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  • VA Rolls Out New Community Care Program

    The US Department of Veterans Affairs (VA) released final rules related to a completely retooled program that allows veterans more choice in health care providers, but some of the provisions will apply only to certain regions (for now), and other interpretations of the new rule—including whether physical therapists (PTs) will be considered primary care providers—will be made as needs arise.

    The final rules released this week are related to implementation of the VA Mission Act of 2018, which consolidates VA’s community care programs into a new community care program known as the Veterans Community Care Program. Among programs being consolidated is VA Choice, the program created in 2014 to increase access and reduce wait times for VA patients by allowing greater use of non-VA providers. The VA Choice Program will continue to provide care to veterans until the new program is fully operational.

    Community Care Eligibility Criteria
    The Veterans Community Care Program final rule provides the nuts-and-bolts guidance on the operation of the new Community Care Network, the centerpiece of the Mission Act, and specifically on 2 of the central features of the Mission Act: how and when veterans might qualify for receiving covered non-VA care, and who can provide it. The new community care provisions will apply only to certain regions of the country upon rollout and will expand incrementally.

    When it comes to which veterans would qualify for non-VA care, the rule includes a long list of criteria, including the inability of a VA facility to provide the type of care the veteran requires, as well as factors including treatment frequency, geographical proximity of an appropriate VA facility, the veteran's ability to travel, and a "compelling reason" for the veteran to receive non-VA services, among others.

    Entities who want to be included as eligible non-VA providers will need to enter into a contract with VA, and either not be a part of (or employee of) VA or not provide the same services provided within the VA. The provider must also be accessible to the veteran, which includes a reasonable wait time to receive services. The rule also states that VA will announce quality standards through a separate document but predicts that "quality comparisons will generally be based on care that is locally available and not on national averages." In its comments on the proposed rule, APTA asked VA to clarify how it would define types of care, including primary and specialty care, and whether physical therapy would be considered primary care. The VA responded by taking a wait-and-see approach, writing that "we believe in a majority of cases that it will be clear what standard should be applied to what care."

    For now, the new system is being rolled out in states in Regions 1, 2, and 3 of VA’s new Community Care Network, which includes mid-Atlantic, southern, and Midwestern states: Alabama, Arkansas, Florida, Georgia, Illinois, Indiana, Iowa, Kansas Kentucky, Louisiana, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Puerto Rico, Rhode Island, South Carolina, South Dakota, Tennessee, US Virgin Islands, Vermont, Virginia, Washington DC, West Virginia, and Wisconsin. The program isn’t expected to be operational everywhere until the end of 2019 at the earliest.

    Urgent care
    In another rule, VA clarified policies and procedures around covering veteran access to urgent care from non-VA providers without prior approval from VA. Qualifying facilities would include urgent care and walk-in retail health clinics.

    As in the community care rule, qualifying non-VA providers would need to enter into a contract or agreement with VA. Veterans could in turn go to those facilities to seek a range of urgent care, including flu shots, vaccines, certain screenings, and other services, so long as the care isn't emergent or based on care over an extended period of time. In the rule, VA states it will provide veterans with information on participating urgent care providers.

    In its comments on the proposed rule, APTA asked VA about whether follow-up care related to a covered urgent care visit would need separate VA authorization. VA responded by stating that follow-up care must be coordinated by VA.

    APTA regulatory affairs staff continues to monitor the implementation of the Mission Act and will post resources and information on its Veterans Affairs and TRICARE webpage.


    • I am 100% disabled I need my spine corrected this was from the Vietnam war in 1969 and I have yet found anyone to respond to me all these years! lemilo1948@gmail.com

      Posted by Louis EmiloJr on 7/29/2019 3:21 PM

    • What VA are you closest to?

      Posted by MiscInfo on 9/10/2019 10:54 PM

    • Where can i go to get incare treatment for alcoholism? I live in Alexandria Va.

      Posted by JEFFREY KENDALL on 10/10/2019 2:02 PM

    • I AM presently being treated for under active thyroid and have a 24/7 hospiTAL 20 miles away while the VA is 54. I an 100% disabled vietnam combat vet. Can I be treated there or are they able to refer me to a local specialist?

      Posted by John A Sullivan on 10/22/2019 10:35 PM

    • I have been waiting to hear from some one at the v.a. who can tell me I've been approved to go to Blue Water ear, nose and throat so i can HEAR! No one has gotten back to me or the doctor at Blue Water. What is going on? Can't i just go and then submit the bill to the v.a.? It would cut out a whole time consuming step.

      Posted by Robert Serido on 11/19/2019 3:38 PM

    • How do I know if I qualify for the community care program?

      Posted by Vickie Vaughan on 11/21/2019 4:49 PM

    • How can I find out if I qualify for the community care program

      Posted by Johnny Ledford on 12/14/2019 1:28 PM

    • As lots of Veterans do not know, As of November 2017 President Donald Trump has established a Veterans hotline phone number 855-948-2311, this is for 24 hrs a day with 60 agents to answer the phone, it provides Veterans an option to report issues that are not being addressed through the VAs normal channels. The hotline agents have access to a multitude of resources and contact information to help Veterans having problems with the VA.

      Posted by Glenn West on 1/14/2020 7:54 PM

    • Great information! Thanks for explaining the eligibility criteria regarding veteran care. It is better to know what kind of veteran falls in the criteria and it eligible for the benefits. Many rules regarding veteran care have been made and it was necessary too for their welfare.

      Posted by Walk in clinic palm bay FL on 1/22/2020 12:11 AM

    • Too see. V.A. Doctor i travel 54 miles. For Speciality care I travel 68 miles. My community providers are 21 miles away. I am 100% disabled and 76 years old. Do I have contact and apply at every step for care. Emergency or otherwise?

      Posted by Arthur William Cartwright 111 on 5/3/2020 3:35 PM

    • I want to know about the apointments scheduled.before the momth of march

      Posted by jorge rodriguez on 5/6/2020 2:05 PM

    • • @Arthur: Veterans eligible for community care generally have the option of choosing to receive care from a VA medical facility or community provider. For Veterans who choice to receive community care, a VA staff member will discuss with them their preferences for getting care from a community provider. For more information, please see: https://www.va.gov/COMMUNITYCARE/programs/veterans/General_Care.asp

      Posted by APTA staff on 5/7/2020 8:05 AM

    • @Jorge: We are not sure what you're asking. For information about the VA Community Care Program, please see: http://www.apta.org/PTinMotion/News/2019/06/07/VACommunityCareFinalRule/

      Posted by APTA staff on 5/7/2020 8:06 AM

    • My wife has Champ VA trying to find what Doctor will take Champ VA, also what pharmacy she can go too. Thanks Larry

      Posted by Larry E Wills on 5/12/2020 9:45 PM

    • @Larry: The family member programs administered by the Veterans Health Administration Office of Community Care, including CHAMPVA, do not have networks of medical providers. However, you may find both the Medicare and the TRICARE websites helpful in locating a provider. For more information, please see: https://www.va.gov/COMMUNITYCARE/programs/dependents/locate_provider.asp

      Posted by APTA staff on 5/13/2020 7:42 AM

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