United States: The VA MISSION Act: Enhancing Healthcare For Veterans

On Wednesday, June 6, 2018, President Trump signed into law the "John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Networks Act" a.k.a. the VA MISSION Act of 2018 ("VAMA"), a $52 billion reform bill aimed at improving access to, and the quality of, medical services provided to veterans by the Department of Veterans Affairs ("VA").

Increase Veteran Access to High-Quality Healthcare Services

In brief, VAMA has two essential components. First, it extends comprehensive caregiver benefits to veterans injured or made ill prior to Sept. 11, 2001. As described by Washington Headquarters Executive Director, Garry Augustine, VAMA takes major strides to bring equality into the VA's coverage of family caregiver services for both veterans insured before 9/11 and veterans injured on or after 9/11.

Second, VAMA directs the VA to combine a number of existing private-care programs, including the "Veterans Choice Program," to improve veterans' access to healthcare services and to improve the quality of such services. More specifically, VAMA's quality and access provisions:

  1. Allow coverage of medical services provided to veterans by private community-based physicians as long as a VA physician believes that the receipt of services from a private community-based physician is in the veteran's best interest;
  2. Make community care programs more efficient and accessible to veterans by expanding the VA healthcare provider network; and
  3. Provide one (1) year of bridge funding ($5.2 billion) for the existing VA Choice Program to ensure that current private-sector medical appointments for veterans are not interrupted while VAMA requirements are implemented – a process which is anticipated to take about one (1) year.

Telehealth

In past Healthcare Blog posts, we have reviewed and commented on telehealth-related initiatives and the efforts being made at the federal and state levels to expand the range of healthcare services that can be provided via telehealth technology and the availability of telehealth services for Medicare, Medicaid, and other patients.1 In furtherance of its goal to expand veteran access to high quality and coordinated healthcare services, VAMA includes various telehealth-related provisions.

First, VAMA retracts the VA's jurisdictional constraints on telemedicine by allowing VA healthcare professionals to practice telemedicine regardless of the location of the provider or patient during the treatment. Historically, in order for the service to be paid for by the VA, VA physicians practicing telemedicine were required to be located and licensed in the same state as their patient, and the service had to be offered in a federal facility. Under VAMA, however, VA professionals providing services to veterans are now able to offer telehealth services irrespective of professional's or veteran's location as long as the VA professional possesses one valid state medical license.

Second, VA health professionals providing healthcare services through telehealth will need to adhere to the same quality and efficiency standards across the country. To ensure quality and efficiency benchmarks are met, the VA will be required to submit a report to congress within one (1) year of the enactment of VAMA outlining, among other things, provider and patient satisfaction and statistics relating to the impact of telemedicine on patient wait times.

Finally, VAMA also provides for changes in the way health data will be transmitted and shared between VA healthcare providers and community-based providers. Specifically, community-based providers will have full access to relevant VA records for their patient, the purpose of which is to enhance the level of continuity of care among VA and community-based providers. For example, VA and community based providers will each have access to the prescription records of their patients in an effort to reduce addiction and over prescribing.

The Pros and the Cons

The Pros. Proponents of VAMA believe that it provides much needed reform to a failed system and would relieve many of the issues veterans currently face when trying to receive healthcare services including inadequate access to specialized care in remote and rural areas, and a lack of continuity of care and quality among providers. VAMA is also praised for providing veterans options so that they are not subject to notoriously long wait times at VA facilities.

Additionally, proponents say that the increase in funding will also improve the talent-pool available to the VA. VAMA encourages job applicants by requiring that the VA be more public about job postings, and establishing a scholarship program for VA doctors.

The Cons. Opponents to VAMA are concerned that the privatization of health services for veterans will lead to a decrease in the resources available to VA facilities and ultimately result in higher out-of-pocket costs for veterans.

For example, there is an ongoing concern amongst VAMA opponents that privatization will deter veterans from visiting VA facilities even though VA facilities have more experience dealing with the common medical issues that veterans face. More broadly, in a May 16, 2018 Press Release issued by Democratic Congresswoman Dina Titus (NV-01), Congresswoman Titus states, as many VAMA opponents have argued, that the VAMA "threatens successful (VA) programs, could lead to budget cuts for VA services, and puts the VA on a path to privatization that hurts our veterans and their families."

