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Multiple Sclerosis Centers of Excellence

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Multiple Sclerosis System of Care Directive 1101.06

Veterans Health Administration (VHA) Directive 1101.06: Multiple Sclerosis System of Care establishes policy and procedures for health care services for Veterans with MS. (MS Directive)

Directive 1101.06 Policy

It is VHA policy that all enrolled Veterans with MS have access to the full spectrum of clinically appropriate multidisciplinary specialty services.

Directive 1101.06 Background

MS is a unique disease in the VA health care system due to its onset in young adulthood, female predilection, and common connection with military service. Its variable presentation make diagnosis difficult along with its dynamic and unpredictable course, its progressive nature, its variable symptoms, its required monitoring with costly testing, its required treatment with frequently changing, costly and potentially dangerous agents, and its radically changing face over the 40 to 50-year course of the disease. To adequately care for Veterans with MS requires a multidisciplinary team, including neurologists, physiatrists, internists, primary care providers, nurses, social workers, psychologists, rehabilitation therapists, urologists, and other health care professionals who are knowledgeable about the care of MS.

To address the unique needs of the Veteran MS populations, in 2001, Congress urged Veterans Health Administration to establish two Multiple Sclerosis Centers of Excellence (MSCoE) for clinical care, education, and research [Conference report (H. Rept. 106-988), Senate Appropriations Committee Report (S. Rept. 106-410) and House Appropriations Committee report (H. Rept. 106-674) that accompanied VA’s Fiscal Year 2001 Appropriation]. In response, VA convened a committee of MS experts who defined the requirements for the two centers. The committee also mandated the establishment of national standards for the care of Veterans with MS and, as only two Centers were to be funded, the development of a network of affiliated Regional MS Specialty Programs supporting local facilities and providers. In 2002, based on competitive applications, two centers were selected, one located at the VA Medical Center (VAMC) in Baltimore, MD, in Veteran Integrated Service Network (VISN) 5, serving VISNs 1-11 and the other jointly based centers are located in the Seattle, WA and Portland, OR VAMCs in VISN 20, serving VISNs 12-23. The MSCoEs were made permanent by “The Veteran’s Benefits, Healthcare and Information Technology Act of 2006.”