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.
• ELIGIBILITY CRITERIA •
- Veteran Needs a Service Not Available at a VA Medical Facility
In this situation, a Veteran needs a specific type of care or service that VA does not provide in-house at any of its medical facilities.
- Veteran Lives in a U.S. State or Territory Without a Full-Service VA Medical Facility
In this scenario, a Veteran lives in a U.S. State or territory that does not have 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.
- Veteran Qualifies under the “Grandfather” Provision Related to Distance Eligibility for the Veterans Choice Program
For this element, there are a few different ways that a Veteran could be eligible for community care. Initially, the following two requirements must be met in every case:
- 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), and
- Veteran continues to reside in a location that would qualify them under that criterion.
If both of these requirements have been met, a Veteran may be eligible if one of the following is also true:
- 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, or
- lives in another State,
- received care between June 6, 2017, and June 6, 2018, and
- requires care before June 6, 2020
- VA Cannot Furnish Care within Certain Designated Access Standards
To be eligible under this criterion, Veterans must meet specific access standards for average drive time or appointment wait-times.
The specific access standards are described below. (Important: Access standards are proposed and not yet final).
Average drive time to a specific VA medical facility
- 30-minute average drive time for primary care, mental health, and non-institutional extended care services (including adult day health care)
- 60-minute average drive time for specialty care
Appointment wait time at a specific VA medical facility
- 20 days for primary care, mental health care, and 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
- It Is in the Veteran’s Best Medical Interest
In this situation, a Veteran may be referred to a community provider when the Veteran and the referring clinician agree that it is in their best medical interest to see a community provider.
- A VA Medical Service Line Does Not Meet Certain Quality Standards
In this scenario, if VA has identified a medical service line is not meeting VA’s standards for quality based on specific conditions, Veterans can elect to receive care from a community provider with certain limitations.
What is described above should be taken as a preview of what the final eligibility criteria may be, because it is not yet final. The new criteria are expected to go into effect in June 2019, after final regulations are published and effective.
- PDF: Fact Sheet – Veteran Community Care – Eligibility (VA MISSION Act of 2018)
- PDF: Fact Sheet – Veteran Community Care – General Information (VA MISSION Act of 2018)
VA serves approximately 9 million enrolled Veterans at 1,255 health care facilities around the country every year.
For more information, visit www.missionact.va.gov.