As for the budgetary concerns voiced by Congresswoman Titus in the above referenced Press Release, many VAMA opponents are worried that the privatization of VAMA services could threaten the existence of veteran healthcare programs. The argument voiced in support of this concern is that if a significant amount of veterans choose private sector healthcare services rather than receiving care at VA facilities, federal dollars that would otherwise go toward VA facilities would go to private entities. If veteran participation at VA facilities were to diminish as a result of veterans using private healthcare providers instead of VA healthcare providers, VAMA could lead to budget cuts that would ultimately harm the VA's other successful non-healthcare related programs such as job training, homelessness, and VA research.

Funding

Although President Trump touted the expansion of veterans healthcare when signing VAMA into law on June 6, 2018, the President is currently fighting a bipartisan plan to fund the much-touted expansion– an expansion that is said to cost $50 billion of additional VA spending.

As described by Erica Werner and Lisa Rein in a Washington Post article, "Trump signs veterans health bill as White House works against bipartisan plan to fund it," dated June 6, 2018, two Senate Republicans heading powerful Senate committees and their Democratic counterparts want to pay for the $50 billion VAMA by lifting existing spending caps within a large funding bill – "Fiscal Year 2019 Transportation, Housing and Urban Development, and Related Appropriations Act" S. 3023 (115th) ("THUD Appropriations Act"). The charge on the THUD Appropriations Act is being led by Senators Richard Shelby (R-Ala.) (Chairman of the Senate Appropriations Committee), Patrick Leahy (D-Vt.) (Ranking Democrat, Senate Appropriations Committee), Johnny Isakson (R-Ga.) (Chairman of the Senate Veterans' Affairs Committee) and Jon Tester (D-Mont.) (Ranking Democrat, Senate Veterans' Affairs Committee).

According to supporters of the THUD Appropriations Act, the appropriation and increased spending caps would shield other veterans' benefits from being cut to pay for VAMA – VAMA expenses largely coming from the funding of claims submitted to the VA by private healthcare providers. Id. As described by Senator Shelby in an interview with The Washington Post, "If we don't get on [the $50 billion appropriation in the THUD Appropriations Act] we're going to have a hole of $10 billion in our [appropriations]." "Trump signs veterans health bill as White House works against bipartisan plan to fund it," The Washington Post, by Erica Werner and Lisa Rein (June 6, 2018).

Some have conjectured that the Trump Administration's unwillingness to consider new spending in support of VAMA is, in part, related to the significant criticism the President received from members of his own party for the $1.3 trillion government-wide spending bill that was signed into law in March, 2018. Id. The THUD Appropriations Act may find its way to the Senate floor as early as this week. We will be following the Act and will provide updates as the legislative process proceeds.

Footnotes

1 Telehealth/telemedicine blog articles include: More Telemedicine Food for Thought: Exception Five to the Haight Act's In-Person Examination Requirement by Kenneth Yood, Esq. and Erica Kraus, Esq.; Texas Telemedicine Saga Finally Over? The Texas Medical Board Substantially Revises Telemedicine Regulations by Kristi Kung, Esq. (December 11, 2017); and Life in the Slow Lane? What the Net Neutrality Repeal May Mean for Telehealth Services by Kristi Kung, Esq. (January 25, 2018), etc.

The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.

To print this article, all you need is to be registered on Mondaq.com.

Click to Login as an existing user or Register so you can print this article.

Authors
Events from this Firm
3 Dec 2018, Other, Los Angeles, United States

National Contract Management Association’s Government Contract Management Symposium

20 Feb 2019, Seminar, Orange, United States

The annual seminar addressing changes and developments in state and federal wage and hour laws is a unique one-day program and hundreds of California employers, personnel managers, controllers, attorneys, payroll managers, and supervisors attend each year.

21 Feb 2019, Seminar, Orange, United States

The seminar is designed to provide a guide to Human Resource Officials, Personnel Specialists, Consultants, Supervisors and other management officials through the ever-increasing maze of state and federal employment discrimination laws.

