The Department of Veterans Affairs today proposed the criteria for determining when covered veterans may elect to receive necessary hospital, medical and extended care services from non-VA entities or providers under the Veterans Community Care Program. The AHA-supported MISSION Act of 2018 requires the agency to consolidate its existing community care programs into this new program by June.
 
Under the proposed rule, covered veterans would have to be enrolled in the VA health care system and meet at least one of six conditions: VA does not offer the required care or services; VA does not operate a full-service medical facility in the state in which the veteran resides; the veteran was eligible to receive care under the Veterans Choice Program and is eligible to receive care under certain grandfathering provisions; VA is not able to furnish care or services to a veteran in a manner that complies with VA’s designated access standards; the veteran and the referring clinician determine it is in the best medical interest of the veteran to receive care or services from an eligible entity or provider based on consideration of certain criteria VA proposes to establish; or the veteran is seeking care or services from a VA medical service line that VA has determined is not providing care that complies with VA’s standards of quality.
 
The proposed rule also designates access standards for the new program, as announced last month; describes non-VA entities and providers eligible to participate in the program; and clarifies payment rates and methodologies for those community providers to include rates for critical access hospitals and other types of providers. According to the agency, providers eligible to participate in the new program would be “substantively identical” to those permitted to participate under the VA’s current Veterans Choice or other community care programs.
 
The proposed rule will be published in tomorrow’s Federal Register with comments accepted for 30 days. VA last month issued a separate proposed rule implementing urgent care provisions for the new program.

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