Q&A: Veterans Health Choice Initative


Staff Report

Question: What is the new Veterans Choice Health Initiative and who is eligible:

Answer:

Background:

In order to improve VA’s ability to deliver high-quality health care to Veterans, section 101 of the Choice Act requires VA to expand the availability of hospital care and medical services for eligible Veterans through agreements with eligible non-VA entities and providers. This is referred to as the Veterans Choice Program.

Veterans who meet certain eligibility requirements will be able to elect to receive care from eligible non-VA entities and providers through the Program. VA must enter into agreements with eligible non-VA health care entities and providers for them to participate in the Program. Prior to the Choice Act being passed, VA had mechanisms in place to purchase non-VA care. Those mechanisms are still available to VA, and the Choice Act will enhance VA’s non-VA care options.

VA will provide a Veterans Choice Card to all Veterans who were enrolled in the VA health care system as of August 1, 2014, and to recently discharged combat Veterans.

Eligibility criteria:

A Veteran must be enrolled in VA health care on or before August 1, 2014, or be eligible to enroll as a recently discharged combat Veteran within 5 years of separation.

Additionally, a Veteran must also meet at least one of the following criteria.

a) The Veteran attempts to schedule an appointment with VA for hospital care or medical services but is unable to schedule an appointment within 30 days of the Veterans preferred date, or the clinically appropriate date

b) The Veteran lives more than 40 miles from the VA facility that is nearest to the Veteran’s residence, including a community-based outpatient clinic.

c) The Veteran lives in a state without a medical facility that provides hospital care, emergency services and surgical care rated by the Secretary as having a surgical complexity of standard, and the Veteran resides more than 20 miles from such facility.

d) The Veteran lives 40 miles or less from a VA health care facility but needs to travel by air, boat, or ferry, or faces an unusual or excessive burden on travel due to geographical challenges.

Cost Sharing If an eligible Veteran has another health-care plan, VA will be secondarily responsible for costs associated with non-service connected care and services furnished to eligible Veterans through the Veterans Choice Program.

Medical Records When a Veteran receives care from an eligible non-VA health care entity or provider, the entity or provider must submit to VA a copy of any medical record information related to the care and services provided. This information will be included in the Veteran’s medical record maintained by the Department. Source: www.va.gov