The Department of Veterans Affairs (VA) has issued a proposed rule implementing provisions of the Veterans Community Care Program — authorized by the MISSION Act — which allows covered veterans to receive necessary hospital, medical and extended care services from non-VA providers.
Under the MISSION Act, veterans enrolled in the VA health system can seek care from non-VA providers if they meet one of the following six conditions:
- VA does not offer the required care or services.
- VA does not operate a full-service medical facility in the state where 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 proposed access standards.
- The veteran and the referring clinician determine it is in the veteran’s best medical interest to receive care or services from an eligible entity or provider based on consideration of proposed criteria.
- 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 defines which non-VA entities and providers are eligible to participate in the program and clarifies payment rates and methodologies for those community providers. VA previously issued a separate proposed rule implementing urgent care provisions for the new program. Comments on the proposed rule are due March 25.