New VA Program Expanding Veterans' Access to Care Up and Running

November 12, 2014 10:23 am News Staff

Veterans who have faced long wait times to receive care at Department of Veterans Affairs (VA) facilities now have the option of meeting with a non-VA physician following the release of regulations implementing a new law designed to increase health care access for veterans.

[U.S. Veteran holding and hugging young boy]

In August, President Obama signed the Veterans Access, Choice and Accountability Act into law. Among issues addressed in the rule are eligibility requirements for veterans and physicians who wish to participate in the new program, as well as related payment policies.

The Veteran's Choice Program established by the act is funded until August 2017 and is intended as a temporary measure to expand access to care until the VA can enhance its own ability to provide care. Earlier this year, media reports revealed that some veterans encountered wait times as long as three months to obtain an appointment at a VA hospital or care facility.

The program allows veterans greater flexibility to receive care or obtain medication outside of a VA facility. Veterans can obtain care from a physician who is not affiliated with the VA in specific circumstances, such as not being able to schedule an appointment at the nearest VA facility within 30 days from the date an appointment is considered clinically necessary or living more than 40 miles from the closest VA facility.

Physicians who wish to treat veterans will be required to sign a contract or a provider agreement with the VA. In addition, they must be participating in Medicare or be part of a federally qualified health center, the Department of Defense or the Indian Health Service.

With the exception of areas considered "highly rural," the VA will pay no more than Medicare rates for care provided to veterans. Under the program, the VA also will fill and pay for prescription medications written by a physician not affiliated with the VA.

Veterans will still need to receive authorization from the VA before scheduled appointments. If a veteran visits a non-VA facility on a nonemergent basis without prior authorization, the VA will not provide reimbursement. To qualify for the program, veterans must have been enrolled in the VA health system before August 1, 2014, or must be within five years of post-combat separation from the military.

A veteran who is already receiving non-VA care through one of the department's other programs authorizing such care is eligible to participate in the new program or he/she can continue as a patient under the existing arrangement.

Veterans will not be responsible for a copayment at the time of service whether they receive care from a VA provider or from a provider outside a VA facility. The copayment will only be billed after the service is provided and the physician has billed the VA for the care. In addition, under the Veteran's Choice Program, the copayment will in no instance exceed current payment levels. In most cases, if the veteran has other insurance that covers the cost of care, he/she will not have to make a copayment.

It's worth noting that the VA's move aligns with recommendations the Academy made earlier this year, when the AAFP sent a letter to Congress and the White House(2 page PDF) offering policy suggestions on how to address the patient backlog at VA facilities. That letter included a provision specifically calling for the agency to allow civilian family physicians to provide primary care for veterans.

According to an August statement from (then) AAFP President Reid Blackwelder, M.D., of Kingsport, Tenn., the AAFP was "the first physician organization to make specific recommendations to President Obama and congressional leaders about how they could leverage America's civilian family physicians to ensure timely access to primary care services for veterans."

The VA is accepting comments on the interim final rule until March 5, 2015. The AAFP is reviewing the final rule and will provide comments in the near future.

Related AAFP News Coverage
VA Launches Campaign to Recruit Physicians
Move Is Intended to Shore Up Primary Care Physician Workforce


Letter to President, Congressional Leaders
Family Physicians 'Stand Ready to Assist' Nation's Veterans