Last June, President Trump signed landmark legislation, known as the VA MISSION Act of 2018, that makes dramatic improvements to how Veterans receive community care—health care provided outside of VA. VA’s goal is to give Veterans greater choice over their health care, allowing VA to deliver world-class, seamless customer service either through a VA facility or community provider.
While the law affects many other VA programs, the changes to community care are among the most complex and far-reaching in recent history. After the legislation was enacted, VA immediately began taking the steps needed to implement the vast changes required.
Understanding the enormous scale of VA health care operations and VA’s responsibility for America’s Veterans, VA has been working hard on many large, interrelated tasks to implement the new Veteran community care program by June 2019. These tasks include the following:
- Design and launch a new internal operating structure for community care, including the new urgent care/walk-in care benefit
- Propose access standards as one of the six eligibility criteria for community care.
- Award contracts to Third Party Administrators (TPAs) to manage regions of VA’s new Community Care Network (CCN)
- Plan to implement Veterans Care Agreements to allow VA to purchase hospital care, medical services, or extended care services in certain situations
- Define competency standards for certain conditions applicable to community providers to make sure Veterans are getting high-quality care when they receive care outside of VA
- Set up new requirements for prompt payments to community providers
- Draft regulations to implement the law
What to Expect
So what can Veterans expect when the new program starts this summer? Given the magnitude of the changes, VA is working hard to make sure the rollout goes smoothly. If you are a Veteran enrolled in VA health care, or a Veteran who can receive care without needing to enroll, you can expect:
- To continue to have access to community care under current programs and then transition to the new program when regulations are final and published
- To follow an improved process to receive community care under the new program, with better access to community providers and improvements to customer service, such as more streamlined eligibility requirements
- A new benefit that provides eligible Veterans with access to urgent, non-emergency care for non-life-threatening conditions in VA’s network of community providers
- Improved care coordination as VA transitions to a single information technology system that better links together VA and community providers
- Your provider to receive timely payments for bills as VA transitions to better claims processing systems
New Eligibility Requirements for Community Care
The new eligibility criteria will be a major improvement over existing criteria in terms of making things simpler: currently, eligibility criteria vary between VA’s community care programs. When the new criteria go into effect, Veterans can expect better access and greater choice in their health care, whether at VA or through a community provider.
The eligibility criteria are projected to go into effect in June 2019 after final regulations are published and effective, so the criteria are not yet final. In addition, key aspects of community care eligibility include the following:
- Veterans must receive approval from VA prior to obtaining care from a community provider in most circumstances.
- 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.
- Eligibility for community care will continue to be dependent upon a Veteran’s individual health care needs or circumstances.
- 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 eligibility for community care.
- Meeting any one of six eligibility criteria listed below is sufficient to be referred to a community provider—a Veteran does not have to meet all of them to be eligible. (Real-world examples of when a Veteran would be eligible for community care are included in the eligibility fact sheet linked at the end of the article).
- Veteran Needs a Service Not Available at a VA Medical Facility
- Veteran Lives in a U.S. State or Territory Without a Full-Service VA Medical Facility
- Veteran Qualifies under the “Grandfather” Provision Related to Distance Eligibility for the Veterans Choice Program
- VA Cannot Furnish Care within Certain Designated Access Standards
- It Is in the Veteran’s Best Medical Interest
- A VA Medical Service Line Does Not Meet Certain Quality Standards
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. Veteran’s must get with their VA Medical Provider to discuss all community care options.
If you have questions concerning VA & State Benefits, contact Montgomery County Veterans Service at 936-539-7842 or via email at firstname.lastname@example.org and like us on Facebook.