TriWest Authorization Delays Update

At the August 2017 Round Table conference we spoke about the delays in receiving TriWest authorizations, which delays the care of Veterans. Please see the attached email Alecia received from Kyle Levin at APTA.

“Dear Mrs. Johnson,

My name is Kyle Levin and I am a regulatory specialist here at the APTA. The reason that I am writing is that your information was forwarded to me by Kara Gainer, the Director of Regulatory Affairs here. I understand that you were having some issues with Triwest regarding long reauthorization times. I have been in contact with Triwest, and I wanted to give you an update on our efforts. Once Triwest receives the request for reauthorization, they submit the request to the appropriate VA Medical center. Once the VA has the request, they have 14 business days to approve or reject the request, and send it back to VV.

So even if Triwest submits the paperwork in a timely fashion, you are still looking at around a three week turnaround before reauthorization is granted in the best case scenario. However, the problem is further compounded due to the sheer volume of authorizations being submitted to TriWest. The VA OIG recently completed a review of the VA Choice Program at the request of Senator Isakson (see https://www.va.gov/oig/pubs/VAOIG-15-04673-333.pdf). The OIG flagged authorization and scheduling procedures as potential barriers to veterans receiving care, and in TriWest’s response to the VA OIG Report, they discussed the number of care requests it receives on a monthly basis, noting that since August 2015, the number of requests submitted to TriWest has increased by 120%.
See: http://docs.house.gov/meetings/VR/VR00/20170307/105529/HHRG-115-VR00-20170307-SD007.pdf

Within the report, the VA OIG made the following recommendations:

1. We recommended the Under Secretary for Health streamline processes and procedures for accessing care under the Veterans Choice Program.
2. We recommended the Under Secretary for Health develop accurate forecasts of demand for care purchased in the community.
3. We recommended the Under Secretary for Health simplify requirements for network providers to bill for services under the Veterans Choice Program.
4. We recommended the Under Secretary for Health ensure eligible veterans are not financially liable for the full cost of treatment authorized under the Veterans Choice Program.
5. We recommended the Under Secretary of Health ensure community providers are paid in a timely manner under the Veterans Choice Program.
6. We recommended the Under Secretary for Health review the Veterans Choice Program to determine if growth of provider networks is being limited by allowing reimbursement below Medicare rates.

The Under Secretary for Health concurred with the OIG’s findings and stated it would implement the recommendations, which the OIG is closely monitoring.

At this point I know that there is a plan to follow up with Senator Isakson’s office to see if there has been any further legislative pushes to help ease some of the burden on Triwest.

Please let me know if you have any further questions or concerns.

Sincerely,

Kyle Levin
Regulatory Specialist
American Physical Therapy Association
kylelevin@apta.org”