CIH Directive VERA CARA CIH Directive GETTING CIH

CIH Directive, VERA, CARA

CIH Directive GETTING CIH INTO THE MEDICAL BENEFITS PACKAGE VETERANS HEALTH ADMINISTRATION 1

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 3 rd, 2016 – Signed by Dr. Shulkin (USH) on May 24 th, 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/View. Publication. 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/Site. Pages/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 • • Acupuncture Meditation Tai Chi Yoga Massage for treatment Guided imagery Biofeedback Clinical hypnosis an be found here: http: //vaww. infoshare. va. gov/sites/O PCC/Site. Pages/IHCC-Approved. VETERANS HEALTH ADMINISTRATION CIH. aspx LIST II • • 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 Partner Supervisor – Yoga Instructor – Tai Chi Instructor – Health Coach developmental PD pending VETERANS HEALTH ADMINISTRATION

CARA: REQUIRED CIH Services VETERANS HEALTH ADMINISTRATION 8

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 9

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 11

VERA and Whole Health • Whole Health will be a new price category in VERA (category 4) – 6 -7 k 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 13

What Qualifies for a CIH/WH Visit? • Proposal to ARC: – CIH Specific CPT Codes –tracked independently of stop code/CHAR 4 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 CHAR 4 – 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 ~Q 3 – 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 CHAR 4 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%20 Docum ents/CIH%20 Coding%20 Guidance VETERANS HEALTH ADMINISTRATION

CHAR 4 M Name CHAR 4 Name ACUP Acupuncture MSGT Massage Therapy BIOF Biofeedback CDTC Expressive Arts NAHL Native American Healing CGQC Qi Gong PILA Pilates GIMA Guided Imagery PNTC Animal-Assisted Therapy 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 SCVT EVP Whole Health* EVP ACT (acceptance and commitment therapy)* SNVC EVP Mindful Movement* MBSR Mindfulness Based Stress Reduction (MBSR) TAIC Tai Chi MDTN Meditation TPHT Therapeutic or Healing Touch WCHC Whole Health Coaching WCEC YOGA Whole Health Education Yoga MMMT Mindfulness other than MBSR MPAT 18 Movement Therapy SCHC *can only be used with Empower Veterans Program (EVP) Pain Program