Free Microsoft Word - 10-0094h.DOC - Federal

EDUCATION AFFILIATION AGREEMENT BETWEEN THE DEPARTMENT OF VETERANS AFFAIRS (VA) AND A NON-VA HEALTH CARE FACILITY OR AGENCY
Use when trainees in a VA-sponsored program receive training in a non-VA health care facility or agency

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VA NETWORK

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VA MEDICAL CARE FACILITY (including city and state)

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VA SPONSORED PROGRAM/DISCIPLINE AND DEGREE(S)

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NAME OF NON-VA HEALTHCARE FACILITY OR AGENCY (including city and state)

This agreement, when duly executed and approved by the Department of Veterans Affairs (VA), establishes an affiliation between VA, its Veterans Integrated Service Networks, the listed VA facility or facilities, and the non-VA healthcare facility or agency for the academic purposes of enhanced patient care, education, and research. VA and the affiliated non-VA health care facility or agency have a shared responsibility for the academic enterprise. It is mutually agreed that clinical or practical experience for trainees in the specified VA sponsored educational program be provided at the non-VA health care facility or agency. Through this agreement, a partnership is created to enable enhanced patient care, education, and research. Additional responsibilities are delineated below.

TERMS OF AGREEMENT
Ultimate responsibility for the control and operation of VA facilities and programs rests with VA. Ultimate responsibility for academic education in the VA sponsored program rests with VA. Ultimate responsibility for the control and operation of non-VA health care facilities or programs rests with the non-VA health care facility or agency. The non-VA health care facility or agency and VA comply with Title VI of the Civil Rights Act of 1964, section 504 of the Rehabilitation Act of 1973, Title IX of the Education Amendments of 1972, Public Law 10491, and the Age Discrimination Act of 1975, and all related regulations, and assures that they do not, and will not, discriminate against any person on the basis of race, color, sex, disability, or age under any program or activity receiving federal financial assistance.

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Nothing in this agreement is intended to be contrary to state or federal laws. In the event of conflict between terms of this agreement and any applicable state or federal law, that state or federal law will supersede the terms of this agreement. In the event of conflict between state and federal law, federal law will govern. Place a checkmark in the box that appropriately defines personal liability for participants in this VA sponsored educational program:

Trainees of the VA sponsored educational program, and the VA-employed faculty members who accompany them on their VA duty time, when at the non-VA health care facility or agency will have personal liability protection provided by the provisions of the Federal Employees Liability Reform and Tort Compensation Act, 28 U.S.C. 2679 (b)-(d) if all the following apply: (1) the trainees and faculty members are providing professional services covered by this agreement; (2) the non-VA facility is not providing them with compensation for these professional services; and (3) the non-VA facility has declined to provide them with coverage under its insurance.

Faculty members and trainees of the VA sponsored educational program, when at the non-VA health care facility or agency, and furnishing professional services covered by this agreement, will have personal liability protection provided by the non-VA health care facility or agency.

RESPONSIBILITIES
1. The affiliated non-VA health care facility or agency has the following responsibilities: A. Operate and manage the non-VA health care facility or agency and maintain accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other accrediting entities as appropriate. B. Participate with the VA in the academic programs of education and research, provide an appropriate learning environment, and supply sufficient resources for appropriate conduct of such programs. C. Encourage appointments of non-VA faculty to the VA for participation in the VA sponsored educational program. D. Assure that staff with appropriate credentials will supervise trainees while at the non-VA health care facility or agency. E. Establish with VA, the minimal qualifications for trainees in the VA sponsored program that will rotate to the non-VA health care facility or agency. F. Orient trainees and faculty to the non-VA health care facility or agency and inform them that they are subject to the rules and regulations of the non-VA health care facility or agency while in those facilities. G. Evaluate the trainee's performance and conduct in mutual consultation with VA faculty and according to the guidelines outlined in the approved curriculum and accepted standards. H. Review and sign appropriate educational program letters of agreement prepared by VA. I. Dismiss any trainee from non-VA health care facility or agency assignment for unsatisfactory educational performance, noncompliance with the policies and procedures of the non-VA health care facility or agency, or for cause.

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2. VA has the following responsibilities: A. Operate, manage, and assume overall educational responsibilities for the educational program and maintain accreditation by an agency that is recognized by the U.S. Department of Education or by the Council for Higher Education Accreditation (CHEA). B. Participate with the non-VA health care facility or agency in the academic programs of education and research, provide an appropriate learning environment, and supply sufficient resources for appropriate conduct of such programs. C. Operate and manage the VA facility and maintain accreditation by the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) and other accrediting entities. D. Assure that staff with appropriate credentials will supervise trainees. E. Appoint qualified health care professionals to VA from the non-VA health care facility or agency as appropriate, as faculty in the VA sponsored educational program. F. Establish minimal qualifications for trainees in VA sponsored educational programs. G. Consult with faculty from the non-VA health care facility or agency on issues of trainee noncompliance with the policies and procedures of the non-VA health care facility or agency, and take appropriate action. H. Evaluate the trainee's performance and conduct in mutual consultation with the program director and according to the guidelines outlined in the approved curriculum and accepted standards. I. Develop educational program letters of agreement for each non-VA health care facility that provides a trainee with educational experience at VA. These agreements must identify faculty, including VA employees, who will teach, supervise, and evaluate trainee performance; outline educational objectives; specify periods and clinical area of assignments. J. Dismiss any trainee from VA assignment in accordance with VA Handbook 5021, Part VI, Paragraph 15 or Paragraph 18, whichever paragraph applies. K. Appoint VA and appropriate non-VA health care facility or agency faculty to the VA Partnership Council and its subcommittees. Non-VA health care facility or agency faculty will be chosen based on the extent of involvement in the VA training program and geographic proximity to the VA facility. L. Conduct periodic reviews of academic programs and policies according to VA policies.

TERMINATION OF AFFILIATION AGREEMENT
This affiliation agreement is in force until further notice and supersedes any previous affiliation agreement. It may be terminated in writing at any time by mutual consent with due consideration of patient care and educational commitments, or by written notice by either party 6 months in advance of the next training experience.

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SIGNATURE PAGE

Signature of Responsible Official for Non-VA Healthcare Facility or Agency

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Date of Signature

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Typed Name of Individual Signing Above

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Typed Title of Individual Signing Above

Signature of VA Healthcare Facility Discipline Leader

Signature of VA Designated Education Official

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Date of Signature

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Date of Signature

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Typed Name of Individual Signing Above

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Typed Name of Individual Signing Above

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Typed Title of Individual Signing Above

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Typed Title of Individual Signing Above

Signature of Director or Equivalent Responsible Official for VA Healthcare Facility

Signature of VISN Director or Designee for Department of Veterans Affairs

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Date of Signature

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Date of Signature

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Typed Name of Individual Signing Above

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Typed Name of Individual Signing Above

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Typed Title of Individual Signing Above VA FORM 10-0094h

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Typed Title of Individual Signing Above PAGE 4 OF 4