The VA establishes a temporary program to make it easier for veterans to obtain medical care.
The U.S. Department of Veterans Affairs (VA) recently issued an interim final rule expanding medical care options for veterans facing excessive wait times at VA facilities. The interim final rule is a short-term effort to mitigate wait times brought about by fraudulent record-keeping and mismanagement of a benefit program for seriously injured post-9/11 veterans.
The interim final rule, issued on November 5, establishes a temporary Veterans Choice Program under which eligible veterans may receive hospital care and medical services from certain non-VA providers. The program, set to expire in August 2017 or when funds are exhausted, is designed to help veterans experiencing treatment delays gain timely access to care.
Although the VA has always had the ability to authorize care through non-VA providers, the Veterans Choice Program enhances funding for this purpose in an effort to remedy recently exposed inefficiencies in the VA’s provision of medical services. The administrative and financial issues plaguing the agency came to light in May, shortly before the resignation of VA Secretary Eric Shineski, when the VA Office of Inspector General released a report exposing a VA facility in Phoenix for falsifying records in order to conceal wait times.
The Inspector General found that the average wait time for an appointment at the Phoenix facility reached 115 days, vastly exceeding 30-day wait-time goals the Veterans Health Administration (VHA) established. The Inspector General further found that as many as 1,700 of the 3,100 veterans seeking appointments were excluded from the official wait list. Those veterans were placed on “secret,” unofficial wait lists until an appointment could be made within the appropriate time frame.
President Obama signed the Veterans Access, Choice, and Accountability Act of 2014 in August 2014, allocating more than $16 billion to help the VA improve access to medical care. The Act required the VA to create the new Veterans Choice Program and also provided for other measures, including hiring of additional doctors and medical staff and leasing of additional medical facilities.
The increased delays at VA medical centers may be at least partially attributed to the agency’s mismanagement of the Family Caregiver Program, a program established in May 2011 to provide support for caregivers of veterans injured in the line of duty after 9/11.
The Government Accountability Office (GAO) published a report in September 2014 concluding that the VA “significantly underestimated” the demand for services under the Family Caregiver Program. The Veterans Health Administration, tasked with overseeing the program, initially estimated that 4,000 caregivers would be approved by September 2014. In fact, more than 15,600 were approved before May.
Caregivers experienced significant delays in approval determinations and services and VA medical centers had trouble managing the heightened workload, leading to increased wait times for other veterans in need of care. The VHA continues to add about 500 approved caregivers to the program each month, making it difficult for VA medical centers to keep up with constantly increasing workloads.
The VA issued the first set of Veterans Choice Cards on November 5, 2014 to veterans who live more than 40 miles from the nearest VA health center. The second set of cards, issued November 17, went to veterans who have waited more than 30 days beyond the date it had been deemed “medically necessary” for them to have an appointment.
Veterans may also qualify for cards if they face excessive burdens in traveling to a VA facility. For example, if a veteran must travel by air, boat, or ferry to reach the nearest facility, or if they reside in a state that does not have a VA medical facility that provides certain types of services, such as hospital and emergency care, they may qualify. The agency expected to issue a total of 700,000 cards in November, and another 8 million in December, to veterans enrolled in the agency’s health network.
Eligible veterans who elect to receive non-VA care may choose their own eligible provider. To be eligible for medical coverage under the VA’s new Choice Program, non-VA providers must be able to provide timely and adequate care, must be within a reasonable distance of the veterans’ home, and must meet the same licensing and other requirements as VA providers. Also under the new program, VA will reimburse veterans’ out-of-pocket costs, such as co-payments, prescriptions, and travel expenses, which exceed the costs for which veterans are normally liable for under existing programs.
The rule goes into effect immediately upon publication and is set to expire in August 2017, unless the funding for the program runs out first. The VA did not seek comments on this interim final rule prior to its effective date in an effort to expedite the program’s implementation, but the rule is open for public comment until March 5, 2015. The VA specifically seeks comments about collection of information from eligible veterans and medical providers.
