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VA Releases the Mission Act’s Community Access Standards

VA Releases the Mission Act’s Community Access Standards

As part of VA’s implementation of the Mission Act, the department released its long-awaited access standards on community care and urgent care that are expected to take effect in June of 2019 when the final regulations are published.  These standards will guide when veterans can seek the care necessary to meet their needs, whether it is with VA or outside community providers.  Lawmakers are expected to hold hearings on the new proposed rules in the coming weeks.

New Access Standards

VA has indicated that the eligibility criteria and final standards are based on an analysis of all the best practices in both the government and in the private sector, and then tailored to the needs of veteran patients.  The new access standards are as follows:

  • Access standards will be based on average drive time and appointment wait times
  • For primary care, mental health, and non-institutional extended care services, VA is proposing a 30-minute average drive time standard
  • For specialty care, VA is proposing a 60-minute average drive time standard
  • VA is proposing appointment wait-time standards of 20 days for primary care, mental health care, and non-institutional extended care services, and, 28 days for specialty care from the date of request with certain exceptions

Eligible veterans who cannot access care within the above-mentioned standards will be able to choose between eligible community care providers and care at a VA medical facility.  The new community access standards also address urgent (walk-in) care.  Specifically, eligible veterans will have access to urgent care that gives them the choice to receive certain services when and where they need it.  To access this new urgent care benefit, veterans will select a provider in VA’s community care network and while emergency appointments will require a copayment from veterans, VA will cover the bulk of the costs.

Mission Act Access Standards vs. Choice Act Access Standards

The VA Mission Act’s community access standards will replace the 40-mile, 30-day guidelines that are currently in place under the Veterans Choice and Accountability Act of 2014 (Choice Act).  This shift in standards could dramatically increase the number of outside health care appointments that VA will have to fund in the coming years.  However, the Choice Act will likely continue until it is replaced by the Mission Act in June.

VA Healthcare Statistics

According to research and statistics, VA is giving veterans the power to choose the care they trust, and more veterans are choosing VA for healthcare than ever before.  Since 2014, the number of annual appointments for VA care is up by 3.4 million, with over 58 million appointments in fiscal year 2018 alone.  Additionally, surveys indicate that patient trust in VA has increased to 87.7 percent.  VA reports that wait times are shorter than those in the private sector in primary care and two of three specialty care areas, as supported by a 2019 study published by the Journal of the American Medical Association (JAMA).  The study compared wait times between VA and private-sector clinics in 15 major metropolitan areas for appointments in primary care, dermatology, cardiology, and orthopedics.  For all specialties except orthopedics, VA wait times were similar to private-sector wait times in 2014, and were shorter in 2017.  Furthermore, the average wait time in 2014 for a VA appointment in one of these specialties was 22.5 days, compared with 18.7 days for outside care physicians.  This average wait time for VA treatment decreased to 17.7 days in 2017, but increased to 29.8 days for private-sector treatment.

Additional studies, including the 2018 Rand study and the 2018 Dartmouth study, found that the VA healthcare system “generally delivers higher-quality care than other health providers” and “VHA hospitals outperform non-VHA hospitals in most health care markets,” respectively.

 

Category: Veterans Law

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