CIH Directive, VERA, CARA - PowerPoint Presentation

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CIH Directive, VERA, CARA

Getting CIH into the Medical Benefits Package

CIH Directive

1

Getting CIH into the Standard Medical Benefits Package

3 Steps to provide guidance and regulatory change

CIH Memo

Supports CIH implementation and will initiate vetting process for CIH services through the VEC and Integrative Health Coordinating Center (IHCC)

Signed by VEC Co-Chairs May 3

rd

, 2016

Signed by Dr.

Shulkin

(USH) on May 24

th

, 2016

Getting CIH into the Standard Medical Benefits Package

CIH Directive

–

Signed by USH May 2017

2

:

http://vaww.va.gov/vhapublications/ViewPublication.asp?pub_ID=5401

LIST I: evidence of promising or potential benefit

Evidence of promising or potential benefit

Vetted by IHCC Advisory Group

VA must provide a mechanism to offer these approaches either within the VA facility or in the community if they are

recommended by the Veterans health care team.

http://vaww.infoshare.va.gov/sites/OPCC/SitePages/IHCC-Approved-CIH.aspx

Getting CIH into the Standard Medical Benefits Package

CIH Directive

LIST II: Generally Considered Safe

Requires common knowledge, throughout the expert scientific community

Both internal and external to VHA

Reasonable certainty that it is not harmful under the conditions of intended use

Optional for inclusion in VA facility, depending on capability (staff/space) at sites

Approved CIH Approaches

LIST I

Acupuncture

Meditation

Tai Chi

Yoga

Massage for treatment

Guided imagery

Biofeedback

Clinical hypnosis

LIST II

Healing Touch

AcupressureAlexander TechniqueReflexologyReikiTherapeutic TouchEmotional Freedom TechniqueAnimal-assisted Therapy (under recreational therapy)

an be found here:

http://vaww.infoshare.va.gov/sites/OPCC/SitePages/IHCC-Approved-CIH.aspx

Getting CIH into the Standard Medical Benefits Package

Regulatory Change

Regulation incorporated into Benefits Handbook

CIH as part of the medical benefits package will be set in stone

NOTE: Wrapping 139 copay exemption into the regulation change

Ongoing Efforts to Help the Field Increase CIH services

Office of Community Care

Telehealth

Volunteer Services

Position Descriptions

Whole Health Partners

Whole Health Partner Supervisor

Yoga Instructor

Tai Chi Instructor

Health Coach developmental PD

pending

CARA: REQUIRED CIH Services

8

CARA 5 required CIH Approaches

5 required CIH approaches for flagship sites – to meet CARA legislation

AcupunctureChiropractic/osteopathic

Meditation/mindfulness

Tai Chi/Qigong

Yoga

9

VERA

11

VERA and Whole Health

Whole Health will be a new price category in VERA (category 4)

6-7k per veteranIn order to qualify for that category, a Veteran needs 10 CIH/WH visits

ARC Tracking CPT Codes:

13

What Qualifies for a CIH/WH Visit?

Proposal to ARC:

CIH Specific CPT Codes –tracked independently of stop code/CHAR4 codes

Hypnotherapy, chiropractic, biofeedback, acupuncture, massage, osteopathic

Non-specific CPT Codes – tracked only in association with either CIH/whole health stop code (139/159) or a CIH/whole health CHAR4

Track both count and non-count CIH/whole health clinics

**Note: Note titles will not be used for VERA tracking

What Qualifies for a CIH/WH Visit?

We will NOT have confirmation that ARC will used our proposed tracking mechanism for CIH/Whole health VERA reimbursement until ~Q3

ARC wants to run the data in the next 2 quarters to help make a final recommendation

Once they see the data, they will make a recommendation to the NLC and final determination for what qualifies for a CIH/WH visit will be made

Their decision at that point will be retroactive to Oct 1, 2017.

What Qualifies for a CIH/WH Visit?

ARC is open to our proposal, but two aspects are unprecedented:

VERA tracking with stop codes and CHAR4 codes

AND

VERA tracking data in non-count clinics

Note: Field may be tempted to try to use count clinics for their whole health model since VERA reimbursement is not typical for non-count clinics

however, the true WHS model includes non-licensed providers (e.g., WH partners, WH coaches, yoga instructors, etc.) which must use non-count clinics and ARC will only agree to track them if there are data in those clinics to track –

THEREFORE, we must encourage the field to stay true to the model!

Quick Reminder:

Business Infrastructure

Two CIH/Wellbeing Stop Codes

159 – Either position

CIH treatment

139 – Either position

Wellbeing approaches

Co-pay exemption regulatory change underway; Timeline 1-2 years

CHAR 4 codes

National Note Title – Integrative Health Note

https://vaww.infoshare.va.gov/sites/OPCC/Shared%20Documents/CIH%20Coding%20Guidance

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CHAR4 M

Name

ACUP

Acupuncture

BIOF

Biofeedback

CDTC

Expressive Arts

CGQC

Qi Gong

GIMA

Guided Imagery

HTFC

Whole Health Partner

HYPN

Hypnotherapy

IACT

BFA Technique (not regular Acupuncture)

IDHC

Integrative Health Consult

MANT

Mantram Repetition

MBSR

Mindfulness Based Stress Reduction (MBSR)

MDTN

Meditation

MMMT

Mindfulness other than MBSR

MPAT

Movement Therapy

CHAR4

Name

MSGT

Massage Therapy

NAHL

Native American Healing

PILA

Pilates

PNTC

Animal-Assisted Therapy

REIK

Reiki

RFLX

Reflexology

RLXT

Relaxation Techniques

SCHC

EVP Whole Health*

SCVT

EVP ACT (acceptance and commitment therapy)*

SNVC

EVP Mindful Movement*

TAIC

Tai Chi

TPHT

Therapeutic or Healing Touch

WCHCWhole Health CoachingWCECWhole Health EducationYOGAYoga

*can only be used with Empower Veterans Program (EVP

) Pain

Program