Boise VA Medical Center

Boise VA Medical Center Veteran Service Organization ‘Officers Day’ December 3, 2010 Fee Basis

What is Fee Basis? A more accurate name would be NON-VA PURCHASED CARE

Non-VA Purchased Care • Is a program to manage and process all requests for Non-VA provided Health Care Services • In general, Veterans seeking health care should obtain treatment at VA facilities. Non-VA purchased care is generally only authorized when appropriate VA services and/or facilities are not available or cannot be economically provided to the veteran. • The use of Non-VA purchased care is NOT considered a permanent solution for veteran health care needs.

Programs Covered Include: • Outpatient Medical • Non-VA Hospital • Fee ID Card • Pharmacy • Dental • Emergent Care

Outpatient Medical • Must be ordered by your VA provider • MUST BE PRE-AUTHORIZED • Is for treatment of a specific condition with specified number of visits, tests or procedures • If Non-VA provider wants to do tests or procedures that are not included on the authorization they MUST contact your VA provider first!!

Non-VA Hospital • Much like the Outpatient Medical Program but only covers inpatient care • MUST BE PRE-AUTHORIZED • Emergent care in a community hospital can be pre-authorized under certain conditions: • Emergent care for a rated Service Connection condition, or condition determined to be adjunct to a Service Connected condition • Emergent care for any patient rated as Permanently and Totally disabled as a result of a Service Connected condition, or a veteran receiving House Bound, or Aid and Attendance

Emergent Care • VA must be notified within 72 hours of admission • Must meet the clinical definition of an emergency • Must accept transfer to a VA facility if VA is available

Fee ID Card • Entitles Service Connected veteran to seek routine care in the community at VA expense for their Service Connected conditions • Limited to $125 per month • Is a very limited program used for Service Connected patients who live long distances from VA care and are too disabled to travel to VA for care

Pharmacy • Fee ID card holders may obtain a 14 day supply of emergent medications, such as antibiotics for treatment of Service Connected conditions at their local pharmacy at VA expense

Dental • Eligibility for Dental care is limited • Non-VA Dental care is only authorized if ordered by a VA dentist

Unauthorized Emergent Care • Emergent treatment of a Service Connected or adjunct condition • Emergent treatment of any condition for a veteran rated as Permanently and Totally disabled as a result of a Service Connected condition • Veteran participating in the Vocational Rehab/Chapter 31 program • VA can only pay to the point of “stability”

Mill Bill • Veteran must meet ALL of the criteria: • Must be enrolled • Has been seen in VA in previous 24 months • Is not covered by health insurance • There is no 3rd party liability • Not eligible for payment under any other VA program • Veteran is financially liable • Meets the layperson definition of emergency

Mill Bill • Other Facts: • Claim can only be paid to the point of stability • Claims must be filed within 90 days of the date of service

Notes • The admission of a veteran to a non-Department of Veterans Affairs hospital at VA expense MUST be authorized in advance. In the case of an emergency which existed at the time of admission, an authorization MAY be deemed a prior authorization if an application (formal or in-formal) by telephone, telegraph or other means of communication is made by the veteran or by others in his/her behalf is dispatched to the VA within 72 hours of the admission.

Notes Continued • Payments by the VA shall be considered as payment in full and the provider may not impose any additional charge on a veteran or their health care insurer for any inpatient services for which payment is made by the VA.

Who Do I Call? • Boise Fee Call Center (208) 422-1252 • VIRS Coordinator *for weekdays (208) 422-1021 • AOD *for off hours and weekends (208) 422-1109

Boise VA Medical Center