The VA Mission Act Of 2018 And Potential Opportunities For Providers

After a concerted effort, the bipartisan bill to reform the way care is delivered to Veterans has been signed into law. While there are a number of significant reforms, perhaps none are so critical as those related to the ability of Covered Veterans (the Veteran) to receive their care outside of the current VA system, and from private health care providers. Through the establishment of the Veterans Community Care Program, a system will be created which will allow qualifying services to be provided to Veterans who, under the provisions of the VA Mission Act of 2018 (The Act) are not able to receive timely and appropriate care to which the Veteran is entitled. While it will take some time to implement, providers may wish to begin to consider whether and how they would like to position themselves to serve this new population. What follows is an informational overview for potential providers of services to Veterans.

Care Required To Be Provided Through Non-VA Providers

The Act is structured to address both the conditions under which care is required to be furnished through non-Departmental providers, and conditions under which that care can be authorized to be furnished by those providers. As to the first element, subject to the necessary appropriation of funds being available, there is a mandate to provide hospital care, medical services, and extended care services if, in general, the following conditions are met:

The care or services required are not offered by the VA; There is not a "full-service" medical facility in the State where the Veteran resides; The Veteran was eligible under the existing Choice set of programs and continues to qualify for eligibility and meets certain residency conditions; The Veteran has requested care or services and the available care or services does not meet "designated access standards"; or The Veteran and the referring physician agree that furnishing care and services through a non-VA provider would be "in the best medical interest" of the Veteran, based on criteria developed by the Secretary. This latter "in the best medical interest" condition will be the one of most interest. The criteria will include such things as the nature of the services and the distance the Veteran must go to receive those services, as well as the timeliness of appointments and the overall burden to access those services, as will likely be spelled out in some detail in regulations. What makes this element of particular significance is that the Veteran will have the discretion to continue to receive services from VA facilities, even if the criteria to go elsewhere are met, and...