Hospice Council of West Virginia

The Hospice Council of West Virginia is a 501 C(3) status corporation which exists solely to promote the hospice care concept in the state of West Virginia.

HOSPICE CARE FOR VETERANS

VA Hospice Care Policy Overview

Points of Contact for Veterans Affairs Medical Centers
in West Virginia

VA Prescriptive Authority and Collaboration with
Community Hospice Programs
Frequently Asked Questions


VA Hospice Care Policy Overview

  1. What is VA's responsibility in terms of offering hospice and palliative care to enrolled veterans deemed appropriate for such care?

    1. Handbook 1140.5 states VA is to "offer(s) to provide or purchase needed hospice and palliative care services for all enrolled veterans, whether these services are needed in an inpatient setting or in the homeHospice and palliative care is a covered benefit for all enrolled veterans, on par with all other medical services included in the Medical Benefits Package (Code of Federal Regulations (CFR) 17.38(a)(1)(xi)A).

  2. If a veteran has Medicare, does VA have to offer to purchase or provide hospice and palliative care to enrolled veterans requiring such?

    1. Veterans have the choice of payer and as outlined in Handbook 1140.5 this "Veteran choice of payer applies even if the veteran is eligible for hospice under Medicare or Medicaid." Veterans are to be informed about their choices of payer and the implications. When VA is payer, veterans may be liable for the outpatient co-payment (e.g. Priority Groups 7 & 8) whereas when Medicare is payer, community hospice programs typically waive the small Medicare Hospice Benefit co-payments.
      "Veterans who choose Medicare retain their eligibility for VA care and benefits.  NOTE:  Veterans need to be notified that VA has no authority to pay for any balances or co-payments that may be due after Medicare or any other non-VA source makes payment for hospice care." 

  3. Under what statutory authority does VA pay for community hospice care?
    1. VA purchases hospice care from community providers under the authority of 38 United States Code (U.S.C.) 1720C (Alternatives to Institutional Care). "Hospice and palliative care is included in VA's Medical Benefits Package on par with other inpatient and outpatient covered services (38 CFR 17.36 and 17.38)."   Although VA does not use Fee Basis statute 38 USC 1703 to authorize the purchase of hospice care, VA relies on the fee package accounting system to process placements and payments.
  1. Does a veteran need to have a service connected condition in order for VA to offer to purchase or provide hospice care in the community or a VA facility?

    1. No, Handbook 1140.5 states "all enrolled veterans are eligible for a comprehensive array of needed in-home services.  These services in VA's Medical Benefits Package,including hospice and palliative care, are playing an increasingly important role in VHA's integrated health care delivery system (CFR 17.38(a)(1)(xi)A)." Service connected status or the lack thereof does not alter the eligibility for VA hospice and palliative care.
  1. If a VA facility offers to provide inpatient hospice care, does this eliminate the need to offer to purchase or provide home hospice care for veterans who desire and are appropriate for such home care?

    1. No, VHA Directive 2003-008 states, "VA must offer to provide or purchase hospice care that VA determines an enrolled veteran needs; this includes inpatient and home hospice care.  (38 CFR 17.36 and 17.38)."
  1. Is there a mechanism to garner eligibility for Priority Group 8 veterans in order for VA to offer to purchase or provide hospice and palliative care?

    1. Yes, VHA Directive 2004-067 Catastrophically Disabled Veteran Evaluation outlines the procedure for the "placement of eligible veterans determined to be catastrophically disabled in to Priority Group 4" through approval by the facility Chief of Staff.
  1. May the VA refer enrolled veterans to community hospice programs for charity care?

    1. No, it is not appropriate to refer enrolled veterans to community hospice programs to receive charity care, as outlined in the May 25, 2005 memo from the Deputy Under Secretary for Health for Operations and Management.
      VHA Directive 2003-008:  "...if a veteran in need of hospice care is not eligible for this care through a non-VA source or chooses to receive this care from VA, needed hospice care services are to be provided or purchased by VA."

