Under the MISSION Act, signed by President Trump in June 2018, there are six different eligibility criteria for community care:
- Services unavailable
- Residence in a State without a full-service VA medical facility
- 40-mile legacy/grandfathered from the Choice program
- Access standards
- Best medical interest
- Needing care from a VA medical service line that VA determines is not providing care that complies with VA’s standards for quality
ACCESS STANDARDS
VA is proposing new access standards, effective when the final regulations publish (expected in June 2019), to ensure Veterans have greater choice in receiving care.
Eligibility criteria and final standards as follows were based on VA’s analysis of all of the best practices both in government and in the private sector and tailored to the needs of our Veteran patients:
- Access standards will be based on average drive time and appointment wait times.
- For primary care, mental health, and non-institutional extended care services, VA is proposing a 30-minute average drive time standard.
- For specialty care, VA is proposing a 60-minute average drive time standard.
- VA is proposing appointment wait-time standards of 20 days for primary care, mental health care, and non-institutional extended care services, and 28 days for specialty care from the date of request with certain exceptions.
Eligible Veterans who cannot access care within those standards would be able to choose between eligible community providers and care at a VA medical facility.
URGENT CARE
Eligible Veterans will have access to urgent (walk-in) care that gives them the choice to receive certain services when and where they need it. To access this new benefit, Veterans will select a provider in VA’s community care network and may be charged a copayment.
VA Secretary Robert Wilkie said, “Our medical services must meet our Veterans’ needs and reinforce the trust that forms the basis for every interaction with VA. Our new access standards are a vital part of this effort.
“Most Americans can already choose the health care providers that they trust, and President Trump promised that Veterans would be able to do the same. With VA’s new access standards, the future of the VA health care system will lie in the hands of Veterans – exactly where it should be.”
Secretary Wilkie’s full statement is available here.
VA encourages the public to comment on the proposed access standards and urgent care benefit during the public comment period once these proposed regulations (RIN 2900-AQ46 and RIN 2900-AQ47, respectively) publish in the Federal Register; we look forward to receiving this feedback.
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