VA Reforms Veteran Access to Community Healthcare
The Department of Veterans Affairs has made it easier for qualifying VA-enrolled vets to get healthcare from community providers. The VA announced the activation of a feature in the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act, simplifying referrals for non-VA medical care. That law prohibits VA administrators from overriding a VA doctor’s referral for a patient to get non-VA medical services.
Dole Act Streamlines “Best Medical Interest” Referrals
A specific section of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act revises the referral process.
This part of the law removes the need for a second VA physician’s approval when a community care referral is based on the veteran’s best medical interest. That’s a determination meant to be made by the veteran and their primary VA clinician. The results of these changes are meant to include fewer delays and administrative hurdles in the process. It’s also created to help veterans get faster community care deemed most appropriate by them and their doctors.
>Never miss a benefits update or a military discount. Sign up for the FREE MyMilitaryBenefits.com newsletter.
Improving on MISSION Act Changes to VA Care
Since 2019, legislation known as the MISSION Act has allowed eligible veterans to receive VA-funded care from community providers. This option applies when outside care is in the veteran’s best medical interest, a decision made by the veteran and their VA physician. Under the original program, a second VA doctor had to review and approve these referrals.
The Dole Act provision mentioned above removes this secondary review. Under the updated rules, when a veteran and their VA clinician decide community care is the best option, that decision is final. This change allows faster treatment access and does not require the veteran to seek approval.
Community Care Access: Who Qualifies?
The MISSION Act of 2019 outlines conditions for enrolled veterans to choose community care. These rules, in effect today, provide a range of scenarios under which a veteran may get non-VA care.
One condition for accessing community care is when the veteran and their VA care provider agree that care outside the VA serves the veteran’s best medical interest; this is the area most directly affected by the reforms.
Veterans may also receive community care if the specific treatment they require is unavailable at a VA medical facility. Furthermore, eligibility extends to veterans living in a U.S. state or territory that lacks a full-service VA medical facility.
The VA’s ability to meet certain wait time or distance standards also determines eligibility. If the VA cannot offer an appointment within 20 days for primary care, mental health, or non-institutional extended care, or within 28 days for specialty care, a veteran may opt for community care.
External options become available if a veteran must drive more than 30 minutes for primary or mental health care or over 60 minutes for specialty care.
Community care is also an option if a VA service line does not meet established quality standards, and veterans who meet the grandfathered distance and location provisions of the former Veterans Choice Program remain eligible under the reforms.
>Never miss a benefits update or a military discount. Sign up for the FREE MyMilitaryBenefits.com newsletter.
About the author
Editor-in-Chief Joe Wallace is a 13-year veteran of the United States Air Force and a former reporter/editor for Air Force Television News and the Pentagon Channel. His freelance work includes contract work for Motorola, VALoans.com, and Credit Karma. He is co-founder of Dim Art House in Springfield, Illinois, and spends his non-writing time as an abstract painter, independent publisher, and occasional filmmaker.
