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VA unveils proposed new rules for expanding private-sector care

George E. Wahlen VA Medical Center (Veterans Health/Flickr)

Veterans who must drive more than 30 minutes to reach their Department of Veterans Affairs mental health or primary care providers would be allowed to use a private doctor for their health care under proposed rules the VA unveiled Wednesday.

For specialty care, veterans could go outside the VA for medical treatment if a VA provider was longer than a 60-minute drive away.

The draft rules are part of the VA Mission Act – a law scheduled to take effect this summer that aims to extend veterans’ access to private-sector doctors. VA Secretary Robert Wilkie said earlier this week that the new access standards would “revolutionize” the VA health care system.

“Most Americans can already choose the health care providers that they trust, and President [Donald] Trump promised that veterans would be able to do the same,” Wilkie said in a statement. “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.”

The Mission Act will replace the Veterans Choice Program, which was created in response to the 2014 VA wait-time scandal. Under that program, VA patients are allowed to go outside the system when they live more than 40 miles driving distance from a VA facility or it is estimated their wait for a VA appointment is longer than 30 days.

There was widespread consensus among veterans and lawmakers that the rules of the Choice program were too rigid. Congress passed the Mission Act with bipartisan support last year, giving the VA secretary broad authority to create new rules governing the private-sector care program.

In addition to the new drive-time standards, the VA is proposing that any veteran who must wait more than 20 days for primary or mental health care be allowed into private-sector care. For specialty care, the agency proposes a 28-day wait.

VA Press Secretary Curt Cashour confirmed statistics from the New York Times, which reported the proposed rules would increase eligibility for community care from 8 percent of VA patients now to somewhere between 20 and 30 percent.

The agency believes not all veterans who are eligible for outside care will opt for it, he said.

“Eligibility for community care is not the same as actually opting for community care,” Cashour wrote in an email. “Veterans like the care VA offers.”

The VA plans to post the proposed rules to the Federal Register, where members of the public will be allowed to provide input. Under the law, the rules must be finalized by the beginning of March.

Wednesday’s announcement came after numerous criticisms from Democratic and Republican lawmakers, as well as major veterans organizations, who believe the VA should’ve worked with them more closely to establish the rules.

Democratic senators warned earlier this week that the VA was gearing up to make all VA patients “nearly automatically eligible” for private-sector health care – a decision they worry would divert billions of dollars to private entities and erode VA services.

The senators said they learned of the plans at recent briefings with VA officials regarding the VA Mission Act.

Twenty-nine Senate Democrats, led by Sen. Jon Tester, D-Mont., wrote Wilkie on Monday to outline their concerns. They criticized Wilkie for his lack of transparency and collaboration as he creates the rules. What they did know about the new access standards at the time was cause for concern, they said.

Many veterans organizations that supported the Mission Act have opposed plans to allow veterans unfettered access to the private sector – a move they worry could strip resources from the VA health care system.

The 29 senators warned in their letter that unfettered access could become a reality under the VA’s plan.

“VA leadership officials have indicated the department now intends to designate all clinical services as making a veteran nearly automatically eligible for community care,” they wrote. “This will significantly increase the overall cost and amount of care VA will send to the community.”

VA officials have been unclear about the potential cost of their plan, the senators said. At one briefing, lawmakers were told it would cost $21.4 billion for five years. At another, the cost estimate was $1 billion for the first year.

“These widely varying and potentially contradictory estimates do not give us confidence that VA is providing accurate and transparent information to Congress,” their letter reads.

The Democrats are also concerned about the source of the funding. Trump has asked each of his Cabinet secretaries for ideas to cut their department’s budget, citing an increase in overall spending during his first two years as president.

The senators wrote they “cannot support” increased costs for private-sector care coming at the expense of the VA health system.

Cashour said Wednesday that the agency estimates their new proposed rules will increase costs by $1.1 billion in fiscal year 2019. The new community care program is scheduled to go into effect in June. The end of the fiscal year is Sept. 30.

The VA insisted they had enough money to handle the cost increase for the remainder of the fiscal year and the changes would not affect funding for VA medical centers.

The VA’s annual budget request, typically released in February, will include additional money to cover the increase in fiscal year 2020, Cashour said.

One group immediately lauded the VA’s plan.

Concerned Veterans for America, a conservative group backed by billionaires Charles and David Koch, has pushed for an aggressive expansion of veterans’ care into the private sector. In a statement, the group said it was mostly pleased with the rules, though they wanted the 20-day wait standard to be shorter.

“These proposed access standards will ensure veterans have better access to health care and will give them more choices in how they receive their care,” said CVA Executive Director Dan Caldwell.

Other groups weren’t as quick to react to the proposals Wednesday.

Veterans of Foreign Wars, which supported the Mission Act, said they needed more time to analyze the rules and “determine what our next steps should be.”

“We are disappointed VA chose not to incorporate the voice of our 1.6 million members in the decision-making process,” VFW Executive Director Bob Wallace said.

The group has already taken issue with one of the rules. Wallace said the VA was making a mistake with the 20-day standard, which he described as “arbitrary.”


© 2019 the Stars and Stripes

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