 
In association with
Related Topics
 
Related Articles
 
Related Video
Up-coming Events Search
Tools
Print
Font Size:
Translation
Channels
Mondaq on Twitter
 
Register for Access and our Free Biweekly Alert for
This service is completely free. Access 250,000 archived articles from 100+ countries and get a personalised email twice a week covering developments (and yes, our lawyers like to think you’ve read our Disclaimer).
 
Email Address
Company Name
Password
Confirm Password
Position
Mondaq Topics -- Select your Interests
 Accounting
 Anti-trust
 Commercial
 Compliance
 Consumer
 Criminal
 Employment
 Energy
 Environment
 Family
 Finance
 Government
 Healthcare
 Immigration
 Insolvency
 Insurance
 International
 IP
 Law Performance
 Law Practice
 Litigation
 Media & IT
 Privacy
 Real Estate
 Strategy
 Tax
 Technology
 Transport
 Wealth Mgt
Regions
Africa
Asia
Asia Pacific
Australasia
Canada
Caribbean
Europe
European Union
Latin America
Middle East
U.K.
United States
Worldwide Updates
Registration (you must scroll down to set your data preferences)

Mondaq Ltd requires you to register and provide information that personally identifies you, including your content preferences, for three primary purposes (full details of Mondaq’s use of your personal data can be found in our Privacy and Cookies Notice):

  • To allow you to personalize the Mondaq websites you are visiting to show content ("Content") relevant to your interests.
  • To enable features such as password reminder, news alerts, email a colleague, and linking from Mondaq (and its affiliate sites) to your website.
  • To produce demographic feedback for our content providers ("Contributors") who contribute Content for free for your use.

Mondaq hopes that our registered users will support us in maintaining our free to view business model by consenting to our use of your personal data as described below.

Mondaq has a "free to view" business model. Our services are paid for by Contributors in exchange for Mondaq providing them with access to information about who accesses their content. Once personal data is transferred to our Contributors they become a data controller of this personal data. They use it to measure the response that their articles are receiving, as a form of market research. They may also use it to provide Mondaq users with information about their products and services.

Details of each Contributor to which your personal data will be transferred is clearly stated within the Content that you access. For full details of how this Contributor will use your personal data, you should review the Contributor’s own Privacy Notice.

Please indicate your preference below:

Yes, I am happy to support Mondaq in maintaining its free to view business model by agreeing to allow Mondaq to share my personal data with Contributors whose Content I access
No, I do not want Mondaq to share my personal data with Contributors

Also please let us know whether you are happy to receive communications promoting products and services offered by Mondaq:

Yes, I am happy to received promotional communications from Mondaq
No, please do not send me promotional communications from Mondaq
Terms & Conditions

Mondaq.com (the Website) is owned and managed by Mondaq Ltd (Mondaq). Mondaq grants you a non-exclusive, revocable licence to access the Website and associated services, such as the Mondaq News Alerts (Services), subject to and in consideration of your compliance with the following terms and conditions of use (Terms). Your use of the Website and/or Services constitutes your agreement to the Terms. Mondaq may terminate your use of the Website and Services if you are in breach of these Terms or if Mondaq decides to terminate the licence granted hereunder for any reason whatsoever.

Use of www.mondaq.com

To Use Mondaq.com you must be: eighteen (18) years old or over; legally capable of entering into binding contracts; and not in any way prohibited by the applicable law to enter into these Terms in the jurisdiction which you are currently located.

You may use the Website as an unregistered user, however, you are required to register as a user if you wish to read the full text of the Content or to receive the Services.

You may not modify, publish, transmit, transfer or sell, reproduce, create derivative works from, distribute, perform, link, display, or in any way exploit any of the Content, in whole or in part, except as expressly permitted in these Terms or with the prior written consent of Mondaq. You may not use electronic or other means to extract details or information from the Content. Nor shall you extract information about users or Contributors in order to offer them any services or products.

