VA Office of Rural Health

1. VA Office of Rural Health Gina L. Capra, MPA Director, Office of Rural Health (ORH) Office of the Assistant Deputy Under Secretary for Health (ADUSH) for Policy and Planning Veterans Health Administration (VHA)/Department of Veterans Affairs (VA)

2. Today’s Presentation • Mission and Overview • Demographics and Needs • Focus and Resources • Environment and Collaborations

3. Mission of the Department of Veterans Affairs (VA) “…to care for him who shall have borne the battle and for his widow and orphan…” - Abraham Lincoln, 1865 Photo by Jeff Kubina

4. Department of Veteran Affairs (VA)Mission, Core Values & Characteristics VA Mission: “…to care for him who shall have borne the battle and for his widow and orphan…” VA Core Values: “I CARE” - Integrity, Commitment, Advocacy, Respect & Excellence VA Characteristics: Trustworthy, Accessible, Quality, Innovative, Agile and Integrated

5. What is the Department of Veterans Affairs (VA)? • Established in 1930 • Elevated to Cabinet level in 1989 • Federal government’s 2nd largest department after the Department of Defense • Three components: • Veterans Health Administration (VHA) • Veterans Benefits Administration (VBA) • National Cemetery Administration (NCA)

6. Veterans Health Administration (VHA) Mission Honor America’s Veterans Provide Exceptional Health Care Improve Health and Well-being

7. VHA is the Largest Integrated Health Care Systemin the United States 151 Hospitals 995 Outpatient Clinics (Hospitals, Community, Independent and Mobile ) 135 Community Living Centers 300 Readjustment Counseling Centers Vet Centers 103 Domiciliary Resident Rehabilitation Treatment Programs

8. 21 Veterans Integrated Service Networks

9. Eligibility for VHA Healthcare • Eligibility for VHA health care services depends on a number of qualifying factors, including: • The nature of a veteran’s discharge from military service (e.g., honorable, other than honorable, dishonorable) • Length of service • VA adjudicated disabilities (commonly referred to as “service-connected disabilities”) • Income level • Available VA resources

10. Who is eligible for VHA Healthcare? Veteran eligibility for VA healthcare is based on category group (“Priority Enrollment Group”) • Category Group 1 Veterans with service-connected disabilities rated 50% or more disabling • Category Group 2 Veterans with service-connected disabilities rated 30% or 40% disabling • Category Group 3 POWs, Purple Heart recipients, those rated 10% or 20% disabled, or those eligible under Title 38, U.S.C., Section 1151 • Category Group 4 Veterans who receive aid and attendance or housebound benefits or are catastrophically disabled • Category Group 5 Veterans whose income and net worth are below established VA thresholds of $31K - $46K annually, (depending on family size), those on VA pension and/or are eligible for Medicaid benefits • Category Group 6 WW I, Mexican Border War Veterans, disorders associated with exposure to herbicides (Agent Orange) while serving in Vietnam, exposure to ionizing radiation in Hiroshima and Nagasaki, Gulf War illness. • Category Group 7Veterans who pay co-payments with income and/or net worth above the VA threshold • Category Group 8Veterans who agree to pay specified co-payments with income and/or net worth above the VA threshold and HUD geographic index who were enrolled before January 2003. Income requirements may change from year to year.

11. Population Served ■ Rural Area: Any non-urban or non-highly rural area. ■ Highly Rural Area: Any areas in counties having < 7 civilians per square mile. U.S. Population Density, 2011 • Of 8.3 million enrolled Veterans, 3.1 million enrolled Veterans live in rural/highly rural areas • 22 million Veterans nationwide6.1 million Veterans living in rural areas • 36% of total enrolled Veteran population live in rural/highly rural areas • About one-third (31 percent) of Operation Enduring Freedom and Operation Iraqi Freedom (OEF/OIF) users of the VA Health Care System in FY12 reside in rural or highly rural areas. Enrolled Veteran Population Density, FY 2010

12. How are rural communities (and Rural Veterans) unique? • Status/Health Equity • Older, sicker, and poorer population • Options for integrated health care and coordination • Primary and Specialty Care • Mental Health Care • Healthcare Workforce • Geography/Transportation • Longer travel distances to receive care • Lack of public transportation • Limited internet/broadband connectivity

13. Rural Veterans’ Most Common Outpatient Diagnoses • High Blood Pressure • Post-Traumatic Stress Disorder(PTSD) • Type II Diabetes • Depressive Disorder • High Blood Cholesterol • At least 1 service-connected disability

14. VHA Office of Rural Health (ORH) • The VHA Office of Rural Health (ORH) was created by Congress in 2007 under Public Law 109-461, Sec 212 • Mandated to work across VA to develop policies, best practices and lessons learned to improve care and services for enrolled rural and highly rural Veterans • ORH falls under the VHA Assistant Deputy Under Secretary for Health (ADUSH)for Policy and Planning

15. Office of Rural Health (ORH) Mission Improve access and quality of care for enrolled rural and highly rural Veterans by developing evidence-based policies and innovative practices to support their unique needs. 3-Pronged Approach: • Promote best practices for maximum impact: Innovative pilots  study and analyze  spread best practices. • Build parternships and collaborations: Engage with VA program offices, Federal and state partners, Veteran Service Organizations and rural health communities to effectively utilize resources. • Bridge operations and policy: Leverage lessons learned to inform policy and contribute to measurable impacts.

