The VA Veterans Choice Program

Getting timely medical care is a major issue for some veterans; the Department of Veterans Affairs has programs to address this issue–one such program was known as  the Veterans Choice Program (VCP).

VCP was created to help veterans in a variety of situations or personal circumstances that make getting care more complicated, including:

• Cases where appointments at the veteran’s local VA medical facility aren’t available for 30 days or more
• Veterans who must make long trips (40 miles driving distance or more from the closest VA medical facility with a full time primary care physician) to get care
• Those who must travel by air, boat, or ferry to the closest VA medical facility
• There are other burdens created by excessive travel to the nearest VA facility

VCP was described on the VA official site as “a benefit that allows eligible Veterans to receive health care from a community provider.”  It was intended to provide alternative access to care rather than waiting for a VA appointment to become available or making a long journey to the nearest VA medical facility.

VA no longer offers community care to Veterans under the Veterans Choice Program (VCP) but veterans may be eligible for community care under the “Grandfather” provision related to distance eligibility for VCP.

VCP was replaced by a program called Veterans Community Care (VCC). This replacement came after a bit of “planned obsolescence” for VCP–it was created to run for a period of time (three years or until the funds for the program ran out) and was intended to operate “separate from VA’s existing program providing Veterans care outside of the VA system” according to the VA official site.

Veterans Community Care (VCC) Program The Replacement to the Veterans Choice Program

In order to comply with the MISSION Act of 2018, the VA on June 6, 2019 sunset its Veterans Choice Program, a program that allowed veterans who received care at the VA to see non-VA community-based providers based upon certain eligibility requirements. The MISSION Act and the new Veterans Community Care Program is streamlining the process to make it easier for veterans to receive the care they need.

All VCP agreements officially expired as of June 6, 2019; the date of the “sunset” of the program.

Community providers may continue providing services for VA-affiliated veterans by participating in a contracted network administered by contracted third-party administrators, TriWest Healthcare Alliance and Optum Public Sector Solutions, Inc. Under certain circumstances, community providers may also contract directly with the VA to participate in the program.

Improvements Featured in the VCC Program

• Streamlined eligibility criteria– There are six criteria eligible requirements for the VCC program.
• Single community care program– Having a single community care program makes it less complicated for Veterans to find care.
• Improvement of customer service– Total revamp of the internal process, with improved education and communications resources for Veterans, Veterans Service Organizations (VSO) partners, and VA employees involved in community care operations to handle claims and payment.
• New urgent care benefit– Veterans now have access to immediate care at urgent care clinics and walk-in providers within the VA network, without prior authorization from the VA. It’s just one of the streamline improvements VCC offers.
  

What You Should Know About the Original VCP

If you seek information on VCP today, you should definitely learn how the program changes since its creation affect you now.

When VCP was first established (see below), the program was not intended to run indefinitely and the VA was not responsible as the primary coordinator. In 2017, the VA (thanks to new legislation) was able to remove barriers to care and information sharing with community healthcare providers.

VCP Providers

Veteran patients may still be able to utilize their original care provider they selected under the prior VCP,  but that may depend on having an existing VCP Provider Agreement. There must also be participation in the contract network with the VA-approved third-party administrator. Call your nearest VA medical facility if you have any questions about your current provider.

Billing

The process for billing did not change during the transition. Any credit collection questions can be directed to the VA Adverse Credit Helpline at 877-881-7618. For general billing questions, you can call Veterans Services at 866-606-8198.

Choice Card Expiration

The new community care program does not require a choice card. The use of the choice card ended with the sunset date of June 6, 2019.

Beneficiary Travel Benefits Remain Intact

VCP program members will remain eligible to use Beneficiary Travel benefits to and from their appointments as proscribed in the VA rules. The Department of Veterans Affairs Beneficiary Travel program is designed to help veterans pay for mileage and/or “common carrier” travel by plane, bus, taxi, etc. to and from VA healthcare. It also covers “VA authorized non-VA health care for which the Veteran is eligible.”

In general, Beneficiary Travel benefits are offered to those who:

• Have a service-connected rating of 30 percent or more
• Are traveling for treatment of a service-connected medical condition
• Are receiving a VA pension
• Have income which “does not exceed the maximum annual VA pension rate”
• “Are traveling for a scheduled compensation or pension,” according to the VA official site

Getting Prescriptions Filled When Using the Veterans Choice Program

VA rules for VCP include allowing the applicant’s community provider to issue short-term prescriptions for two weeks (14-days) of a “national formulary drug.” These 14-day prescriptions may be filled at any non-VA pharmacy.

The cost of prescriptions may be reimbursed via the Business Office/Non-VA Care Coordination Office at VA facilities. It may take as long as 45 days to process. You will need to provide copies of the original receipt and the original prescription. So be sure to hang on to that paperwork for future claims. The VA official site reminds, “Veterans cannot be reimbursed at the VA Pharmacy.”

For those who need more than a 14-day supply, the VCP rules state that standard procedures should be used to get a prescription at a VA pharmacy.

VCC adopted the same rules for VA prescriptions after the sunset of VCP on June 6, 2019.

How It All Started

How did these choices come to be offered to veterans in the first place? The VA describes the program as a means to “fulfill President Lincoln’s promise” to care for those who served their country, “…and for his widow, and his orphan”. Congress passed Public Law 113-146, the Veterans Access, Choice, and Accountability Act of 2014.

Also known as the “Choice Act” or the Veterans Choice Act, this law is described as a bipartisan effort to address VA healthcare issues involving delays and difficulty accessing VA care. The program was financed via something called the Veterans Choice Fund, and required the VA not only to provide access to care outside the VA system where appropriate, but also  to enter into contracts and partnerships with independent reviewers who were tasked with assessing the level and quality of “hospital care, medical services, and other health care processes in VA medical facilities”.

Those reviews would be included in submissions to Congress with the intent of posting the results online.

The original program was set to expire in 2017, but legislation extended the sunset date; Public Law 115-26 allowed the program to move beyond the original August 7, 2017 expiration and continue to operate until the initial funding (some $10 billion) had been spent. Furthermore, this public law also permitted additional funding to the tune of more than $2 billion to further the program.

The VA MISSION Act, also known as Public Law 115-182, was signed in 2018, authorizing even more funds for VCP, but also establishing a permanent Veterans Community Care Program (VCCP) to replace VCP.