As part of the ongoing reforms to address and remedy the systemic scheduling problems and other procedural violations affecting hospitals across the country operated by the U.S. Department of Veterans Affairs (VA), President Obama signed the Veterans Access, Choice and Accountability Act of 2014 (Choice Act) into law on August 7, 2014. Technical revisions to the Act were made on September 26, 2014, when the President signed into law the VA Expiring Authorities Act of 2014 (Public Law 113-175).
The VA aims to provide timely, high quality health care to veterans, and effective November 5, 2014, the new Choice Program covers non-VA care for eligible veterans enrolled in VA health care. Veterans are eligible if any of these situations apply:
- Veterans have been told by their local VA medical facility that they will need to wait more than 30 days from their preferred date or the date medically determined by their physician.
- The veteran's current residence is more than 40 miles from the closest VA health care facility.
- The veteran needs to travel by plane or boat to the VA medical facility closest to his or her home.
- The veteran faces a geographic challenge, such as extensive distances around water or other geologic formations, such as mountains, that present a significant travel hardship.
Many veterans also now have the option to receive non-VA health care rather than wait for a VA appointment or travel to a VA facility for services.
As the Choice Program rolls into effect, health care providers are reminded of the opportunities available to them to fulfill the health care needs of veterans under the Patient-Centered Community Care, or PC3, program.
A relatively unknown VA program, PC3 allows hospitals and other providers to contract with HealthNet and TriWest (depending upon the provider's geographic location) to provide services to local veterans when their local VA hospital is unable to do so, whether because of a lack of available specialists, prolonged wait times, geographic inaccessibility or other factors.
PC3 contracts cover the following services:
- Inpatient specialty care
- Outpatient specialty care (including skilled home health and home infusion therapy services)
- Mental health care
- Limited emergency care
- Limited newborn care for enrolled female veterans following the birth of a child
Services by a non-VA contracted provider are authorized by local non-VA Care Coordination staff, who also assist with appointment coordination. Reimbursement rates are typically 92 to 97.5 percent of Medicare.
During FY 2013, the VA purchased non-VA medical care for more than one million veterans at a cost of $4.81 billion. Non-VA expenditures for outpatient and ancillary care exceeded $1.4 billion, and non-VA expenditures for inpatient and ancillary care exceeded $1.3 billion.
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