1. VA Access Update, Veterans Access, Choice and Accountability Act of 2014 (VACAA) and Tribal Health Program Reimbursement Agreements Northwest Portland Area Indian Health Board Quarterly Meeting October 21, 2014

2. VETERANS HEALTH ADMINISTRATION Update on VA Access 2 Goals of Accelerating Access to Care Initiative: Increase timely access to care for Veterans patients Decrease the number of Veterans patients on the electronic wait list (EWL) and waiting greater than 30 days for their care Standardize the process and tools for ongoing monitoring and access management at VA facilities

3. VETERANS HEALTH ADMINISTRATION Accelerating Access to Care Initiative - Implementation Systematically reviewed clinic capacity to maximize ability to provide Veterans timely appointments Identified the resources required to provide timely care VA increased the use of care in the community through the non-VA care program (FEE) Each facility reached out to Veterans to coordinate the acceleration of their care – either to fee out or reschedule with VA at patients preference 3

4. VETERANS HEALTH ADMINISTRATION Accelerating Access to Care Initiative - Implementation Progress Toward Achieving Goals Electronic Wait List (EWL) in VISN 20 reduced from 11,613 on 5/15/14 to 3,003 on 9/1/14 Challenges Lack of supply in community Difficulty in recruiting providers in rural areas 4

5. VETERANS HEALTH ADMINISTRATION VA Secretary Robert McDonald Continue to improve access to VA health care Regain trust of Veterans we serve - Quarterly local town hall meetings for Veterans, VSOs, other stakeholders Mr. McDonald and Deputy Secretary Sloan Gibson meet with VA employees, Veterans and stakeholders 5

6. VETERANS HEALTH ADMINISTRATION Veterans Access, Choice and Accountability Act of 2014 (VACAA) – Enacted August 7, 2014 Section 101 Eligible Veterans may seek care from non-VA health care entities if: - Unable to secure an appointment within 30 days - Reside more than 40 miles from a VA medical facility Veterans Choice Card 6

7. VETERANS HEALTH ADMINISTRATION Veterans Access, Choice and Accountability Act of 2014 (VACAA) – Enacted August 7, 2014 Section 102 Increased outreach to encourage establishment of reimbursement agreements with Tribal Organizations Report on feasibility of entering into agreements with Urban Clinics Report on feasibility of reimbursement for treatment of non-Native Veterans at IHS/Tribal Clinics 7

8. VETERANS HEALTH ADMINISTRATION Veterans Access, Choice and Accountability Act of 2014 (VACAA) – Enacted August 7, 2014 Section 201 Independent assessment of VA’s health care delivery system Section 202 Independent commission on care Section 204 Evaluate use of Mobile Medical Units in rural areas 8

9. VETERANS HEALTH ADMINISTRATION Improving Access for American Indian and Alaska Native Veterans through Reimbursement Agreements 9 9 VA recognizes and values our relationships with Tribes Eligible American Indian and Alaska Native (AI/AN) Veterans can choose to receive their health care from the Tribal Health Program (THP) facility and/or VA Medical Center (VAMC) Reimbursement agreements with Tribal Health Programs focus on increasing coordination, collaboration, and resource-sharing for eligible AI/AN Veterans

10. VETERANS HEALTH ADMINISTRATION Improving Access for American Indian and Alaska Native Veterans through Reimbursement Agreements 10 The agreements promote quality health care through collaborative relationships Over $12.5M in reimbursements to date servicing approximately 4,000 Veterans

11. VETERANS HEALTH ADMINISTRATION Basic THP Process for Establishing Agreements 11 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 VA’s Chief Business Office, Network Contracting Office and Regional Counsel, respectively. After final signatures, reimbursement for direct care can commence.

12. VETERANS HEALTH ADMINISTRATION Questions Regarding Reimbursement Agreements 12 Jodie Waters, VISN 20 Planner, Josephine.Waters@va.gov, 360-567-4684 Josephine.Waters@va.gov Terry Bentley, Tribal Government Relations Specialist, Western Region, Terry.Bentley@va.gov, 541-440-1271Terry.Bentley@va.gov VHA Chief Business Office for Purchased Care, tribal.agreements@va.gov tribal.agreements@va.gov