CHA News

VA Issues Final Rule Implementing Veterans Community Care Program

For CFOs, Reimbursement Staff

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The Department of Veterans Affairs (VA) has issued its final 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. The final rule became effective June 6, when the Veterans Community Care Program replaced the Veterans Choice Program, as required by the MISSION Act of 2018.

In comments on the proposed rule, CHA raised concerns that the VA did not include the required regulations to implement the prompt payment provisions required by the MISSION Act. In the final rule, VA states that it will issue these regulations in a separate notice and comment period, but did not establish a timeline for that rulemaking process.

Notably, the VA has not yet selected a third-party administrator for California’s region to establish networks under the new Veterans Community Care Program. Community providers that currently participate in the Veterans Choice Program under a contract administered by the TriWest Healthcare Alliance can continue to provide care to veterans who meet eligibility requirements under the new program until the new contracts are established.

Community providers that have a Veterans Choice Program provider agreement with a VA medical facility are no longer able to provide care under those arrangements, as of June 6. To continue to provide care, those providers will be required to participate in a contracted network administered by the third-party administrator, once established. A fact sheet about the transition is available on the VA website.

The VA issued a separate final 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.