Medical Quality Assurance Activities. At least annually AVAHS and ATHP agree to use existing medical quality assurance activities, as required under accreditation or certification standards or maintained for reporting to IHS, unless other activities or criteria have been agreed upon. ATHP agrees to share information with VA regarding its medical quality assurance activities, which shall include periodic review of care utilization (health system level trends) and care delivery consistent with current standards of care and evidence-based practices.
Medical Quality Assurance Activities. At least annually, VA and IHS/THPs agree to use existing medical quality assurance activities as required under accreditation or certification standards. How is the IHS Reimbursement Agreement different from THP Agreements? IHS Agreement will be implemented in a phased approach with Phase 1 including 10 selected sites. At the end of Phase 1, other IHS sites will start implementation. THP facilities will not be subject to a phased model and can begin developing agreements with relevant VA Medical Centers (VAMC) immediately. What are the timelines for implementation for both programs? The graph below details implementation timelines for IHS and THP agreements. Phase 1 of IHS implementation begins in January 2013 and will extend through June 2013. Phase 2 will then be marked by expansion to other IHS facilities. The THP implementation process is ongoing. How many AI/AN Veterans are estimated to fall under these agreements? Nationally, the estimate is about 48,000 for both IHS and THP Agreements. Are all priority groups eligible under VA,IHS and THP Agreements? Yes, however, a Veteran’s Medical Benefits Package is based on the Veteran’s eligibility and enrollment in VA health care. IHS/THP facilities can only seek reimbursement for care if that service is covered within the Veterans medical benefits package. Prior to providing care, it is recommended that the IHS/THP facility check eligibility with VA Health Eligibility Center or their local VAMC to ensure enrollment is completed and covered services are known. How will we know that the Veteran is registered with a Tribe? The Tribe is responsible for managing tribal memberships and each tribe sets their membership criteria. Can non-AI/AN Veterans also be covered under these agreements? This is contingent upon the capacity of the particular THP facility and must be stipulated in the agreement. In Alaska, non-AI/AN Veterans have been included in agreements due to the highly rural nature of the environment there. Non-AI/AN Veterans would require prior authorization and would be subject to a co-pay. This only applies to THP facilities as IHS facilities cannot treat non- AI/AN Veterans. If the THP or IHS facility is not able to provide specialized care and the Veteran is referred out, does VA pay? The agreements will not cover referrals or contract care provided outside the agreement facility providing direct care. However, the IHS/THP can work with their local VAMC to request VA to coordinate the care needed. This...
Medical Quality Assurance Activities. At least annually, VA and THP agree to use existing medical quality assurance activities, as required under accreditation or certification standards or maintained for reporting to IHS. THP agrees to share information with VA regarding its medical quality assurance activities, which shall include periodic review of care utilization (health system level trends) and care delivery consistent with current standards of care and evidence-based practices.
Medical Quality Assurance Activities. At least annually, VA and THP agree to use existing medical quality assurance activities, as required under accreditation or certification standards or maintained for reporting. THP agrees to share information with VA regarding its medical quality assurance activities, which shall include periodic review of care utilization (health system level trends) and care delivery consistent with current standards of care and evidence-based practices. Developing a process consistent with applicable privacy laws to share patient summary information (summary of care documents) electronically through the Nation Wide Health Information Network. Agree to meet requirements for Meaningful Use of electronic health records (EHR) and to report on Meaningful Use clinical quality measures as required by Medicare or Medicaid. Meeting at least annually with THP representatives to review the overall quality of care provided to AI/AN Veterans served under this agreement and implementing joint system-wide quality improvement activities as needed. Convening ad hoc meetings to discuss program-specific quality issues if issues or concerns develop. Developing a joint patient advocacy/ombudsman process to address appeals on patient grievances and complaints that are not resolved at the local VA or THP level. GENERAL PROVISIONS Veteran’s Choice of Provider. Nothing in this Agreement affects the right of AI/AN Eligible Veterans to choose whether they receive health care services in VA or THP facilities.
