The VA Mission Act of 2018 is designed to greatly improve veteran access to VA healthcare. What does it mean for veterans? The VA Mission Act addresses in-network and non-VA healthcare issues, veterans’ homes, access to walk-in VA care, prescription drug procedures, and much more.
This VA reform law affects a wide range of areas and the “official” name of this law says a lot of about its focus; informally known as the VA Mission Act, this legislation’s formal name is the VA Maintaining Systems and Strengthening Integrated Outside Networks Act.
President Trump signed the Mission Act into law on June 6, 2018, but there are important changes in the program, effective June 6, 2019 that all veterans who use or potentially could be affected by the VA Mission Act should know. Over 30 veteran service organizations (VSOs) have endorsed this reform effort as it worked its way through legislative channels.
VA Mission Act Updates As Of June 6, 2019
The End of The VA Veterans Choice Program (VCP)
Effective June 7, 2019, the Department of Veterans Affairs will no longer offer care to eligible veterans under Veterans Choice benefits. This is not a termination of all VA benefits, just the end of the Veterans Choice Program. The VA started transitioning out of VCP before this announcement in order to help veterans avoid a lapse in medical coverage.
However, the VA official site advises that some who were eligible for VCP care due to their geographic location and commuting distance to VA care, “may still be eligible to receive community care after June 6, 2019, under the “grandfather” eligibility criterion established under the MISSION Act.”
If you believe you may be entitled to continue to receive VCP-like care, discuss your concerns with a VA healthcare provider at your nearest VA facility.
The End Of VCP Is Not The End Of Community Care
The VA Mission Act changes to VA community care are complex and challenging; the agency admits that the challenges proposed by the act has required a large-scale set of changes needed to “…implement the new Veteran community care program by June 2019.”
The VA has designed a new “internal operating structure” for providing community-type care including a new walk-in care benefit (see below) and new processes including VA purchasing of medical care and services “in certain situations,” arranging new payment processes for community healthcare providers, and creating criteria of care and standards of provider competency.
VA Community Care Requirements
If you are a veteran and are interested in community care benefits, you should know that eligibility for VA community care depends on individual needs and other factors including the requirements below as published by the VA official site:
- Veterans must receive approval from VA before using healthcare from a community provider;
- Veterans must either be enrolled in VA health care or be eligible for VA care without needing to enroll to be eligible for community care;
- VA staff members generally make all eligibility determinations;
- Veterans will usually have the option to receive care at a VA medical facility regardless of their community care options.
General Eligibility Rules For VA Community Care
The Veteran Needs a Service Not Available at a VA Facility
On a case-by-case basis, veterans may be eligible to be treated in the community when the VA does not have in-house options for a certain kind of approved treatment.
The Veteran Lives In An Area Without a Full-Service VA Medical Facility
There are a variety of areas where a veteran may qualify for community care because there is no full-service VA facility available within a reasonable distance. These areas include, but may not be limited to, Alaska, Hawaii, New Hampshire, and the U.S. territories of Guam, American Samoa, the Northern Mariana Islands, and the U.S. Virgin Islands.
The Veteran Is Eligible For The “Grandfather” Provision
Two VA requirements must be met to be considered under the “Grandfather Provision”:
- The veteran was eligible under the 40-mile criterion under the Veterans Choice Program on the day before the VA MISSION Act was enacted into law (June 6, 2018);
- The veteran continues to reside in a qualifying location.
If BOTH conditions are met, eligibility would be determined if one of the following apply:
- The veteran lives in one of the five States with the lowest population density from the 2010 Census: North Dakota, South Dakota, Montana, Alaska, and Wyoming;
- The Veteran lives in another State and received care between June 6, 2017, and June 6, 2018, and requires medical care before June 6, 2020.
The VA Cannot Furnish Care Meeting Certain Standards
There are VA standards for “average drive times” and “appointment wait-times.” These standards are under review and subject to change due to legislation, alteration of program guidelines, or other variables.
At the time of this writing the criteria included certain drive times to a specific VA medical facility of 30 minutes for primary care and certain other services and a 60-minute drive time for specialty care.
Appointment wait time standards are similarly subject to change, but in general the following standards apply at the time of this writing:
- 20 days for primary care
- 20 days for mental health care
- 20 days for non-institutional extended care services, unless the Veteran agrees to a later date in consultation with their VA health care provider
- 28 days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with their VA health care provider
Other VA Community Care Eligibility Rules
Situations Where Community Care Is In The Veteran’s Best Medical Interest
On a case-by-case basis, a veteran may be referred to a community healthcare provider when the patient and the referring doctor or agency agree that it is in the patient’s best interests to get care in the community.
Situations Where A VA Medical Service Does Not Meet Quality Standards
There may be instances where the Department of Veterans Affairs notes that a medical service line “is not meeting VA’s standards for quality based on specific conditions” and in such cases the VA Mission Act allows veterans to opt for care from a community provider, though the VA advises this is possible, “with certain limitations.”
The VA Urgent Care Benefit
Implementation of the VA MISSION Act of 2018 and the updates for 2019 include a VA urgent care benefit “for the treatment of minor injuries and illnesses, such as colds, sore throats, and minor skin infections.” This is offered “in addition to the opportunity to receive care from a VA provider,” since same-day services are also available from the VA.
