VA offers updated criteria for getting care at outside hospitals

• The Trump Administration has offered criteria to determine when veterans can get care outside the VA. That includes in areas where the VA doesn’t provide the needed care, doesn’t have a full-service facility in the veteran’s state or doesn’t provide adequate access to care in the area.
• Congress passed the VA MISSION (Maintaining Internal Systems and Strengthening Integrated Outside Networks) Act of 2018, which combined the VA’s community care programs into one Veterans Community Care Program. This rule, if finalized, would implement the criteria for those services.
• Last month, the VA proposed access standards, such as allowing veterans to get non-VA care if they have to travel more than 30 minutes for primary care and mental health and 60 minutes for specialty care. The proposal would also limit appointment wait time to 20 days for primary care and mental health and 28 days for specialty care.

Dive Insight:

Proponents say the Veterans Community Care Program will improve access to care, but critics charge it’s a way to privatize the VA.

The department came under added scrutiny during the Obama Administration as longer wait times caused life-threatening situations. That includes a Government Accounting Office report that highlighted the problem for primary care in 2016.

In response, Congress created the Veterans Choice Program to help improve access to care. The VA Mission Act builds upon that template.

Under the new proposal, the VA will allow veterans to visit providers and receive services that are “substantively identical” to care offered by the VA. The proposal would also help veterans in rural areas. A 2016 RAND report found that only one-quarter of veterans live within an hour of a VA medical facility.

In addition to concerns about the proposal looking to privatize the VA, critics say veterans might not get the same level of care by private providers as what they get from the VA. There are additional worries that the VA better understands the medical and psychological needs for veterans. Former VA Secretary David Shulkin shared that concern, but not current Secretary Robert Wilkie, who also rejects the argument that the move is a step toward privatization.

The federal government will accept comments for the VA proposal for 30 days.