMINISTRATION 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 Tribal.Agreements@va.gov to receive a calendar invite. Additional information on VA Health Benefits: http://www.va.gov/healthbenefits/ http://www.va.gov/healthbenefits/ 18

19. VETERANS HEALTH ADMINISTRATION 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 tribal.agreements@va.gov

20. VETERANS HEALTH ADMINISTRATION Questions / Points of Contact 20 Organizational email tribal.agreements@va.gov VA Kristin Cunningham Director, Business Policy VHA kristin.cunningham@va.gov Majed Ibrahim Program Mgr, IHS/THP Reimbursement Agreements VHA majed.ibrahim@va.gov IHS Terri Schmidt Terri.schmidt@ihs.gov