On July 31, 2014, Congress approved the Veterans Access, Choice and Accountability Act of 2014. The legislation was passed in response to media revelations of inadequate care and access to care experienced by veterans at health care facilities operated by the VA. The legislation enables veterans in certain circumstances to seek health care services through non-VA facilities. This creates opportunities for hospitals and other health care providers to provide care to a broad population of veterans enrolled in the VA’s health benefits program. The legislation is expected to become law with President Obama’s signature.
The Congressional Budget Office (CBO) estimates that approximately 8.4 million veterans are currently enrolled in its health care program. Approximately 8 million additional veterans qualify for the VA health care program but have not yet opted to enroll. Based on the changes with this legislation, there may be a marked increase in demand for care at non-VA providers by veterans currently enrolled or expected to enroll in the VA health benefit program.
Under current law, veterans enrolled in VA health benefits programs principally receive health care services through one of 1,700 hospitals, clinics and other facilities across the United States. Under current law, veterans can access care today from non-VA providers only when VA medical facilities are not “feasibly available,” i.e.,because of a lack of available specialists, long wait times or extraordinary distance from the veteran’s home. The criteria are ambiguous and; in order to be compensated for these services, non-VA providers are obligated to contract with the U.S. Department of Veterans Affairs.
The new legislation expands the range of instances where veterans may seek medical care from a non-VA provider. Per this legislation, the Department of Veterans Affairs will now authorize and pay for care at a non-VA provider for the following reasons:
- The veteran is unable to schedule an appointment with a VA facility within 30 days.
- The veteran resides more than 40 miles from the VA medical facility that is closest to his or her residence.
- The veteran resides in a state without a VA medical facility that provides the specific type of medical care needed, and lives more than 20 miles from a VA medical facility in another state.
- The veteran resides within 40 miles of a VA medical facility but would be required to travel by air, boat or ferry to reach the medical facility, or faces a hardship accessing the facility because of “geographical challenges.”
- Any provider participating in Medicare will be eligible to contract with the VA to provide health care services. The Veterans Health Administration is permitted to contract directly with providers who seek to be eligible to deliver care to veterans. By executing an agreement with the VA, these providers will not be treated as federal contractors or subcontractors by the Office of Federal Contract Compliance Programs of the U.S. Department of Labor.
Except in emergency situations, prior to rendering care to a veteran the provider must confirm that the veteran is eligible and that the care is authorized. Reimbursement for such services will be determined through negotiated contracts with the VA and cannot exceed the amount Medicare would pay for such services. There is an exemption for payment limits when a veteran receiving the care resides in a “highly rural area,” – defined as a county with a population density of fewer than seven individuals per square mile. Veterans will be required to pay the same deductibles or co-payments they would have to pay when receiving care from a VA provider.
Within 90 days of the legislation passage, the Secretary must provide rules for an efficient U.S.-wide system for the billing and payment of authorized care from non-VA providers.
The program allowing access to non-VA care is authorized only until appropriated funds ($10 billion) are exhausted or for three years, whichever occurs first. Consummating these contracts in a timely manner may be stumbling block for the VA. While the VA was given additional funds to administer this program, the department still must obtain and implement the necessary resources.
