Department of Veterans Affairs Memorandum Date: October 1, 2015 From: Acting Principal Deputy Under Secretary for Health (10A) Subj: VA Care in the Community (Non-VA Purchased Care) and use of the Veterans Choice Program To: Veterans Integrated Service Network (VISN) Directors (10N1-23) 1. The Veterans Health Administration’s (VHA) objective is to provide high quality care in a manner that maximizes service to Veterans while ensuring good financial stewardship. This memorandum modifies the May 12, 2015 memorandum of the same title by removing limitations on the use of VA Care in the Community beginning in FY 2016. The Veterans Choice Program (VCP) should be the primary mechanism available when patients are waiting for care or need care VA cannot provide. However, if the service under VCP is not available or the Veteran is not eligible for VCP, this memorandum provides mandatory guidance on the utilization of various options available for providing VA Care in the Community (Non-VA Purchased Care). 2. Hierarchy for Purchased Care: The following hierarchy of care must be used when the Veteran’s primary Department of Veterans Affairs (VA) medical facility cannot readily provide needed care to a Veteran, either because the care is unavailable at the primary medical facility or because the primary medical facility cannot meet VHA’s timeliness standard based on the clinically indicated date. When care cannot be provided in a VA facility within required timeliness standards, the Veteran’s primary medical facility will: a) Refer to another VA medical facility using usual interfacility referral patterns, or Department of Defense (DoD), Indian Health Service (IHS), or Tribal Health Facility in accordance with the terms of the applicable agreement, if that facility can accommodate the patient within the specified timeliness standards. If a referral VA medical facility can schedule the service within VHA’s timeliness standard, the patient is not eligible for VA Care in the Community. A “usual” referral facility means that the VA medical facility is the primary location for this type of care, is staffed to accommodate the referrals, and the primary medical facility usually sent this service to the referral medical facility prior to VCP. Page 2. VA Care in the Community (Non-VA Purchased Care) and use of the Veterans Choice Program b) Facilities may make exceptions to this referral rule when the service is not offered in the primary facility and it was normally sent out in the community prior to VCP or there is a wait list at the referral medical facility. The primary facility should refer the Veteran to Care in the Community using VCP. This would be accomplished using the Choice First business processes. c) If the Veteran’s primary medical facility cannot secure care from another VA medical facility as specified in 2a, the primary medical facility will refer the Veteran to VCP when the needed services are covered by the program. This would be accomplished using established Choice First business processes for care not available or an infinite wait in the primary medical facility. d) If the Veteran is not eligible or the needed services are not covered by VCP, the primary facility may utilize other VA Care in the Community options, pending availability of local funds. Local facility leadership must make this determination. e) If the Veteran is eligible for VCP, but elects not to use the program, then the medical facility should either schedule an appointment in VA, use the recall reminder system, or place the patient on the EWL, consistent with VHA policy. In rare circumstances, the facility may use Care in the Community options to secure care, pending availability of local funds, when the Veteran elects not to use VCP. Local facility leadership must make this determination. f) If VCP care is authorized, but the VCP contractor returns the authorization, the primary facility may use other VA Care in the Community options, pending availability of local funds, until the VCP provider agreement option is available later in FY 2016. g) Medical facilities may continue to use radiation oncology services acquired through an existing contract or sharing agreement where those services are integral to the oncology program at the VA medical facility. If no existing contract or sharing agreement that are integral to the VA medical facility oncology program exists, these services should continue to be sent to VCP. 3. New/Renewal of Local Contracts and Sharing Agreements: At this time, no new agreements or renewals of existing local contracts and local sharing agreements should be implemented for the purchase of services covered by VCP or national contracts. Affiliation agreements or contracts for direct care services provided on-site at a VA facility are allowed, as are sharing agreements where VA clinicians are providing care in non VA facilities. Contracting officers should examine these requirements before awarding new contracts or exercising option years. Exceptions may be granted only in urgent circumstances as determined by the Deputy Under Secretary for Health for Operations and Management (DUSHOM). Page 3. VA Care in the Community (Non-VA Purchased Care) and use of the Veterans Choice Program 4. The provisions in this memo must be strictly enforced. VISNs/facilities who do not follow the hierarchy and incur costs for VA Care in the Community outside of the guidelines will be required to use operating funds from the medical services account to cover the expense. 5. Questions regarding this memo may be directed to the Chief Business Office at 202-382-2500 or sent to the following Outlook email address CBOPCNVCHierarchy@va.gov. James Tuchschmidt, MD cc: Chief Business Office (10NB) VISN Business Implementation Managers (BIMs)