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Veteran Community Care: Eligibility
Community Care Services
Jim Strickland is a Vietnam era Army veteran and nationally recognized expert on VA disability benefits who is also editor and webmaster of the popular VA Watchdog website. Jim writes extensively about VA and Social Security disability benefits. Jim is kind enough to answer questions from visitors on StatesideLegal.org here in Jim's Mailbag.
About Jim's Mailbag
Jim's Mailbag is a regular column where veterans, servicemembers, and family members can ask Jim Strickland their questions about VA and Social Security disability benefits. You can browse all of these Q&As here, and search the Jim's Mailbag archives for helpful answers. If Jim hasn't already addressed the questions you have, you can submit your own question.
(SEYMOUR) – Schneck Medical Center in Seymour has announced it is now a VA Community Care Network provider for Veterans.
The new network serves as the direct link between the Department of Veterans Affairs (VA) and Schneck healthcare providers. Optum, part of UnitedHealthcare, will manage the network and process claims on behalf of VA.
Schneck is honored to serve our Veterans, said Warren Forgey, President/CEO, Schneck Medical Center. W
“We feel a deep sense of privilege and honor as we partner with the Department of Veterans Affairs to help meet the healthcare needs of our local Veterans,” he added.
To be eligible, a Veteran must be enrolled in VAs patient enrollment system AND have an approved referral from VA for community care. The VA will provide a referral for a Veteran to receive community care when services are not available at a VA medical facility, an appointment is not available at a VA medical facility within a certain timeframe or the Veteran lives too far away from a VA medical facility.
This service is for veterans only. Caregivers and family members are not eligible.
For more information on the VA Community Care Network, call Schneck Patient Financial Services at 812-522-0411.
WOW! What a year so far! I am honored to serve as the President of the NC Chapter of HFMA. If anything the crazy year of 2020 thus far has taught me to appreciate your friends and family and our HFMA members are just that to me. It is my pleasure to serve you, and my sincere goal to continue to provide value to all of our members this year, just in a slightly different setting.
Our National Theme for 2020-2021 is Your Challenge, Our Mission. If ever a theme hit home, this one does to me. Your Board of Directors and I have spent many hours trying to determine how we can meet the challenges of this year and continue to provide the great education, networking, and overall experience which our members deserve. We feel the challenge, but if there is one thing I am certain of, we can rise to and above any challenge if we work as a team. If we’ve been able to juggle jobs in a new setting, becoming full-time teachers, babysitters, chefs, social directors, optum va community care much, much, more, we can do just about anything.
This year, my ask of membership is three-fold: be in patient, get involved, and speak-up. We need your creativity, we need your insights, we need your expertise and we will need your patience as we grow through the challenges. If we can do all these things together, we can come out stronger on the other end. That said, please send me your thoughts, ideas, and feedback at any time [email protected], I look forward to hearing from you all.
Veterans Choice Program Sunsets as Community Care Network Launches
On May 29, 2019 by Roni Falck
The U.S. Department of Veterans Affairs is shifting the way in which it works with non-Veterans Affairs (VA) providers to expand the provider network and improve customer service for veterans and timeliness of payments for providers.
Currently, clients may attend a non-VA program as part of the Veterans Choice Program. This program is expected to sunset on June 6 and be replaced by Community Care Networks (CCNs). CCNs, which are anticipated to launch later in June, will be managed by a separate contractor responsible for contracting and payments for community-based providers.
UnitedHealthcare/Optum will manage the Community Care Network for Minnesota and is currently in the process of developing its provider network. In preparation for the interim weeks, providers should complete Veteran Care Agreements as a stopgap measure to ensure proper reimbursement for services provided.
An FAQ has been developed with information accurate as of May 28. Updated information will be shared as soon as it becomes available.
I would like to be part of the Community Care Network but haven’t heard from UnitedHealthcare.
Providers who have not heard from UnitedHealthcare can email the mailbox below to optum va community care information about becoming part of the Community Care Network. [email protected]
How quickly will contracts be effective?
The roll out schedule is pending.
How will providers bill?
Claims will be filed electronically directly with UnitedHealthcare. Billing is a key function shifting to UnitedHealthcare from VA under this model.
When can payment be expected?
Unclear and no timeline is written in to contracts. Additional inquiries have been made.
Who will determine authorizations and eligible services?
The VA will continue to set authorizations/limits.
How can I get a Veteran Care Agreement?
Providers should reach out to VA contacts to receive the Veteran Care Agreement and ensure contracting is set to continue once Veterans Choice Programs end.
How long are Community Care Network contracts effective? Is annual renewal required?
Contract language suggests that the contracts are open-ended.
For current outstanding claims, should providers continue to work with the VA or will that shift to UnitedHealthcare?
All current outstanding payments will need to be resolved with the VA. UnitedHealthcare is not handling any backlog issues.
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2 Investigates: Veterans, health care providers outline problems with VA program for outside providers
ATLANTA — Veterans and health care providers are sounding off on a VA program designed to connect veterans with outside health care providers, complaining the authorization and payment process has led to veterans missing out on critical care. The Atlanta Veterans Administration Medical Center is now pointing to new leadership and plans to mitigate the issues that are also outlined in recent federal reports.
