The Department of Veterans Affairs today finalized a rule implementing 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, which begins June 6. 

Under the final rule, covered veterans must 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 agency also finalized a rule implementing the program’s urgent care provisions, which grant eligible veterans access to care from qualifying non-VA entities or providers without prior approval from VA for services provided at urgent care facilities and walk-in retail health clinics as designated by the Centers for Medicare & Medicaid Services. The rule also establishes the copayment obligations for veterans.

The AHA-supported MISSION Act of 2018 requires the agency to consolidate its existing community care programs into the new program

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