Dear Urban Indian Organization Leadership:

Since 2012, the Department of Veteran Affairs (VA) has administered the Indian Health Services/Tribal Health Program (IHS/THP) Reimbursement Agreement Program (RAP). VA has a national agreement with IHS and individual agreements with Tribal Health Programs to cover reimbursement of Direct Care Services. The program allows eligible American Indian/Alaska Native (AI/AN) Veterans to receive care in a culturally sensitive setting without preauthorization or a copayment. The scope of services may include those provided as part of VA’s medical benefits package.

Pub. L. 116–260, §1113, the Consolidated Appropriations Act, 2021, amended Section 405 of the Indian Health Care Improvement Act (25 U.S.C. § 1645), by inserting the phrase “urban Indian organizations” (UIOs), which expands VA’s authority to enter into arrangements for the sharing of medical facilities and services to now include UIOs and allows their participation in VA’s Reimbursement Agreement Program. VA’s Office of Community Care is working to expand the program to included UIOs and is drafting the reimbursement agreement template, which is informed by our current agreement template.

For services, including outpatient hospital services and freestanding clinic services, VA proposes to reimburse UIOs using Medicare rates. This methodology is consistent with the reimbursement rates UIOs receive from Medicare, as well as rates VA pays our Community Care Network, serving the same population in the same geographic areas as UIOs.

For UIOs that operate a pharmacy, VA proposes to reimburse for medications on VA’s formulary, consistent with current agreements. VA proposes to adopt the same rates as THPs will be reimbursed. Consultation on pharmacy reimbursement rates was posted in the Federal Register on June 3, 2021 and was open for comment until July 5, 2021.

Please find attached a draft agreement template for your reference and review. VA values your input and will be holding a listening session on Friday, July 23rd, 2021, 2-3:30 p.m. (Eastern Time). Written responses or questions can be emailed to Kara Hawthorne, RAP manager, at

Thank you for partnering with VA to serve American Indian/Alaska Native

Best Regards,

/s/Elizabeth L. Brill MD, MBA, FACOG
Deputy Assistant Under Secretary for Health for Clinical Services

cc: IHS Office of Urban Indian Health
National Council of Urban Indian Health (NCUIH)

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Published on Jul. 8, 2021

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