Serving America's Veterans: How Florida Health Centers Can Answer the Call Florida Association of Community Health Centers Webinar 08/19/2015 3pm, EST

Discussion Topics Topic AreaPresenter Veterans Health AdministrationLelia Jackson, Director, Office of Community Engagement Health Net Federal ServicesJim Jones, Director, Provider Network Management 2

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 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 Defense Military 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 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 3

November 2014 Veterans Choice Program (VCP) launched February 1995 VA 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 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 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 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 2014 VA 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 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 4

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 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. 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 5

HR Surface Transportation and Veterans Health Care Choice Improvement Act of 2015 Sec 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 7

Florida Health Care Delivery Sites Orientation 8

1 2 3 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 9

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 Provider10

How to Become a VCP Provider (continued) 11

How to Become a VCP Provider (continued) 12

How to Become a VCP Provider (continued) 13

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 14

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 15

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 16

Tom Grahek, Chief, Non-VA Purchased Care, Chief Business Office, VHA: or Veterans Choice Program overview: "How to Become a Veterans Choice Program and/or Patient- Centered Community Provider" fact sheet: heet_Choice_Program_508c_Internet.pdf heet_Choice_Program_508c_Internet.pdf VHA Choice Locator PC3 Provider Map: Key Resources 17

Military Culture Training Course Training for community providers on treating the unique Veteran patient community PTSD Consultation Program Post-traumatic stress disorder training offered for health care professionals who treat Veterans Veterans Choice Program Toolkit Outreach materials (e.g., fact sheets, FAQs) designed to make it easy to share information and spread awareness about VCP Key Resources (continued) 18

Lelia Jackson Director, Office of Community Engagement, VHA Jim Jones Director, Provider Network Management, Health Net Federal Services Contact Information 19