Dear Tribal Leader:

The Department of Veterans Affairs (VA) is writing to facilitate a tribal consultation to improve health care access for Veterans by re-issuing the VA Reimbursement Agreements.

VA held two listening sessions on December 16th, 2021, and January 13, 2022, and received written comments through February 13, 2022, regarding VA’s Reimbursement Agreement Template. The purpose was to gain comments on expanding the Indian Health Service/Tribal Health Program (IHS/THP) Reimbursement Agreement Program (RAP) to adopt Purchase Referred Care (PRC) and contract travel. VA received many comments from both IHS and THP representatives, and as a result, we have developed a new draft Reimbursement Agreement template for discussion.

VA would like to invite tribal leaders (or their representative designees) to provide feedback and comments on a draft template to assist in finalizing the THP Reimbursement Agreement template for the lower 48 states. We are seeking consultation on the Agreement template in its entirety, and specifically regarding the topics below:

  1. VA endeavors to make THP billing for PRC as easy as possible and heard from several stakeholders the preference for monthly billing submissions. VA proposes monthly billing submission to include a cover letter and excel spreadsheet with the THP facility information and claims information with associated EOBs or similar documentation attached showing proof of THP payment. Facilities would electronically submit those using VA’s g-invoice or e-Invoice system, which conforms to the X12 electronic data interchange (EDI).
    • Would THPs have technical issues invoicing VA for PRC as proposed? If so, what alternative approach do you propose that would be consistent with submitting invoices and attached document as proof of payment for PRC.
  2. Both Medicare and Medicaid pay providers separately from the IHS All Inclusive Rate (AIR) for certain outpatient services when not billed with a clinic visit.
    • Do THPs or IHS facilities have recommendations on services that should be excluded from the IHS AIR reimbursement and paid at Medicare Fee for Service rates instead? What is the rational for proposal?

Please find attached a draft agreement template for your reference and review. An in-person consultation is scheduled for Tuesday, September 27, 2022, between 4:30 pm and 6:00 pm (Eastern Time) at the Hyatt Regency Washington, 400 New Jersey Ave NW, Washington, DC 20001, hosted by the National Indian Health Board.

Additionally, a virtual listening session is scheduled for September 30th, 2022, between 1:00 – 2:00 p.m. (Eastern Time). Access the session to participate.

Written comments may be submitted via email by September 30, 2022. For additional information regarding this effort, please contact Kara Hawthorne.

We look forward to meeting with you and we appreciate your support as we move forward together to enhance and improve the healthcare experience for our American Indian/Alaska Native Veterans.

Best Regards,

Miguel H. LaPuz, MD, MBA
MBA Assistant Under Secretary for Health for Integrated Veteran Care


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Published on Aug. 12, 2022

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