June 1, 2016

Sgt. Shaft caricatureDear Sgt Shaft
Are the Veterans Service Organizations supporting the Veterans Choice healthcare program?

Lester G.
Via the internet

Dear Lester
I know that during a recent congressional hearing, The American Legion delivered written and oral testimony regarding access to healthcare through the Department of Veterans Affairs (VA).

Director of Veterans Affairs & Rehabilitation Lou Celli addressed members of the Senate’s Committee on Veterans’ Affairs, highlighting the Legion’s views on the Care Veterans Deserve Act of 2016.

If enacted, this Act would eliminate the VA’s Veterans Choice Program (VCP) termination date, expand program eligibility, and extend certain operating hours of VA pharmacies and medical facilities.

“We stated at the time and state here again today, that we never supported Choice becoming a permanent program,” Celli said. “The reason is because we know that VA already has every authority granted to it through Choice when it comes to providing contracted care to our nation’s veterans.”

The director also mentioned several contracting vehicles VA already had in place that allowed them to send veterans into their local communities for care, regardless of how far they live from the nearest VA facility. However, there are issues with outside providers not returning medical records in a timely fashion.

“This is an issue that The American Legion was very concerned about,” Celli said. “That was the main reason that the provision in the original act that required Choice contracted doctors to turn over the medical records before getting paid.”

Before concluding his testimony, Celli weighed the pros of the drafted legislation to improve and modernize the current VA disability claims appeals process. “This new proposed process requires congressional approval and will ultimately save money. We’ve done our part – now it’s your turn,” he added.

To see the Legion’s written testimony in its entirety, visit the legislative center http://www.legion.org/legislative/testimony/232825/pending-veterans-affairs-legislation.


Shaft Notes
The Department of Veterans Affairs (VA) is proposing a rule to grant full practice authority to Advanced Practice Registered Nurses (APRN) when they are acting within the scope of their VA employment. Full practice authority will help optimize access to VA health care by permitting APRNs to assess, diagnose, prescribe medications and interpret diagnostic tests. This action proposes to expand the pool of qualified health care professionals authorized to provide primary health care and other related health care services to the full extent of their education, training, and certification to Veterans without the clinical supervision of a physician.

APRNs are clinicians with advanced degrees and training who provide primary, acute and specialty health care services. APRNs complete masters, post-master or doctoral degrees. There are four APRN roles: Certified Nurse Practitioner, Clinical Nurse Specialist, Certified Registered Nurse Anesthetist and Certified Nurse Midwife. All VA APRNs are required to obtain and maintain current national certification.

“The purpose of this proposed regulation is to ensure VA has authority to address staffing shortages in the future,” said VA Under Secretary for Health Dr. David J. Shulkin. “Implementation of the final rule would be made through VHA policy, which would clarify whether and which of the four APRN roles would be granted full practice authority.At this time, VA is not seeking any change to VHA policy on the role of CRNAs, but would consider a policy change in the future to utilize full practice authority when and if such conditions require such a change,” Shulkin said. “This is good news for our APRNs, who will be able to perform functions that their colleagues in the private sector are already doing.”

The American Nurses Association (ANA) applauds VHA’s leadership for proposing to grant full practice authority to the four types of Advanced Practice Registered Nurses. “VA will be able to more effectively meet the health care needs of our nation’s Veterans,” said ANA President Pamela Cipriano. “This proposal removes barriers that prevent APRNs from providing a full range of services and will assist VA in its ongoing efforts to address staff shortages and improve Veterans’ access to care. APRNs are critical members of the health care workforce and an integral component of the health care delivery system with a proven track record of safe quality care and high patient satisfaction.”

The proposed rule can be found for comment at www.regulations.gov.


To enhance Veterans’ access to care and eliminate delays in Choice provider payment, the Department of Veterans Affairs (VA) is eliminating administrative burdens placed on VA community providers. Previously, payments to Choice providers were not allowed until a copy of the Veteran’s medical record was submitted. Now, community providers, under the Choice program, will no longer be required to submit medical records prior to payment being made. To facilitate the change, VA has modified the Choice Program contract, making it easier for Health Net and TriWest to promptly pay providers.

VA continues to require pertinent medical information be returned to ensure continuity of care; however, it is no longer tied to payment. VA is taking these steps to more closely align with industry standards.

“This administrative step just makes sense,” said VA Under Secretary for Health Dr. David J. Shulkin. “It ensures Veteran access, timely payments and strengthens our partnerships with our Choice providers. We know that providing Veterans access to high-quality, timely healthcare would be impossible without collaboration with our community providers.”

VA’s Plan to Consolidate Community Care Programs outlines additional solutions to improving timely provider payment. VA is moving forward on two paths to further improve timely payment.  First, VA is working toward a single community care program that is easy to understand, simple to administer and meets the needs of Veterans, community providers and VA staff.  Secondly, VA plans to pursue a claims solution that moves to a more automated process for payment. VA envisions a future state where it is able to auto-adjudicate or process a high percentage of claims, enabling the Department to pay community providers promptly and correctly, while adopting a standardized regional fee schedule to promote consistency in reimbursement.

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