For questions, please contact Scott T. Shreve, DO, National Director of Hospice and Palliative Care via email at Scott.Shreve@med.va.gov or phone a t 717-228-5946

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Points of Contact for Veterans Affairs Medical Centers
in West Virginia


VISN

Program Manager

Local VA Palliative Care POC

4

Denise Stahl, MSN
Denise.Stahl@va.gov
(412) 954-4946

Clarksburg VAMC

Kathy Ellis, RN
Kathy.ellis@va.gov
(304) 623-3461

5

Vivian Mathews Vivian.Mathews@va.gov (410) 691-7776

Martinsburg VAMC

Dr. Alan Fischler, Alan.Fischler@va.gov  (304) 263-0811 x 4514

Carmen Rodriguez-Munyan, Carmen.Rodriguez-Munyan@va.gov (304) 263-0811 x 2086

Karen Blackstone, Karen.Blackstone@va.gov (202) 745-8000 x 5042

9

Shellena Storey
Shellena.storey@va.gov
615-695-2141

Huntington VAMC

Jeanine Bledsoe, Palliative Care Coordinator
Jeanine.Bledsoe@va.gov
304-429-6741 ext 2848

 

6

Randy Johnson, MS
William.johnson10@va.gov
757-722-9961 x 3026

Jorge Cortina, MD
Jorge.cortina@va.gov
(757) 722-9961, ext 3456

Beckley VAMC:

Irma Adams, FNP
200 Veterans Avenue
Beckley, WV       25801
304-255-2121 x 4951

Palliative Care Coordinator Jacqueline Hartsog  304-2121 ext 4951 or 4346

Palliative Care - social worker Ben. Wilson 304-255-2121 ext 4259

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VA Prescriptive Authority and Collaboration with
Community Hospice Programs
Frequently Asked Questions (Community Version)

Q. Can VA physicians prescribe medications for enrolled veterans receiving care from a community hospice program?

A. VA Handbook 1140.5 states "VA encourages the referring VA staff physician to remain as the primary care physician attending of record during community hospice care.  The VA staff physician serving as attending of record for hospice care must, within the limits of ability and authority, sign relevant hospice care orders and forms, and participate with the care plan team. The care plan is controlled by the agency team, not by the physician"

Q. Can VA practitioners write for medications to be provided under the Medicare Hospice Benefit that are not part of the VA formulary?

A. Yes, writing prescriptions for non-VA formulary medications is permissible but local policy should reflect this ability. Payment for the medication may be provided by the Medicare Hospice Benefit when the veteran chooses this payer.

Q. Are VA practitioners immune from personal liability when they write for a non-VA formulary medication filled under the Medicare Hospice Benefit?

A. VA practitioners are immune from personal liability when writing for non-VA formulary medications as long as they are acting within the scope of their employment at the VA. The VA provider writing for these medications may provide these prescriptions for veterans receiving hospice care paid for by the VA or under the Medicare Hospice Benefit depending on the veteran's choice as outlined in VA Handbook 1140.5.

Q. Can prescribers use Drug Enforcement Administration (DEA) registration numbers assigned to VA medical care facilities?

A. The DEA registration numbers assigned to VA medical care facilities should not be used as practitioner identifiers for the purpose of writing prescriptions to be filled in non-VA pharmacies. Prescribers' personal DEA numbers are to be used for this purpose if required by the non-VA pharmacy. The good news here is that VA physicians can apply for a fee exempt DEA number after a VA management physician like the COS certifies they are a federal provider and acting solely on VA patients.

Q. How can a VA practitioner obtain a DEA number and is there a charge?

A. Federal employees can register via the DEA website at http://www.deadiversion.usdoj.gov/drugreg/index.html
Fees for personal DEA numbers are waived for federal employees.

Q. Can VA practitioners telephone prescriptions to private pharmacies?

A. This is not desirable in general and not possible for Schedule II (C-II) prescriptions.  In most cases pharmacies will not be familiar with the VA providers and given an institutional DEA number, some pharmacies will not fill the prescriptions.  Practitioners are, however, permitted to telephone prescriptions to private pharmacies at a VA patient's requests, if they meet all State requirements for the state in which the prescription is being filled. Telephoning or otherwise transmitting prescriptions to private pharmacies may not be delegated to other clinical staff and must be documented in the medical record.

Q. Can VA facilities create their own local prescription blanks?

A. This is an appropriate option. In cooperation with VHA Forms staff, VA facilities can develop local prescription blanks to write prescriptions to be filled in non-VA pharmacies however these blanks are subject to the same security and control requirements as the VA prescription blanks used for internal Schedule II (C-II) prescribing.

Q. What are VA practitioners required to document and how is this done?

A. It is an expected part of clinical care for practitioners to obtain and record a complete list of all medications currently used by patients.  The Non-VA medication file has been developed and should be used for the purpose of documenting medications obtained outside the VA.  It is particularly important that any medications prescribed by VA practitioners for outside fill are documented in this file.

Please contact your local VA hospice and palliative care team should you require further clarification.

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