VA Rolls Out New Private-Sector Health Care Programs

Urgent care building
(Getty Images/Kameleon007)

The Department of Veterans Affairs implemented the largest changes to veterans health care in four years on Thursday, with Secretary Robert Wilkie hailing the changes as "putting veterans at the center of their care."

Provisions of the VA Mission Act, signed by President Donald Trump last June, are now in effect, including a program that allows veterans to go to an urgent care facility for acute illness or injury and the Veterans Community Care Program that expands access to health care services in the private sector.

Under new Community Care rules, veterans who drive more than 30 minutes to a local VA facility or must wait more than 20 days for a primary care or mental health appointment may be eligible for private care.

And if they drive more than 60 minutes to a VA facility or have to wait more than 28 days for a specialty care appointment, they will be considered for receiving care in the private sector.

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The new rules also allow veterans to seek private care if services aren't provided by the VA or if they live in a state without a full-service VA medical center.

"The changes not only improve our ability to provide the health care veterans need, but also when and where they need it," Wilkie said in a prepared statement.

VA officials originally estimated that the new program would give an additional 1.5 million veterans access to private care, up from 560,000 under legacy private-care programs. But Wilkie said on C-Span's Newsmakers program Friday that he didn't expect to see a major spike in veterans seeking private health care, given the progress the department has made reducing wait times.

"The number of veterans requesting to go into the private sector has dropped," he said, adding that veterans aren't likely to "experience a great change" under the new system, since the option to get private care will be available only when the VA can't meet the standards set by Mission Act rules.

"Remember what Mission is -- it is only available if we don't not have a particular service," Wilkie said.

"It is not Libertarian VA," he added referring to concerns that the government would shuffle its health care obligations to the private sector.

The Mission Act was designed to consolidate the VA's disparate community care programs, including the Veterans Choice program, into a single enterprise, and improve VA medical provider recruitment and retention, the department's program for caregivers and its infrastructure.

Wilkie said the rollout would not be without "a few hiccups," but expressed confidence that the team is ready.

"It's a lot to unpack in this act. It was a very comprehensive bill. ... They've been working on it. This has been almost the single focus of VA for a year now. It's showtime; let's see how it goes," Wilkie said.

Earlier this month, the VA published an interim rule in the Federal Register that allowed it to utilize provider agreements signed under Veterans Choice for the Community Care program "so that VA has time to establish new purchasing relationships with community providers."

The VA awarded a contract worth up to $55 billion to Optum Public Sector Solutions to manage the Community Care network in 36 states and the District of Columbia. It has not awarded a contract for Region 4, which covers most of the western United States. TriWest, the contractor that has managed the Choice Act program for portions of that region since 2013, remains in place until a contract is awarded.

To use private-care options, veterans must consult with their VA medical team to determine whether they are eligible for such care. If needed services are determined not to be offered at a VA facility within the specified time frame, the team's decision support tool will provide a list of services available locally in the private sector.

Lawmakers who worked to pass the VA Mission Act had praise Thursday for the law's speedy implementation.

"I commend VA for implementing the Veterans Community Care Program in a timely manner so veterans can benefit from increased options for care, just one year after the VA Mission act was signed into law," said Sen. Johnny Isakson, R- Georgia, chairman of the Senate Veterans Affairs Committee.

Some veterans service organizations, however, have concern about the haste. Disabled American Veterans Executive Director Randy Reese said his group remains "cautiously optimistic" that the Mission Acts program rollout will be successful, but he is not without reservations.

"Only time will tell if the VA's new access standards and decision support tool will have quality assurance gaps or adverse consequences," Reese said.

From a historic perspective, Reese's concerns aren't without merit. Community Care Program's predecessor, the VA Choice Program, was plagued with claims processing delays that frustrated doctors, as well as issues with medical and insurance records sharing. Veterans had trouble receiving authorization for appointments, and the contractors that oversaw the program were investigated for overcharging the VA.

"Rest assured, DAV will be soliciting feedback from our membership and working closely with the VA and Congress to ensure the Mission Act is fully and faithfully implemented as intended," Reese said.

One conservative veterans group said the Mission Act does not go far enough. Concerned Veterans for America Senior Adviser Dan Caldwell said that, while the program represents a huge step forward in expanding private-care access to veterans, his group "still strongly believes veterans who use the VA should eventually be given the ability to choose to access a non-VA provider ... without prior authorization."

"We will continue working for additional reforms toward that end," Caldwell said.

Still, many are happy with the promise of expanded options for veterans health care.

"Ultimately, the new community care program should improve access to health care for veterans, ensuring they have the ability to get the care they need when they need it and where it is most appropriate," said Carl Blake, executive director of the Paralyzed Veterans of America.

-- Patricia Kime can be reached at Patricia.Kime@Military.com. Follow her on Twitter at @patriciakime.

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