Contracting: Understand different programs

Q. What are the different types of VA contracts?
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Tuesday, January 3, 2017

A. Most HME providers understand that the Department of Veterans Affairs provides healthcare services nationwide for America’s veterans and that in addition to having facilities across the country, the VA has additional methods to provide timely, high quality care to veterans.  

What providers may not understand is that there are three contracting options available to them. First is Patient-Centered Community Care (PC3), a program for active duty, retirees and their families, that increases access to health care services closer to their homes. PC3 is available through either TriWest or Health Net, based on the provider’s geographic location. This program increases the VA’s ability to provide specialty inpatient and outpatient health care services, along with behavioral health care, limited emergency care and newborn care services to enrolled veterans.

Next is the Veterans Choice Program (Choice Program or VCP), a supplemental program available to veterans that have not yet retired from the military. VCP is utilized when a veteran cannot obtain an appointment within 30 days or if the VA's closest medical facility is hard to access. The purpose of VCP is to provide healthcare services when the local VA health care facility cannot provide the services due to a lack of specialists and long wait times.  As with PC3, in order provide services under VCP, providers must establish a contract with either TriWest or Health Net.

Third, providers have the option to become a Non-VA provider by signing up with their local VA Medical Center to provide services to veterans when VA medical facilities cannot provide the necessary care. Non-VA providers are required to obtain preauthorization prior to treatment, except in cases of medical emergencies.

Regardless of which option a provider chooses, they will benefit from being able to serve America’s veterans while increasing revenues.

Steve Selbst is CEO-co-owner, Healthcents, Inc. Reach him at selbst@healthcents.com. Nicole Medina and Courtney Pollock, Executive Account Managers at Healthcents Inc. contributed to this article and may be reached at nmedina@healthcents.comand cpollock@healthcents.com