Valerie Rachel owns and operates Simplicity Healthcare in Riverdale. The home health care service is responsible for the in-home care of dozens of veterans, including a 91-year-old whose family recently moved him from metro Atlanta to Chicago.
That’s because he’d gone months without services. Rachel said it was tied to expired authorizations she couldn’t clear through the VA’s Community Care program. In other words, benefits the veterans are due are not being processed, causing lapses in services.
“(At) any moment, it can happen,” Rachel told Channel 2 investigative reporter Nicole Carr. " At any moment, because each month, we have to send them a list of our veterans that are … their authorizations are going to expire.”
The VA’s Community Care program gives veterans across the nation, including thousands here in Georgia, a way to connect with licensed health care providers outside of the VA system for both clinical and in-home care. The payment for those providers comes directly through the VA by way of a new private payment vendor: Optum. Optum is a part of United Healthcare Group.
But since the transition to Optum’s electronic processing system last fall, Rachel said she’s consumers energy automated bill pay to track authorizations the way she did prior to September. Rachel said the VA has continually allowed veteran authorizations to expire in recent months, citing administrative and technical delays through Optum’s online system.
It has become a race against the clock to provide care to veterans before their benefits expire. No authorization, which is also needed for government audits, means no payment and no way for Rachel to send her nursing staff into the veterans’ homes. Veterans like the 91-year-old client whose family just relocated him.
Delays have caused breaks in service for up to half a dozen veterans at bank of america allegiant credit card time or for Simplicity to render services without payment. All this happens while Rachel said she continues to get the runaround from the Atlanta VAMC.
“We was brought up in that generation where you don’t stop until you get what you need,” Rachel said when asked why she continues to work through the program. “Yes, it is tiring. And it’s hurtful. It is very hurtful emotionally; it’s breaking me down. But I have to keep going.”
Donna Bell is one of the veterans who described problems linked to the Community Care program with Carr. Bell, an Air Force veteran, has been fighting the system for the past six months to raise awareness about her own mental health clinician.
“He’s not been paid since September 2020,” Bell said. “And that’s that.”
Bell said she is grateful for her Tucker-based doctor because he has not discontinued her care. She said he’s connected to her through the Community Care program but, like Rachel, has struggled to process authorizations for Bell’s care since the VA transitioned to Optum.
“He has continued to give me treatment because he knows I need it. But it’s just a difficult process for any physician or therapist to go through because they’re not versed in this (new authorization process),” Bell said.
Rachel said nothing appears clear through the system, as it did prior to the transition.
“If it (authorization) is in a pending status, if it was denied . if it was denied, why it was denied . those systems are no longer in place,” Rachel said.
“So you can’t see anything?” Carr asked of the electronic portal.
“We can’t see anything,” Rachel said. “We can’t see anything. So it’s a combination, the new system and just leadership is not familiar (with it).”
“I think it’s a lack of training with the new system that was put santander consumer my account login place in September, along with new management and leadership, the changes and with the new system,” Rachel added. “No one has had a chance to adapt or learn.”
In its latest statement to Channel 2, the Atlanta VA Medical Center acknowledged challenges with the Air fryer oven walmart Care program, particularly as it relates to the veteran authorization processing. In a statement, the VAMC stated new leadership is mitigating the problems but did not specify how. It also indicated Bell’s doctor’s issue may be outside of its control.
“The Atlanta VA Health Care System has taken actions to improve community care including installing a new community care leadership team in October of 2020. One of the initiatives of optum va community care new leadership team has been a collaborative effort with community health nursing to develop an improved process for tracking home health referrals to ensure no authorizations inadvertently expire,” the statement read.
“Outside of emergencies, Veterans must have an authorization before receiving care from a community provider. Care can only be authorized with providers who are credentialed in the Community Care Network, which in our region is Optum (part of UnitedHealth Group). Unfortunately, VA is unable to pay for non-emergency care that was not pre-authorized. Information for community providers who wish to join the Community Care Network of Providers can visit the website https://provider.vacommunitycare.com or call 888-901-6613 for more information.”
The Atlanta VAMC also moved to immediately address issues tied to veterans whose names were provided by Channel 2.
Recent problems with community care
The problems veterans like Bell and providers like Rachel describe are well-known to the Government Accountability Office. By the time Rachel had filed a complaint with Congressman David Scott’s office late last year, the GAO released a study on worsening delays in its Community Care program, tying them to the VA appointment system and surging request for care during the pandemic and the Optum transition.
In another Channel 2 investigation last fall, whistleblowers from the Atlanta VAMC shared documentation showing more than 5,000 referrals that were outstanding for more than 30 days, and hundreds more that had been sitting for months.
Those whistleblowers suspected the delays were tied to Optum’s new fidelity bank and trust anamosa iowa and a lack of training with the private vendor for the Atlanta VAMC’s community care workers.
“In order for it to be fixed, it starts from the top,” one whistleblower said, wishing to remain anonymous.
In response to that report, the VA stated it’d revamped leadership and increased staffing. At the same time, it points to providers’ “fundamental misunderstanding of how the medical appointment scheduling and referral process works. Preventive care is routinely and appropriately scheduled three to six months – or even longer – in advance.”
“They are therapists and doctors. They’re not computer programmers,” said Bell. “They don’t know how to manipulate the system or, and they don’t get any guidance.”