Miguel H. LaPuz, MD, MBA
Assistant Under Secretary for Health
for Integrated Veteran Care

Each year VA publishes an updated VA Fee Schedule (VAFS) that establishes reimbursement rates for community providers that are used in certain circumstances. This year, the VAFS yearly update cycle has been adjusted to ensure rate-setting includes comprehensive data from additional industry sources. To accommodate this change, the existing 2022 VAFS rates will apply to service dates through Jan. 31, 2023. Beginning Feb. 1, 2023, the new VAFS rates will cover services through Jan. 31, 2024.  

VA reimburses medical services, hospital care and extended care services up to the maximum allowable rate. The maximum allowable reimbursement rate is generally the applicable rate published by the Centers for Medicare and Medicaid Services (CMS). When there is no CMS rate available, VA reimburses the lesser of VAFS or billed charges. 

VA continues to reevaluate reimbursement methodology for community providers to ensure maximum allowable VAFS rates are consistent with industry reimbursement benchmarks and that most services have maximum allowable rates. Reimbursement rates are subject to change. 

The VA Formulary Advisor search tool has been re-launched with a new public web address: www.va.gov/formularyadvisor. The tool helps VA and community providers look up VA national formulary information. 

Since it was launched, the site has evolved from a simple reproduction of the traditional VA formulary spreadsheet into a comprehensive formulary resource. It now includes additional filtering options, access to criteria for use and clinical guidance documents, urgent/emergent formulary status, and options to view potential formulary alternatives for non-formulary items.  

Users can enter a medication name in the search field and select whether to filter by VA Formulary items only, Urgent/Emergent Care Formulary items only, or all items in the database. In addition to searching by drug name, users can search by VA class (number or description), or Therapeutic Class/VA Parent Class by using the corresponding filters above the search box. A glossary is also available. 

VA will expand PACT Act Toxic Exposure Screening (TES) access points to physicians, osteopathic doctors, advanced practice nurses, and physician assistants with clinical privileges. This expansion will streamline TES into one encounter reducing the backlog of Stage 2 clinical reminders. 

VBA will prioritize benefit applications for terminally ill Veterans, and facilities should consider terminally ill Veterans early to better support Veterans and their families. Facilities have flexibility to effectively address the needs of local Veterans and should consider expanding screenings to other high-demand services including mental health after Jan. 17. Staff should remind Veterans all TES are conducted only at VA. 

All screening staff must complete TES training. This training is mandatory for physicians, registered nurses, advanced practice nurses, psychologists, and social workers and is available at WRIISC MOD 1-Assessing Deployment-Related Environmental Exposures (TMS ID 33195). 

HSRM Receives New Enhancements in
Releases 18 and 19  

Several enhancements were made to HealthShare Referral Manager (HSRM) when releases 18 and 19 were rolled out in November 2022. The updated system is available for all VA end users. To learn more about the updated features and additional information, refer to the Release 19.0 Release Notes and Release 19.0 Quick Reference Guide.  

For full functionality guidance in HSRM, refer to the HSRM End User Guide and HSRM Quick Reference Guide. 

Course: Access 101 - Fundamentals of Access Principles provides a high-level overview of Veteran access to care and related principles. The course also covers VHA’s commitment and how you play a role in maintaining and improving access to care for Veterans and beneficiaries. (TMS ID VA 4637203)