CIH Directive, VERA, CARA

CIH Directive, VERA, CARA

CIH Directive GETTING CIH INTO THE MEDICAL BENEFITS PACKAGE VETERANS HEALTH ADMINISTRATION 2

Getting CIH into the Standard Medical Benefits Package 3 Steps to provide guidance and regulatory change 1. 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 3rd, 2016 – Signed by Dr. Shulkin (USH) on May 24th, 2016 VETERANS HEALTH ADMINISTRATION

Getting CIH into the Standard Medical Benefits Package 2. 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 VETERANS HEALTH ADMINISTRATION

Getting CIH into the Standard Medical Benefits Package 2. 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 VETERANS HEALTH ADMINISTRATION

Approved CIH Approaches LIST I LIST II Acupuncture Meditation Tai Chi Yoga Massage for treatment Guided imagery Biofeedback Clinical hypnosis an an be be found found here: here: http://vaww.infoshare.va.gov/sites/O http://vaww.infoshare.va.gov/sites/O PCC/SitePages/IHCC-Approved-CI PCC/SitePages/IHCC-Approved-CI H.aspx VETERANS HEALTH ADMINISTRATION H.aspx Healing Touch Acupressure Alexander Technique Reflexology Reiki Therapeutic Touch Emotional Freedom Technique Animal-assisted Therapy (under recreational therapy)

Getting CIH into the Standard Medical Benefits Package 3. 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 VETERANS HEALTH ADMINISTRATION

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 VETERANS HEALTH ADMINISTRATION

CARA: REQUIRED CIH Services VETERANS HEALTH ADMINISTRATION 9

CARA 5 required CIH Approaches 5 required CIH approaches for flagship sites – to meet CARA legislation – Acupuncture – Chiropractic/osteopathic – Meditation/mindfulness – Tai Chi/Qigong – Yoga VETERANS HEALTH ADMINISTRATION 10

VA Provider Places Wellbeing Program Consult Wellbeing Program Orientation Overview of Program, Provider Bios, PHI/PHP Opportunity, Baseline Measures, Consult Closure Wellbeing Program Services Wellbeing/CIH Services Tracks

VERA VETERANS HEALTH ADMINISTRATION 12

VERA and Whole Health Whole Health will be a new price category in VERA (category 4) – 6-7k per veteran In order to qualify for that category, a Veteran needs 10 CIH/WH visits VETERANS HEALTH ADMINISTRATION

ARC Tracking CPT Codes: VETERANS HEALTH ADMINISTRATION 14

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 VETERANS HEALTH ADMINISTRATION

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. VETERANS HEALTH ADMINISTRATION

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! VETERANS HEALTH ADMINISTRATION

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%20Docum ents/CIH%20Coding%20Guidance VETERANS HEALTH ADMINISTRATION

CHAR4 M Name CHAR4 Name ACUP Acupuncture MSGT Massage Therapy BIOF Biofeedback NAHL Native American Healing CDTC Expressive Arts PILA Pilates CGQC Qi Gong PNTC Animal-Assisted Therapy GIMA Guided Imagery HTFC Whole Health Partner REIK Reiki HYPN Hypnotherapy RFLX Reflexology RLXT Relaxation Techniques 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 SCHC EVP Whole Health* SCVT EVP ACT (acceptance and commitment therapy)* SNVC EVP Mindful Movement* TAIC Tai Chi TPHT Therapeutic or Healing Touch WCHC Whole Health Coaching WCEC YOGA Whole Health Education Yoga 19 *can only be used with Empower Veterans Program (EVP ) Pain Program