In your use of the Website and/or Services you shall: comply with all applicable laws, regulations, directives and legislations which apply to your Use of the Website and/or Services in whatever country you are physically located including without limitation any and all consumer law, export control laws and regulations; provide to us true, correct and accurate information and promptly inform us in the event that any information that you have provided to us changes or becomes inaccurate; notify Mondaq immediately of any circumstances where you have reason to believe that any Intellectual Property Rights or any other rights of any third party may have been infringed; co-operate with reasonable security or other checks or requests for information made by Mondaq from time to time; and at all times be fully liable for the breach of any of these Terms by a third party using your login details to access the Website and/or Services

however, you shall not: do anything likely to impair, interfere with or damage or cause harm or distress to any persons, or the network; do anything that will infringe any Intellectual Property Rights or other rights of Mondaq or any third party; or use the Website, Services and/or Content otherwise than in accordance with these Terms; use any trade marks or service marks of Mondaq or the Contributors, or do anything which may be seen to take unfair advantage of the reputation and goodwill of Mondaq or the Contributors, or the Website, Services and/or Content.

Mondaq reserves the right, in its sole discretion, to take any action that it deems necessary and appropriate in the event it considers that there is a breach or threatened breach of the Terms.

Mondaq’s Rights and Obligations

Unless otherwise expressly set out to the contrary, nothing in these Terms shall serve to transfer from Mondaq to you, any Intellectual Property Rights owned by and/or licensed to Mondaq and all rights, title and interest in and to such Intellectual Property Rights will remain exclusively with Mondaq and/or its licensors.

Mondaq shall use its reasonable endeavours to make the Website and Services available to you at all times, but we cannot guarantee an uninterrupted and fault free service.

Mondaq reserves the right to make changes to the services and/or the Website or part thereof, from time to time, and we may add, remove, modify and/or vary any elements of features and functionalities of the Website or the services.

Mondaq also reserves the right from time to time to monitor your Use of the Website and/or services.

Disclaimer

The Content is general information only. It is not intended to constitute legal advice or seek to be the complete and comprehensive statement of the law, nor is it intended to address your specific requirements or provide advice on which reliance should be placed. Mondaq and/or its Contributors and other suppliers make no representations about the suitability of the information contained in the Content for any purpose. All Content provided "as is" without warranty of any kind. Mondaq and/or its Contributors and other suppliers hereby exclude and disclaim all representations, warranties or guarantees with regard to the Content, including all implied warranties and conditions of merchantability, fitness for a particular purpose, title and non-infringement. To the maximum extent permitted by law, Mondaq expressly excludes all representations, warranties, obligations, and liabilities arising out of or in connection with all Content. In no event shall Mondaq and/or its respective suppliers be liable for any special, indirect or consequential damages or any damages whatsoever resulting from loss of use, data or profits, whether in an action of contract, negligence or other tortious action, arising out of or in connection with the use of the Content or performance of Mondaq’s Services.

General

Mondaq may alter or amend these Terms by amending them on the Website. By continuing to Use the Services and/or the Website after such amendment, you will be deemed to have accepted any amendment to these Terms.

These Terms shall be governed by and construed in accordance with the laws of England and Wales and you irrevocably submit to the exclusive jurisdiction of the courts of England and Wales to settle any dispute which may arise out of or in connection with these Terms. If you live outside the United Kingdom, English law shall apply only to the extent that English law shall not deprive you of any legal protection accorded in accordance with the law of the place where you are habitually resident ("Local Law"). In the event English law deprives you of any legal protection which is accorded to you under Local Law, then these terms shall be governed by Local Law and any dispute or claim arising out of or in connection with these Terms shall be subject to the non-exclusive jurisdiction of the courts where you are habitually resident.

You may print and keep a copy of these Terms, which form the entire agreement between you and Mondaq and supersede any other communications or advertising in respect of the Service and/or the Website.

No delay in exercising or non-exercise by you and/or Mondaq of any of its rights under or in connection with these Terms shall operate as a waiver or release of each of your or Mondaq’s right. Rather, any such waiver or release must be specifically granted in writing signed by the party granting it.

If any part of these Terms is held unenforceable, that part shall be enforced to the maximum extent permissible so as to give effect to the intent of the parties, and the Terms shall continue in full force and effect.

Mondaq shall not incur any liability to you on account of any loss or damage resulting from any delay or failure to perform all or any part of these Terms if such delay or failure is caused, in whole or in part, by events, occurrences, or causes beyond the control of Mondaq. Such events, occurrences or causes will include, without limitation, acts of God, strikes, lockouts, server and network failure, riots, acts of war, earthquakes, fire and explosions.

By clicking Register you state you have read and agree to our Terms and Conditions