Background
In August, Congress passed and the President signed into law the Veterans Access, Choice, and Accountability Act. Among other elements, this new law requires the VA to establish procedures for veterans to get care outside the VA system under certain circumstances. This law was a reaction to the news that several VA facilities across the country were not meeting legally-mandated procedures (primarily appointment times) for providing treatment to veterans. It was determined that the VA system did not have the capacity to achieve its service delivery goals and that capacity outside the VA system should be tapped.
What is the PCCC Program?
The VA created the PCCC program to give veterans access to healthcare services, including mental health and SUD, outside the VA system when the VA did not have the capacity to treat those veterans. This program is not available to all veterans. Veterans only qualify when their local VA Medical Center:
- Lacks available specialists;
- Has a long wait time for an appointment (over 30 days); or
- Is an extraordinary distance from the veteran’s home (over 40 miles).
Who is Eligible to Provide Behavioral Health Services?
Only the following behavioral health providers are currently eligible to provide services under the PCCC program:
- Psychiatrists;
- Clinical nurse practitioners;
- Psychologists; and
- Licensed clinical social workers.
The VA has indicated a willingness to discuss adding providers to this list in the future, but for now, reimbursement is only available for the providers noted above. Additionally, providers of Evidence Based Therapies are required to have received specialized training and experience in the therapy.
How does the Program Work?
Here is a rough outline of the process for behavioral health providers to treat eligible veterans within the PCCC program. Please note that HealthNet is a VA contractor hired to handle many aspects of the PCCC program for the VA.
Becoming a Provider
- The provider signs a participation agreement with the VA (done through HealthNet).
- The provider becomes credentialed with the VA (via a credentialing application provided by HealthNet, which interfaces with CAQH).
- The provider receives an “on-boarding packet” from the VA containing contact information, program expectations, certain forms (see below), and other resources.
Identifying Qualified Veterans
- The VA identifies a veteran as eligible to receive community services.
- The VA identifies a community provider for that veteran based on the veteran’s clinical need and geographic location.
- HealthNet contacts the provider to schedule the initial appointment on the veteran’s behalf. Appointments must be scheduled within 14 days, and the veteran must spend no more than 20 minutes in the waiting room on the appointment date. Subsequent appointments are scheduled by the veteran.
- HealthNet faxes the provider a Provider Notification Packet once the initial appointment is scheduled that outlines the authorized services (providers will only be reimbursed for services that are authorized), including a date range and number of visits.
- The veteran must request an authorization for services from the VA (the provider cannot).
Treating Veterans
- To request additional services (beyond what’s detailed in the authorization for services), the provider must submit an Additional Sessions Request Form before all the sessions have been completed. If all session have been completed, the veteran must contact the VA for a new authorization (the provider cannot).
Medical Records and Claims Payment
- Medical documentation must be returned to HealthNet via fax before claims for those services are paid. Documentation provided by the VA states the following requirement: “Medical documents are expected within 10 days after the first visit and within 10 days after the last visit.” At a meeting discussing the PCCC program, a HealthNet representative stated that medical documents should be sent to HealthNet within 14 days of service provision.
- You can submit paper claims to HealthNet or submit electronic claims to Emdeon.
- The VA pays providers by check within 30 days of receipt of the claim (assuming the medical documents have also been provided). The VA is working on an electronic funds transfer system for these payments, but it is not available at this time.
Reimbursement Rates
Reimbursement rates are based on CMS PPS and Fee Schedules. They will be:
- 85% of the CMS maximum allowable by license level for social workers, psychiatric nurse practitioners, and psychologists; and
- 90% of the CMS maximum allowable for psychiatrists.
Other Issues
- Wrap-around services—If the veteran needs other services (not included in the authorization for services), the VA provides referrals to the community for those additional services.
- ID card—Veterans will not present a VA healthcare ID card when they show up for services.
- Copays—Veterans do not have copays, deductibles or cost-sharing.
- No shows—No entity can be billed for missed appointments (not veterans, the VA or HealthNet).
How do you Start the Process to Become a PCCC Provider?
E-mail your request for a provider agreement to Guss Riddles at HealthNet (a VA contractor for the PCCC program) at guss.riddles@healthnet.com. Please put “PCCC Contract Request” in the subject line of your e-mail. In the body of that e-mail, please list the following information:
- Name of the individual provider or group/practice name
- Tax ID number or SSN
- Practice address—if you have multiple locations, please use your main/corporate address
- Phone number for the individual/group/practice
- E-mail address—if it’s different than the sender address
Once your e-mail has been sent, you will receive a credentialing application and participation agreement to your designated e-mail address within 5 business days. The credentialing process typically takes 30-45 days to complete (on the VA’s end). HealthNet uses CAQH for credentialing.
More detailed information about the PCCC program can be found here.