Physicians outside the VA may see an uptick in veteran patients as the U.S. Department of Veterans Affairs (VA) launched its revamped Veterans Community Care Program, implementing portions of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which both ends the Veterans Choice Program and establishes a new Veterans Community Care Program.
In 2014, veterans in Phoenix and across the country experienced wait lists that lasted for months, which resulted in the Choice Act.
“Veterans Choice was a very hasty response to the problem in Phoenix,” VA San Diego director Robert Smith said, according to KPBS. “This department was given 90 days to change its direction, change its ethos, and that was absolutely impossible to do.”
Under the new Veterans Community Care Program, veterans can work with their VA healthcare provider or other VA staff to see if they are eligible to receive community care based on new criteria. Eligibility for community care does not require a veteran to receive that care in the community; veterans can still choose to have VA provide their care. Veterans may elect to receive care in the community if they meet any of the following six eligibility criteria:
A veteran needs a service not available at any VA medical facility.
A veteran lives in a U.S. state or territory without a full-service VA medical facility. Specifically, this would apply to veterans living in Alaska, Hawaii, New Hampshire and the U.S. territories of Guam, American Samoa, the Northern Mariana Islands and the U.S. Virgin Islands.
A veteran qualifies under the “grandfather” provision related to distance eligibility under the Veterans Choice Program.
VA cannot furnish care within certain designated access standards. The specific access standards are described below:
Drive time to a specific VA medical facility
Thirty-minute average drive time for primary care, mental health and noninstitutional extended care services
Sixty-minute average drive time for specialty care
Note: Drive times are calculated using geomapping software.
Appointment wait time at a specific VA medical facility
Twenty days from the date of request for primary care, mental health care and noninstitutional extended care services, unless the veteran agrees to a later date in consultation with his or her VA healthcare provider
Twenty-eight days for specialty care from the date of request, unless the veteran agrees to a later date in consultation with his or her VA healthcare provider
The Veteran and the referring clinician agree it is in the best medical interest of the Vveteran to receive community care based on defined factors
VA has determined that a VA medical service line is not providing care in a manner that complies with VA’s standards for quality based on specific conditions.
“The changes not only improve our ability to provide the healthcare veterans need, but also when and where they need it,” said VA Secretary Robert Wilkie. “It will also put veterans at the center of their care and offer options, including expanded telehealth and urgent care, so they can find the balance in the system that is right for them.”
In preparation for this landmark initiative, senior VA leaders will visit more than 30 VA hospitals across the country to provide in-person support for the rollout. VA serves approximately 9 million enrolled veterans at 1,255 healthcare facilities around the country every year.
For more information, visit www.missionact.va.gov.