Legal authority established in 2010 Legal authority established in 2010 (ACA)(ACA)

Reimbursement agreements allows the Reimbursement agreements allows the VA to pay Indian Health Service (IHS) VA to pay Indian Health Service (IHS) and Tribal Health Programs (THP)and Tribal Health Programs (THP)

Reimbursement is for direct care Reimbursement is for direct care services provided to eligible American services provided to eligible American Indian Veterans enrolled in VAIndian Veterans enrolled in VA

Initiated by Letter of Intent from Tribe to VAMC

Orientation Checklist provided by VA Centralized Business Office (CBO)

Tribe/VA meeting to review checklist

When checklist is complete, packet submitted to VA for review

Final Agreement signed by both parties

• Muscogee (Creek) Nation: July 1, 2012, 1 hospital, Muscogee (Creek) Nation: July 1, 2012, 1 hospital, 8 clinics 8 clinics

• Pawnee IHS: March 22, 2013, 1 clinicPawnee IHS: March 22, 2013, 1 clinic• Choctaw Nation: March 31, 2013, 1 hospital, 8 clinicsChoctaw Nation: March 31, 2013, 1 hospital, 8 clinics• Pawhuska IHS: May 16, 2013, 1 clinicPawhuska IHS: May 16, 2013, 1 clinic• Claremore IHS: May 16, 2013, 1 hospitalClaremore IHS: May 16, 2013, 1 hospital• Cherokee Nation: (under review) 1 hospital, 8 clinicsCherokee Nation: (under review) 1 hospital, 8 clinics• Chickasaw Nation: November 21, 2013, 1 hospital, Chickasaw Nation: November 21, 2013, 1 hospital,

4 clinics4 clinics

Wewoka Service Unit, May 16, 2013, 1 clinic Clinton Service Unit, May 16, 2013, 3 clinics Lawton Service Unit, May 16, 2013, 3 clinics Ponca Tribe, November 21, 2013, 1 clinic NE Tribal Health System February 11, 2014, 1

clinic Indian Health Resource Center of Tulsa, April

30, 2014, 1 clinic

Agreements increase access sites to care for Agreements increase access sites to care for American Indian Veterans with 6 hospitals American Indian Veterans with 6 hospitals and and 40 clinics 40 clinics

Choice of Care Provider: Eligible Veterans Choice of Care Provider: Eligible Veterans can choose to receive their health care from can choose to receive their health care from IHS/THP and/or VA facilityIHS/THP and/or VA facility

CMOP: Saves patients travel/wait time in CMOP: Saves patients travel/wait time in pharmacy & allows pharmacists more time to pharmacy & allows pharmacists more time to focus on patient carefocus on patient care

Additional Resources: Allows tribes/IHS to Additional Resources: Allows tribes/IHS to expand care for usersexpand care for users

Agreements allow for better coordination of Agreements allow for better coordination of carecare

Inpatient Care/Specialties: simplifies Inpatient Care/Specialties: simplifies appointments since the Veteran is within the appointments since the Veteran is within the VA systemVA system

Shortens access times for medical careShortens access times for medical care Increases access at VA facilities for other Increases access at VA facilities for other

VeteransVeterans

Initial funding (fy12-16) to support reimbursements

Workload capture by VA is vital to ensure VERA reimbursement funds in out years

Native American Veterans need annual “vesting” level visits to retain active user

status in VHA Coordination of care between systems

will maintain continuity of care for Veterans