One of the VA’s solutions to the problem of timely care is the Veterans Choice Program. VCP is described on the VA official site as “a benefit that allows eligible Veterans to receive health care from a community provider.” It is an alternative to waiting for a VA appointment to become available or making a long journey to the nearest VA medical facility.
The VA has established a set of criteria for using VCP. In order to use VCP, prior authorization from the Department of Veterans Affairs is required. The VA must establish the veteran’s eligibility to use the program and further authorization is required if care is required that is “beyond the scope of the first authorization.”
What You Should Know About the Current Version of the Veterans Choice Program
In 2018 there were funding issues with VCP that threatened the continuation of the program. On May 11, 2018, the VA posted a notice on the official site’s VCP page. It states, “The Veterans Choice Program (VCP) will have exhausted all of its funding as early as May 31, 2018, and possibly as late as June 15, 2018, due to the unique nature of health care and the variability in health care costs.”
That announcement included the warning that once those funds were gone, the Department of Veterans Affairs would no longer provide such services. However, in June of that same year, the MISSION Act of 2018 provided more than $5 billion in “mandatory funding” for the Veterans Choice Program.
If you read the warnings on the VA official site and didn’t hear about the additional funding, it would be easy to make the mistake of assuming the program is dead. It is not.
What You Should Know About the Original VCP
When VCP was first established, the program had an expiration date. The Department of Veterans Affairs was not the primary coordinator. An April 2017 law changed those things and “removed barriers with sharing necessary health information with community providers.”
Veterans who explored their VCP options in the earliest days of the program should consider them again now that the rules have changed and there is no program expiration date.
If you seek information on VCP today, you should definitely learn how the program’s changes since its creation affects you now.
What You Should Know About The Future of VCP
Originally, the VA had contracts with private providers to administer VCP in certain regions. But the VA has moved to take over responsibility for many such administration needs. One of the most recent consolidation efforts happened in late 2018 when the VA contract with Health Net Federal Services (HNFS) was allowed to expire without renewal on September 30, 2018.
HNFS was the third party administrator for the eastern region of the Veterans Choice Program (VCP) and Patient-Centered Community Care (PC3) network. But in succeeding months following the end of the contract, the VA has assumed control. This does not affect other contracts in other regions, but VCP users should not be surprised to see the VA move to further consolidate the program and bring it back “in-house.”
Eligibility Criteria for Consideration under The Veterans Choice Program
To begin, the veteran must be enrolled in the VA health care system and meet at least one of the following requirements:
- The VA medical facility needed requires a 30-day-or-more wait for an appointment.
- The veteran lives farther than 40 miles (driving distance) from the closest VA medical facility “with a full time primary care physician.”
- The veteran is required to travel by air, boat, or ferry to the nearest VA medical facility.
- There is an unusual or excessive burden in traveling to the closest VA medical facility.
- The veteran lives in an area without a full-service VA medical facility that provides hospital care, emergency services and surgical care. This is intended for veterans in Alaska, Hawaii, New Hampshire, Guam, American Samoa, Commonwealth of the Northern Mariana Islands, and the U.S. Virgin Islands.
Veterans must use the VA system to explore their options for VCP. It is not possible to get VCP authorization from a non-VA doctor.
The “40-mile rule” listed above includes a specific calculation. It is based on the specific driving distance from the veteran’s home or “active temporary address” to the closest VA facility.
Eligibility under the 40-mile rule is determined when the applicant resides more than 40 miles (as calculated from the veteran’s home address) from the closest medical facility that has a full-time primary care physician.
VCP Eligibility and Health Insurance Co-Payments
The Department of Veterans Affairs official site states that since the VA is the primary coordinator of VCP benefits, the veteran is “only responsible for your VA copayment.” It is determined by the VA after care is given. These co-pays are billed from the Department of Veterans Affairs once the appointment is over.
Using The Veterans Choice Program and Other VA Medical Benefits
“Ordinary” VA healthcare options are unaffected by the veteran’s use of VCP. The VA official site states that VCP is part of a larger program to create a “high-performing integrated health care network to deliver the best of VA and the community.” Using VCP does not endanger the veteran’s other VA healthcare benefits.
How to Get Started with VCP
You can begin the process of registering by calling the VCP Call Center at 866-606-8198. Or you can visit the Veterans Choice Program page on the VA official site to verify eligibility.
Using the Veterans Choice Program Includes the Ability to Use Beneficiary Travel
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.”
Those using the VCP program are eligible to use Beneficiary Travel benefits to and from their appointments as proscribed in the VA rules for both VCP and Beneficiary Travel.
In general, Beneficiary Travel benefits are offered to those who:
- Have a service-connected rating of 30 percent or more, or;
- Are traveling for treatment of a service-connected medical condition, or;
- Are receiving a VA pension, or;
- Have income which “does not exceed the maximum annual VA pension rate” or;
- “Are traveling for a scheduled compensation or pension,” according to the VA official site.
VCP Benefits and The VCP “Choice Card”
Those approved for the Veterans Choice Program may receive a VCP card to use as identification for program benefits. However, you do not need the card to use VCP. The VA official site advises those who either lost or did not receive a card to call 866-606-8198 to discuss eligibility or make appointments.
Getting Prescriptions Filled When Using the Veterans Choice Program
VA rules for VCP include allowing the applicant’s community provider to issue prescriptions for two week (14 day) supplies 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 to 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.
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