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VA Sends Congress Draft Proposal for Veterans Choice Program

The new Veterans Choice Program draft proposal scraps the 30-day wait period and 40-mile eligibility parameters.

VA veterans choice program

Source: Thinkstock

By Sara Heath

- The Department of Veterans Affairs presented its Veterans Coordinated Access & Rewarding Experiences (CARE) Act to the House and Senate Veterans Affairs Committees. The proposed draft is a Veterans Choice Program revamp that gets rid of the 30-day wait period and 40-mile eligibility rules.

Under the Choice Program’s original iteration, veterans were entitled to receive non-VA healthcare if they faced a wait period exceeding 30 days or faced extraordinary barriers to receiving care, such as living 40 miles or more from a VA healthcare facility.

The CARE Act would scrap those requirements and replace them with provisions putting more decision-making power in the hands of veterans and their providers. For example, the new bill will let veterans and their providers decide whether the veteran should seek care outside of VA, the agency said.

Additionally, the new bill will create a network of walk-in clinic options for veterans to easily access treatment for minor illnesses or injuries. The bill will also establish parameters by which VA can surveil and support its facilities to ensure they maintain adequate workforce and other resources to offer access to veteran care in a reasonable timeframe.

The bill will allow VA to leverage its business relationships to improve the fiscal health of its Community Care program. The agency also plans to strengthen its partnerships with other federal groups to improve VA’s ability to deliver care to veterans.

On a larger scale, the bill aims to:

  • Clarify and simplify eligibility requirements
  • Set the framework for VA to continue to build a high-performing network
  • Streamline clinical and administrative processes
  • Implement new care coordination support for Veterans
  • Merge and modernize community care programs

Ultimately, these moves are geared toward putting care decisions back in the hands of veterans, while creating a better network of healthcare resources with which VA can better serve its patient population.

“We want Veterans to work with their VA physicians to make informed decisions that are best for their clinical needs, whether in the VA or in the community, and this bill does just that, while strengthening VA services at the same time,” VA Secretary Dr. David J. Shulkin, MD, said in a public statement.

Currently, the Veterans Choice Program hosts a list of qualifying access criteria based upon a patient’s ability to access VA care, including:

  • the next available medical appointment with a VHA provider is more than 30 days from the veteran’s preferred date or the date the veteran’s physician determines he or she should be seen;
  • the veteran lives more than 40 miles driving distance from the nearest VHA facility with a full-time primary care physician;
  • the veteran needs to travel by air, boat, or ferry to the VHA facility that is closest to his or her home;
  • the veteran faces an unusual or excessive burden in traveling to a VHA facility based on geographic challenges, environmental factors, or a medical condition;
  • the veteran’s specific healthcare needs, including the nature and frequency of care needed, warrants participation in the program;
  • the veteran lives in a state or territory without a full-service VHA medical facility.

Although the program was intended to address treatment access issues that run rampant throughout VA, the Choice Program has faced several hurdles, most notably including its own long wait time issues.

A March 2017 report from the Government Accountability Office (GAO) showed that veterans participating in the Choice Program face wait times of up to 81 days, far exceeding the 30-day threshold the agency says it upholds in treatment access cases.

A complex approval process – which includes vetting from VA and third-party providers – makes for the long wait period, GAO found.

As a result, members of Congress and VA representatives have debated overhauling the Choice Program. VA received the go-ahead for a proposal back in August when Congress also approved extended funding to preserve the program.

At time of publication, the draft proposal’s full text is not available. The proposal now awaits the greenlight from Congress.

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