Successfully Navigate Affiliation Agreements with Veterans Affairs Hospitals Using VA Form 10-0094g

Editor’s Note: This article was originally featured in the Spring 2009 edition (Volume 101) of the NAACLS news. The article was referenced frequently in the question and answer session of  the 2012 CLEC workshop, and often mentioned by program directors as a helpful resource. With this in mind, we are republishing the article with the hope that those that missed it can benefit from the information.

Many program directors have found obtaining a signed current Veterans Affairs (VA) Hospital affiliation agreement that clearly meets the intent of Standard 1 to be a lengthy and frustrating process. Some resolute program directors have spent countless hours navigating through code of federal regulations, VHA directives and VA Handbooks to draft proposed addendums which are then funneled into a prolonged legal review and concurrence process. If the medical center director or legal counsel reviewers have significant concerns, it is often unclear how program directors can successfully resolve the issue. Unfortunately, this can result in needlessly abandoning potential VA training sites for laboratory science students.

Affiliation agreements that do not meet each of the nine required elements of Standard 1 remain a frequently cited cause for marginal non-compliance. There has been considerable attention to this issue from multiple members of RCAP who have periodically published guidance for program directors facing this problem. NAACLS Board of Directors members encourage flexibility and a broader interpretation of Standard 1 by committee members in this litigation prone era of healthcare. At the same time, we must ensure that the intent of each general and specific item required within Standard 1 is fulfilled by the affiliation agreements for the ultimate protection of both our students. Historically, navigating a successful new affiliation agreement with a federal facility, such as a Department of Veterans Affairs hospital, results in an additional level of complexity, due to federal supremacy regulations and limited authority to addend a nationally developed agreement.

There is good news for program directors still struggling with how to approach VA affiliation agreements. RCAP members recently reviewed VA standardized form 10-0094g (Associated Health Education Affiliation Agreement between the Department of Veterans Affairs [VA] and an Educational Program) in conjunction with other applicable VHA documents and developed a crosswalk annotating how the VA fulfills the intent of all nine elements within Standard 1. Addenda for VA affiliation agreements ….. are no longer needed! For more information regarding VA Form 10-0094g and other education related VA documents, visit the VA Office of Academic Affairs internet website.

Standard 1 Institutional Affiliation: In programs in which the education is provided by two or more institutions, responsibilities of the sponsoring institution and of each affiliate for program administration, instruction, and supervision must be described in writing and signed by both parties. All provisions of the agreement must be active with written documentation of the following items:

By Margie Scott, MD