Last summer, Congress passed (with overwhelming bipartisan support) the VA Mission Act, mandating that department officials consolidate the existing community care programs and come up with new eligibility rules. The Department of Veterans Affairs (VA) will shortly publish draft rules providing criteria (drive time replaces miles/distance) for veterans to use private sector health care options.
VA plans to post the proposed rules in February in the Federal Register, where members of the public will be allowed to provide input. Under the law, the rules must be finalized by the beginning of March. The rules are scheduled to take effect in June 2019.
New Standards (Drive Time)
Under VA's proposed rules, veterans who must drive more than 30 minutes to reach their VA mental health or primary care providers - or wait longer than 20 days for an appointment - would be allowed to use a private doctor. For specialty care, veterans could go outside VA for medical treatment if a VA provider was longer than a 60-minute drive away or there was longer than a 28-day wait. VA estimates the new rules would extend eligibility for community care from 8 percent of VA patients now to 20 percent for primary care and 30 percent for specialty care. VA estimates costs to increase by $1.1 billion for fiscal year 2019, ending on September 30.
VA officials said the new rules are designed to give veterans more options and insist that the changes will not significantly alter how the majority of veterans in America get their care, since many are satisfied with their current care plans. Secretary Wilkie said "With VA's new access standards, the future of the VA health care system will lie in the hands of veterans, exactly where it should be."
Drive times would be calculated according to a private-sector program based on Microsoft's Bing search engine maps. About 600,000 veterans enrolled in VA health care are eligible for the existing community care programs. The proposed expanded standards will raise that number to between 1.5 million and 2.1 million patients, according to the department.
Existing Standards (Miles/Distance)
These Mission Act changes replace the Veterans Choice Program, which was created in response to the 2014 VA wait-time scandal. Under that program, VA patients are now allowed to go outside the system when they live more than 40 miles driving distance from a VA facility or it is estimated their wait for a VA appointment is longer than 30 days.
TREA members, please provide comments and feedback on your experiences.
Do you currently use VA health care services?
Have you experienced delays in scheduling appointments?
Would you use private sector services if you were eligible?
TREA Legislative Affairs will continue to be your voice. We will continue to obtain and share details to assure that you are informed and that access to VA and and private sector care is properly funded.