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May 24, 2018

Congress sends Trump bill to reform Veterans Choice Program

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    The Senate on Wednesday voted 92-5 to approve a bill (S 2372) that would reform the Veterans Choice Program (VCP).

    Sens. Bob Corker (R-Tenn.), Jeff Merkley (D-Ore.), Mike Rounds (R-S.D.), Bernie Sanders (I-Vt.), and Brian Schatz (D-Hawaii) voted against the bill, The Hill reports.

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    The House last week voted 347-70 to approve the bill. The measure now heads to President Trump, who is expected to sign it.

    About VCP

    VCP aims to increase veterans' access to health care by providing them with federally subsidized care at non-Veterans Affairs (VA) facilities. Veterans are eligible to use the program if they have been waiting more than 30 days for a VA health care appointment, if they live 40 miles or farther from a VA facility, or if they face undue burdens accessing care at VA medical centers.

    However, veterans advocates have criticized the program, saying its eligibility requirements are cumbersome and citing delays in reimbursements for care provided by private providers. In addition, the program has faced funding issues, and progress on updating VCP stalled amid controversy and department infighting related to former VA Secretary David Shulkin.

    Acting VA Secretary Robert Wilkie—who Trump intends to nominate as the department's permanent secretary—earlier this month warned lawmakers that, without Congressional action, VCP likely would run out of funding in the beginning of June.

    Bill details

    The bill, called "The VA MISSION Act of 2018," would allocate $5.2 billion to fund VCP until it can be replaced with a revamped program, called the Veterans Community Care Program.

    According to a summary of the legislation, VA providers under the new program would be required to:

    • Coordinate coverage for veterans who use health care services outside of the region in which they live;
    • Ensure continuity of health care services and care;
    • Ensure that veterans can schedule medical appointments "in a timely manner"; and
    • Ensure veterans do not experience lapses in health care.

    The bill also would require VA to allow veterans to access "community care" if a veteran lives 40 miles or farther from a VA facility "and meets certain other criteria," or if a veteran and his or her "referring clinician agree" that receiving community care "would be in the best medical interest of the veteran," after considering certain criteria. In addition, veterans under the bill would be able to access "community care" if VA:

    • Cannot provide the services a veteran needs at the same level of quality "when compared with two or more distinct and appropriate quality measures at non-VA medical service lines";
    • Cannot provide the services a veteran needs within a timeframe comparable "with the same medical service line at different VA facilities";
    • Does not operate a full-service medical facility in the state in which a veteran lives;
    • Does not provide the services a veteran needs; or
    • Is not able to provide care "within the designated access standards established by VA."

    Veterans under the new program also would be permitted to access "walk-in care" at community providers that have contracted with VA if the veterans have "used VA health care services in the 24-month period before seeking walk-in services."

    According to the summary, the bill would create "a prompt payment process" that would require VA to pay or deny payment to community health providers within 30 days of receiving an electronic claim for rendered services or within 45 days of receiving a paper claim for rendered services.

    The bill also would require VA to create and implement an educational program intended to inform veterans about their health care options, as well as a program to train VA staff on how to implement the new Community Care Program. The bill also calls for VA to create certain policies to govern how community care providers should interact with VA, including policies on opioid prescribing, medical record sharing, and certain "competency standards" for "treating veterans for injuries and illnesses that VA has a special expertise in, such as post-traumatic stress disorder, traumatic brain injury, and military sexual trauma."


    Sen. Johnny Isakson (R-Ga.) called the bill "the last piece of a great mosaic to reform [VA] benefits for our veterans to make them contemporary with the 21st century and see to it that the best care, the best attention, and the best legislation is in place."

    According to NPR's "All Things Considered," dozens of military and veterans service organizations have indicated their support for the legislation, but said they intend to monitor how the legislation is implemented.

    Carlos Fuentes, a legislative director at Veterans of Foreign Wars, said the bill "strikes that balance between improving internal care [at VA] and relying on the community when necessary."

    However, some have voiced opposition to the legislation.

    For instance, Sanders said he thought the bill would continue a "slow, steady privatization of the VA" and "will open the door to the draining, year after year, of much-needed resources from the VA." Sanders also raised concerns that the bill "provides nothing to fill the vacancies at the VA."

    The American Federation of Government Employees and other groups in a letter sent Tuesday to lawmakers wrote that they "vehemently oppose" the bill. They wrote, "Too much is at stake for veterans, their families, and everyone who benefits from the VA's extraordinary accomplishments to succumb to political pressures to hurriedly pass potentially damaging changes with many unknown consequences" (Lawrence, "All Things Considered," NPR, 5/23; Carney, The Hill, 5/23; Luthi, Modern Healthcare, 5/23; Fandos, New York Times, 5/23; Clason, CQ News, 5/23 [subscription required]; AFGE letter, 5/22).

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