16. Office of Rural Health (ORH) VHA Assistant Deputy Under Secretary for Health for Policy and Planning Secretary’s Veterans’ Rural Health Advisory Committee (VRHAC) ORH Director Veterans Rural Health Resource Centers (VRHRCs) ORH Deputy Director VRHAC Program Analyst Staff Assistant Budget Analyst VRHRC Western Region VRHRC Central Region VRHRC Eastern Region 4 Program Analysts Health Systems Specialist Staff Assistant VISN Rural Consultants (VRCs) Full-Time 10 Positions Funded VISNs 6, 7, 9, 11, 12, 15, 16, 17, 19, 21 Part-Time/Collateral Duties 11 Positions VISNs 1, 2, 3, 4, 5, 8, 10, 17, 18, 20, 22, 23 16

17. Office of Rural Health Components • Veterans’ Rural Health Advisory Committee (VRHAC) • Federal advisory committee to advise the Secretary of Veterans Affairs on health care issues affecting enrolled Veterans residing in rural areas • Veterans Rural Health Resource Centers (VRHRCs) • Three regional centers: Gainesville, FL; Iowa City, IA; Salt Lake City, UT • Serve as rural health experts • Field-based clinical and education laboratories for VA demonstration projects/pilot projects • Provide programmatic support and technical assistance to funded VA partners • Veterans Integrated Service Network (VISN) Rural Consultants (VRCs) • Serve as primary interface between ORH and VISN rural activities and projects • Develop rural health service plans based on VISN-wide needs assessments • Facilitate information sharing across the 21 VISNs • Perform outreach to develop community relationships • Office of Rural Health (ORH) Central Office • Provides national leadership on issues pertaining to rural veterans • Administer special purpose appropriation and resources • Provides technical assistance, project monitoring and performance analysis functions • Coordinates IHS-VA MOU to promote access for American Indian/Alaska Native Veterans

18. Location of ORH Veterans Rural Health Resource Centers Central Region Iowa City, IA Western Region Salt Lake City, UT • Eastern Region Resource Center’s focus • Clinical Telehealth, workforce development, GIS • Central Region Resource Center’s focus • Big Data Analysis, Women’s Health, Treatment adherence • Western Region Resource Center’s focus • Native American Veterans, Geriatric Care VA and Community Outreach 1 2 3 ORH Washington, DC Eastern Region, Gainesville, FL

19. Collaborate to increase service options Measure, evaluate, and document impact of best practices Identify, recruit and retain rural health care professionals Use emerging studies and analyses to improve care Educate and train VA and non-VA providers Use emerging health information technologies ORH STRATEGIC FOCUS AREAS

20. ORH Priorities – FY 2013

21. Project Focus Areas – FY 2013

22. ORH Communications ORH Publications • “The Rural Connection” Quarterly Newsletter • Research Briefs • Monthly Fact Sheets • Website, www.ruralhealth.va.gov Dissemination Strategies • “Push” dissemination to email contacts (> 3,000 internal and external to VA) • Publish articles in VA, Veteran Service Organizations (VSO), and other rural health publications (ex. National Rural Health Association e-newsletter and Rural Roads magazine) • Leverage the VA social media channels and VAntage Point blog • Present at national meetings • Conduct ORH-sponsored webinars and broadcasts through My VeHU(VA eHealth University)

23. FY14: Eye on the Environment • Population Migration, Demographics and Definitions • Affordable Care Act Implementation • Rural Economies and Service Markets • Outreach, Coordination and Collaboration • Workforce Development • Technology Impact • Effective Use of Resources

24. Affordable Care Act and VA • Since the Affordable Care Act’s (ACA) enactment, VA has been proactive in working to understand the law’s impact on Veterans, other beneficiaries, and VA’s health care system and in preparing for implementation of the law. • The most significant provisions of the ACA are the individual mandate requirement, which requires most individuals to have health insurance coverage and the Medicaid expansion provision, which expands Medicaid eligibility to up to 138% of the Federal Poverty Level. • The individual mandate is a provision that requires all individuals to have minimum essential insurance coverage or face a tax penalty. • Enrollment in VA health care, CHAMPVA or Spina Bifida programs meet the minimum essential coverage requirement. • Veterans or other beneficiaries currently enrolled in VA health care do not have to take any additional steps to comply with the health insurance requirement outlined in ACA. • Veterans and other eligible beneficiaries not currently enrolled in VA health care can apply for enrollment at any time.

25. Collaboration and Communication Leverage collaborations, communications and coordinated efforts to seize strategic opportunities and improve efficiencies in service to rural Veterans and their families.

26. Additional Resources:ORH Website www.ruralhealth.va.gov

27. Thank You for Your Service

28. Questions? Ideas? Contact Information For additional information, please contact: Gina L. Capra, MPADirector, Office of Rural Health Gina.Capra@va.gov (202) 461-1884 (direct) (202) 461-1681 (main line) • VHA Office of Rural Health1722 Eye St, NW, Suite GL16Washington, DC 20006-3710