Normally, a CHAMPVA beneficiary shares in the cost of services covered by the program, unless he or she has other health insurance like a CHAMPVA supplement. But with the CHAMPVA Inhouse Treatment Initiative or CITI, it’s possible to get health care without paying out of pocket; that is, for free. You are eligible for this benefit if there is a participating facility near you that can receive you, and you don’t have Medicare, HMO or PPO.
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What Is the CHAMPVA Inhouse Treatment Initiative (CITI) Program?
CITI stands for CHAMPVA Inhouse Treatment Initiative. Through this program, participating VA medical centers provide certain services to CHAMPA beneficiaries at no cost to the latter. Which services can be provided will depend on what’s available at each location.
Because VA medical centers must attend to the needs of the veterans themselves first, they can join CITI only when veterans haven’t used the center’s resources to the full, and even then they can give only services that are unused. In other words, a participating VA medical center in CITI provides whatever it has to spare.
When you receive services at a CITI facility, you pay nothing out of your own pocket. Consequently, you will not receive a CHAMPVA Explanation of Benefits for said services.
Benefits of the CITI Program
- You have no deductible and no cost share
- You receive covered services for free
- Preauthorization that CHAMPVA normally requires for various services is waived (except bone marrow transplant and dental care)
- Preauthorization for DME’s (Durable Medical Equipment) is waived
Who Is Eligible to Use Services at a CITI Facility?
You are eligible to receive treatment at a CITI facility if:
- You are eligible for CHAMPVA benefits
- You are not eligible for Medicare or enrolled in HMO or PPO
However, the final decision whether or not to accept you rests with the VA medical facility. This will depend on factors such as your OHI (other health insurance) and available services and resources.
Also, policy regarding CITI services may change depending on that facility’s workload. They may join in CITI, reduce their services offered or discontinue participation as the situation demands.
Impact of Medicare Benefits on Participation in the CITI Program
As explained in the CHAMPVA handbook and policy manual, beneficiaries who are enrolled in Medicare cannot use CITI. This is because VA medical facilities are prohibited by law from charging Medicare. CHAMPVA is only secondary payer to Medicare and if Medicare does not pay, neither will CHAMPVA.
How Does a VA Medical Center Join the CITI Program?
The decision to participate or not in CITI is up to individual VA medical center directors. If a facility has unused capacity, the director may decide to participate in the CITI program. But if a participating facility sees an increase in the needs of the veterans it serves, the director may choose to discontinue its participation in CITI.
How to Find a Participating VA Medical Center for the CITI Program
To find out more about CITI and to locate the nearest CITI facility near you, visit the VA Health Administration Center page for the CITI program. See also the CITI brochure.
This website, CHAMPVAbenefits.com, is NOT affiliated with the Department of Veterans Affairs or any part of the U.S. government. Please DO NOT send us information about yourself such as your SSN, name, address, etc. for help with CHAMPVA…. The pharmacy network for CHAMPVA now is Catamaran (formerly SXC)…. Further, we cannot guarantee that the information here is accurate and up-to-date. To ensure you have the latest information, please visit the official CHAMPVA home page at http://www.va.gov/hac/forbeneficiaries/champva/champva.asp. Your use of this site means you agree to and understand this disclaimer. Thank you!
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