Urgent care options are available from a care provider “which is part of VA’s contracted network of community providers without prior authorization from VA.” Veterans should know that VA payment for urgent care services is only possible if the care meets the following criteria:
- The patient must be eligible for the healthcare benefit;
- The urgent care provider is part of VA’s contracted network;
- The services are not excluded under the benefit
Excluded services may include (but are not limited to) dental care and preventive medicine. The VA official site reminds patients that they may have urgent care copays billed separately by the VA, “depending on their assigned priority group and the number of times they use the urgent care benefit in a calendar year.”
Checking Eligibility For VA Urgent Care On Or After June 6, 2019
Contact your nearest VA medical facility to check your eligibility for the urgent care benefits mentioned above.
Finding An Urgent Care Provider In The VA Network
Do you need to find an available urgent care provider in VA’s contracted network of community providers? You can contact your nearest VA medical facility or use the VA official site to search for locations of urgent care providers (via https://www.va.gov/find-locations/ at the time of this writing).
The Department of Veterans Affairs official site has a warning: “If an eligible Veteran goes to an out-of-network urgent care provider, they may be required to pay the full cost of care.”
What VA Urgent Care Coverage Includes
According to the Department of Veterans Affairs, VA urgent care options are for “non-emergent symptoms.” These may include:
- Flu-like symptoms
- Sore throats
- Painful urination
- Bumps and bruises
- Ear pain
- Minor skin issues
The Department of Veterans Affairs pledges to pay for or fill urgent care prescriptions but you cannot get routine care prescriptions filled under this benefit. In some cases a copay may be required for medication in an urgent care capacity.
The VA Mission Act: Eliminating Funding Gaps, Consolidating Programs, And Modernization
The VA Mission Act does some important things in the short term as well as introducing long-care fixes. The short term improvements are crucial for some veterans; the Act eliminates a gap in care due to funding issues associated with the VA Choice program.
VA Choice funding ended on May 31, 2018. VA Choice was designed to help veterans get non-VA healthcare if distance or wait list issues are a problem. VA Choice continues to be funded in the short-term until replaced.
The long-term fixes are associated with the replacement of VA Choice; the VA Mission Act consolidates seven different programs offering community care including VA Choice into a single entity.
Funding is also provided for education and training, VA medical staff recruitment, and a review of VA medical facilities. This review process is intended as the first step in a modernization program for VA locations that need upgrades.
Veteran Care Program
In the past, among the chief complaints about VA healthcare involved timely scheduling of appointments, care and services. Under the VA Mission Act, the Department of Veterans Affairs is required to coordinate timely care including help for those who need VA medical services outside their region of residence.
The VA is also tasked with making sure veterans “do not experience a lapse in health care services.”
A significant improvement under the VA Mission Act is that the Department of Veterans Affairs is now required to provide, “access to community care if VA does not offer the care or services the veteran requires, VA does not operate a full-service medical facility in the state a veteran resides, the veteran was eligible for care in the community under the 40-mile rule in the Veterans Choice Program” and when the veteran meets certain requirements.
The VA is required to enter into contracts with private networks to insure veterans get this care when warranted.
Authorization For Veteran Care Contracts
To implement the Veteran Care Program, the VA is authorized to enter into contracts-Veterans Care Agreements-with community healthcare providers with rates comparable to the VA Veterans Community Care Program. In addition to this authorization, certain procedures are also included in the act to guide this process in terms of making the agreements, how they are paid, and how they are enforced.
Veteran Care Homes
The VA is now authorized to enter Veteran Care Agreements with State Veterans Homes with the purpose of eliminating competitive contracting; State Veterans Homes are not technically considered to be federal contractors, but under the VA Mission Act these homes are required to follow federal Fraud, Waste, And Abuse requirements.
Veteran Access To Walk-In Services
Veterans have walk-in care access under the VA Mission Act, but this portion of the law includes certain conditions including a requirement that vets must have used VA healthcare services within a 24-month period prior to requesting walk-in services. Walk-in care is available from community healthcare providers who have a contract or other agreement with the VA to provide the services.
According to the text of the law, “Veterans who are not required to make a copayment at VA would be entitled to two visits without a copayment and then VA would be authorized to charge an adjustable copayment.”
Those who are required to co-pay may pay for the first two walk-in visits, with a VA-authorized copayment adjustment for successive walk-in care. The Department of Veterans Affairs is required to “ensure continuity of care” including accessibility to medical records from walk-in care providers and medical record sharing between VA and these agencies.
Expanding The VA Veteran Caregiver Program
Important changes to the VA Comprehensive Assistance For Family Caregivers includes expanded eligibility for veterans with service-connected medical issues. In the past access to this program was more limited and emphasized post-9/11 military service.
“Safe Opioid” Procedures For VA Prescriptions
The VA is now required to ensure its care providers-including contractors-are using “evidence-based guidelines” for prescribing opioid-based painkillers or pain management approaches. These guidelines are found in the Opioid Safety Initiative which must be adhered to as a condition of providing community care.
Under the new rules, VA is required to insure that community health care providers have the appropriate access to patient medical histories including “all medication prescribed to the veteran as known by VA.”
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