Legislation Expands Access to Health Care for Veterans, Creates Opportunities for Non-VA Hospitals - McDermott+Consulting

Legislation Expands Access to Health Care for Veterans, Creates Opportunities for Non-VA Hospitals

In response to challenges veterans have experienced at Veterans Affairs (VA) health care facilities, the Veterans Access, Choice and Accountability Act allows veterans to receive care from non-VA providers in certain circumstances.  All health care providers participating in Medicare have an opportunity to contract with the VA to provide care to the veterans population.

On July 31, 2014, Congress approved H.R. 3230, the Veterans Access, Choice and Accountability Act of 2014, which seeks to address revelations of inadequate care and access to care experienced by veterans at Veterans Affairs (VA) health care facilities across the United States.  The legislation enables veterans in certain circumstances to seek health care services through non-VA facilities, creating 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.  President Obama is expected to sign the legislation.

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.  Veterans can access care from non-VA providers 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.  Non-VA providers are obligated to contract with the U.S. Department of Veterans Affairs to provide and be paid for these services.

The new legislation expands the range of instances where veterans may seek medical care from a non-VA provider.  Specifically, 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 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, except when the veteran receiving the care resides in a “highly rural area,” which is defined as a county with a population density of fewer than seven individuals per square mile.  Veterans will be required to pay deductibles or co-payments only if they would be so obligated 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.

The Congressional Budget Office 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 under this legislation, it is expected that there will 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.  Nonetheless, providers may be frustrated by the VA’s ability to enter into contracts in a timely manner.  While the VA was given additional funds to administer this program, the department still must obtain and implement the necessary resources.