0. Brian Reinhart Health Systems Specialist September, 2015
Veterans Access, Choice and Accountability Act of 2014 (VACAA) The Choice Program and the Choice Card
Brian Reinhart
Health Systems Specialist
September, 2015

1. VACAA – The Choice Program / Choice Card Fast Facts Overview
Background:
Major element of Public Law , passed Aug. 7, 2014
Funded at $10 billion
Temporary 3-year program to bridge gap while VA expands capacity, access
Approximately 600,000 Veterans immediately eligible: 40 miles / 30 days
9 million enrolled Veterans to receive a Choice Card
Program to be run by a contracted third party administrator
Rolled out on Nov
Dependent upon OMB approval of VA-proposed regulations and establishment of TPA contracts – thus, all information in this presentation is subject to change!

2. Third Party Administrator – Health Net
TPA to provide most business processes:
Card distribution
Provider management
Call centers
Appointment management
Reporting
Billing

3. Choice Card Production / Distribution
TPA contract to include Choice Card production and distribution
Instruction letter accompanied card
Phased distribution

4. Choice Program Eligibility
VA CHOICE PROGRAM
40 Mile
Geo-Burden
Choice-First
Choice

5. Veterans Choice Program – 40+ Miles
TPA is provided list of eligible Veterans that reside more than 40 miles from VA facility
Distance is calculated by address in VistA
This list is updated monthly
Veterans is notified of their eligibility through mailings
Veteran can choose to contact TPA and coordinate ALL care
Care is pre-authorized by VA based on eligibility and clinical criteria is determined by TPA using InterQual standards
Care Provided is paid by CBO with funding authorized in PL
Ex: Vet needs hip replacement, all related care, i.e. workup, surgery and rehab considered episode of care. Approval for episode of care is only authorized for 60 days and must be renewed

6. Veterans Choice Program – 40+ Miles (continued)
VA will own the Electronic Health Record (EHR) – even if the Veteran is never seen in a VA facility
Veteran is seen by Non-VA Choice Provider
Choice provider submits claim, Explanation of Benefits (EOB) (if applicable) and clinical documentation to TPA
TPA processes payment to Choice Provider

7. Choice – 30+ Days
Clock starts ticking based on “clinically indicated date” (CID)
If no clinically indicated date, patient preferred date is used
If we KNOW that community wait is longer than VA wait, we should inform the Veteran, who can then make an informed choice about care
When Veteran is added to VCL, VA schedules appointment
Veteran is made aware that they are eligible to use Choice Program and provided the number for the TPA
Veteran contacts TPA for information and/or use of Choice Program

8. Choice – 30+ Days (continued)
If Veteran decided NOT to use Choice for this episode of care
TPA and/or patient notifies VAMC
Veteran keeps appointment at VA
If Veteran selects to use Choice Program
TPA gathers information from Veteran
VA uploads documentation to the portal
TPA provides Veteran with list of approved Choice providers

9. Choice Program – 30+ Days (continued)
TPA schedules appointment for Veteran with selected provider
TPA provides appointment information to VAMC
VA staff cancel existing appointment
VA staff documents information in CPRS
Veteran is seen by Choice Provider
Choice provider submits claim, Explanation of Benefits (EOB) (if applicable) and clinical documentation to TPA
TPA processes payment to Choice Provider, payment is at Medicare rate or other specific rates identified in regulation when Medicare rates do not exist

10. VA Choice-First
This program is for services that the VA Medical Center does not offer, or offer very little of.
All requests have to be approved by Chief of Staff or designated individual.
We reach out to the patient and inform them of this and upload appropriate documentation to Health Net.
From this point forward the Choice-First process is handled very similar to regular Choice.

11. Third Party Administrator
VA pays no more than Medicare rate
Providers are either part of the TPA network or have a Choice Provider Agreement which meet requirements of the Choice Act
TPA will schedule Veterans community appointment OR send back to VA
Responsible to provide clinical documentation to VA
Notifies VA if/when community appointment scheduled
Coordinates other health insurance (OHI) information with provider and responsible to provide Explanation of Benefit (EOB) to VA
TPA is Health Net

12. Third Party Administrator (continued)
TPA will provide list of approved providers to Veteran to choose from
If desired provider is not on list – TPA will coordinate getting agreement with provider
If provider refuses agreement they are not available for the Choice Program
TPA will schedule appointment with selected provider
TPA sends through portal appointment information to primary facility
NVCC office will enter into FBCS in preparation of receipt of claim
If Veteran is Service Connected
TPA will contact CBO to obtain SC/NSC determination
If for NSC condition AND Veteran has insurance TPA will notify provider they must bill OHI first

13. Challenges
Coordinating Pre and Post care (prosthetics, therapy, etc.).
Medications.
The retrieval of medical documentation from TPA.
Coordinating communication between TPA and Veterans.

14. The VACAA Intranet Page – Your “Hub” for Choice Program Information, Resources:
VA Choice Information available at: Public: VA Employees (intranet):
Information
Toolkits
Fact Sheets
FAQs
News Releases
More added regularly

15. Reminder: Contents of this Presentation are …