The U.S. Department of Veterans Affairs (VA) launched its new and improved Veterans Community Care Program on June 6, 2019, 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.
The MISSION Act will strengthen the nationwide VA Health Care System by empowering Veterans with more health care options.
“The changes not only improve our ability to provide the health care 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.”
Under the new Veterans Community Care Program, Veterans can work with their VA health care 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 health care 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 health care provider.
The Veteran and the referring clinician agree it is in the best medical interest of the Veteran 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.
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.
The VA MISSION Act:
Strengthens VA’s ability to recruit and retain clinicians.
Authorizes “Anywhere to Anywhere” telehealth across state lines.
Empowers Veterans with increased access to community care.
Establishes a new urgent care benefit that eligible Veterans can access through VA’s network of urgent care providers in the community.
VA serves approximately 9 million enrolled Veterans at 1,255 health care facilities around the country every year.