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Veterans Now Eligible for More Private Health Care Options

New MISSION Act aims to provide greater access to high-quality care

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The bipartisan supported MISSION Act went into effect Thursday, giving service members more health care options and expanding the number who qualify for private care through the Department of Veterans Affairs (VA).

The MISSION (Maintaining Internal Systems and Strengthening Integrated Outside Networks) Act allows veterans to receive primary care and mental health services outside the VA system if the average time it takes to drive to a VA facility is 30 minutes or more. It also includes better customer service, an urgent care benefit and modern information-technology (IT) systems.

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"We listened to veterans and heard they preferred standards based on drive times rather than driving mileage because those standards better reflect veteran experiences, especially in large urban areas with lots of traffic,” said VA Secretary Robert Wilkie in a Fox News op-ed.

Urgent care

The MISSION Act's urgent care policy is aimed to bring “greater choice and access to timely, high-quality care,” according to a VA statement. Veterans can use urgent care options for the treatment of minor injuries and illnesses, such as colds, sore throats, and bumps and bruises that are typical to urgent care and other walk-in medical facilities. This benefit is offered in addition to same-day services already offered by the VA.

Here are three requirements to consider when seeking urgent care.

  • Veterans first must be eligible for the benefit.
  • The urgent care provider is part of the VA's contracted network of providers.
  • It cannot include services such as preventive care or dental screening.

If a veteran goes to an out-of-network urgent care provider, they may be required to pay the full cost of care. Otherwise, copayments vary based upon the veteran's VA-assigned priority group, but they should not cost more than $30.

Community care

The existing community care programs will be combined into one single program. “With one program and a single set of rules and processes, there is less complexity and likelihood of errors and problems,” a VA official said.

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Here are five elements to consider when seeking private or community care.

  • For primary or mental health care, veterans are eligible to seek community care if their drive is over 30 minutes to a VA health care facility or there is a 20-day wait for a VA appointment.
  • For specialty care, veterans are eligible if their drive is over an hour or there is a 28-day wait for a VA appointment.
  • The provider must be a part of the VA's network of providers.
  • There are no changes to how prescriptions are processed.
  • A VA provider and VA medical facility staff member will assist in determining if a veteran is eligible under the new criteria.

Delays to caregiver assistance

Part of the MISSION Act expands the Program of Comprehensive Assistance for Family Caregivers, which provides a monthly stipend to primary caregivers, including relatives or friends, who care for veterans who need assistance with everyday activities. The previous program was limited to veterans injured on or after Sept. 11, 2001, but Congress instructed the VA to extend the program to veterans of all eras.

The VA missed its first deadline to update its IT infrastructure to support the expansion in October 2018 and recently said that it is still encountering ongoing issues.

"VA's efforts to implement an IT system that supports the Family Caregiver Program have been continuing with no end in sight,” said Carol C. Harris, director of IT management issues, in a statement to the House Veterans Affairs Health and Technology Modernization Committee in May. “We have ongoing work to further evaluate the status and progress of the department's efforts to implement a system to support the Family Caregiver Program consistent with the VA MISSION Act requirements."

Concerns remain among some veterans and lawmakers that the act's implementation will shift federal dollars to the private sector, leading to privatization of the VA health system, and that funding will be inadequate, leading to an erosion of care.

Yet Wilkie has insisted that the “future of the VA health care system will lie in the hands of veterans — precisely where it should be."

When a previous VA-funded private care program, the Veterans Choice Program, was initiated, it “proved so much more popular than anticipated that it led to increased amounts of veteran users and thus depleted the federal funding more rapidly than expected,” says Rebecca Burgess, research fellow at the American Enterprise Institute. “We should take our cue from history and anticipate that even more veterans will be seeking out their community care options [under the MISSION Act]."

Burgess says that although most VA medical facilities are clustered east of the Mississippi River, large portions of veterans live west, nowhere near a 30-minute drive time from a VA hospital.

It's estimated that 40 percent of veterans qualify for non VA health care under the new MISSION Act access standards, and the VA still hasn't finalized all the contracts with third-party administrators for their care network regions, according to Burgess.

"While I want to be optimistic about VA's intentions and hard work over the past year being in the right place, I have to be realistic about the historical record and say the jury is very much still out about how well this will work initially,” she said.

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