Change Doubles Number of Vets Eligible for Care Outside VA

March 25, 2015 03:02 pm News Staff

About twice as many military veterans will be eligible to see a physician who is not affiliated with the Department of Veterans Affairs (VA) under a new standard for measuring the distance from a veteran's home to the nearest VA facility.

[Stethoscope and dog tags on American flag]

The VA will begin using actual driving distance rather than an "as the crow flies" straight-line measurement.

Veterans who face a waiting time longer than 30 days or who live at least 40 miles from the nearest VA facility may seek care outside the VA. Those stipulations were critical components of the Veterans Access, Choice and Accountability Act of 2014, which was signed into law in August.

The change will become official through regulatory action in the coming weeks. It is expected to double the number of veterans who are eligible for care outside VA facilities, according to a March 24 statement( by the agency.

Congress and the president moved quickly to pass the 2014 legislation after media reports surfaced about veterans encountering long waits for physician appointments at VA facilities.

Since the program went into effect in November, more than 45,000 medical appointments have been scheduled.

In his proposed fiscal 2016 budget, President Obama is seeking authority from Congress to move any excess funding from the Veterans Choice program set up under the Act to other areas of the VA to cover administrative costs. Funding for the program was initially set at $10 billion.

The law established that the maximum payment for care provided outside a VA facility would be no higher than Medicare rates, but no minimum threshold was announced. To kick-start the program, the VA contracted with two third-party administrators to handle physician payments.

Some physicians reported that the contractors were offering to pay 30 percent less than Medicare rates, however, which swiftly prompted an AAFP letter asking the VA to review its payment policies.

Another potential complication regarding care for veterans by physicians outside the VA is the lack of payment deadlines. Although the AAFP urged Congress to include provisions in the legislation that ensure claims would be paid within 30 days, the VA has not addressed payment deadlines to date.

Related AAFP News Coverage
New VA Program Expanding Veterans' Access to Care Up and Running

Additional Resource
Progress Report: Veterans Access, Choice and Accountability Act 2014(