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  • Washington Highlights

    Senate VA Committee Holds Hearing on Community Care Network Implementation


    Christa Wagner, Manager, Government Relations
    Matthew Shick, Sr. Director, Gov't Relations & Regulatory Affairs

    The Senate Committee on Veterans’ Affairs held a hearing Feb. 5 titled “VA MISSION Act: Update on the Implementation of the Community Care Network,” focusing on the implementation of a new community care network that aims to provide veterans access to more health care providers.

    The hearing addressed how the VA MISSION Act will provide veterans better access to health care through the newly formed Community Care Network (CCN) and improve the Department of Veterans Affairs (VA) ability to recruit and retain medical providers. Committee members heard testimony from witnesses including Dr. Richard Stone, Executive in Charge of the Veterans Health Administration, representatives from Disabled American Veterans and third party administrators tasked with managing the CCN.

    The John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018,  or VA MISSION Act (P.L. 115-182), established the new CCN for veterans, including new eligibility criteria for care and access to more health care providers outside of the VA [see Washington Highlights, May 4, 2018, and April 19, 2019]. CCN began implementation on June 6, 2019, and Region 1 in the northeastern United States recently completed deployment of its new provider network.

    In his opening statement, new Committee Chair Jerry Moran (R-Kan.) stated the importance of an efficient and accountable implementation of CCN, both for the benefit of veterans and as a central component to the MISSION Act. Chairman Moran expressed  concerns about the VA’s ability to handle increased demand from veteran patients.

     “A recent VA OIG report predicts wait times could worsen once MISSION is in full effect. This is in addition to reports that the VA is still struggling with scheduling delays and paying community providers on time,” Sen. Moran said.

    Ranking Member Jon Tester (D-Mont.) said  CCN was created by Congress to supplement, not supplant, care provided by the VA. Sen. Tester expressed disappointment that the VA does not have data on the number of appointments completed through CCN in the first eight months of the program leading up to the expected release of the president’s fiscal year 2021 budget request on Feb. 10.

    In his opening statement, Dr. Stone described health care access improvements through greater reach in rural locations, new urgent care benefits, and increased telehealth utilization. Dr. Stone also highlighted the new medical school scholarship program, which will support two veterans at each of the Teague-Cranston Schools and four HBCU medical schools beginning in 2020.

    During the questioning, Sen. Moran focused on challenges in implementing CCN, including the disconnect around access standards and narrow networks. Dr. Stone stated that the new network contracts are often not able to meet the access standards finalized in regulation because the commercial market is not set up to meet those standards, particularly in rural areas.

    Kameron Matthews, MD, assistant undersecretary for health for community care, stated that TPAs are not required to adhere to the standards because their contracts for Regions 1-4 were finalized before the access standards were established. She added that the Region 5 request for proposal, though solicited after the regulation went into effect, includes waivers that will allow the TPAs to operationalize without meeting the standards.

    Sen. Moran also commented that veterans in his state had access to more providers through the previous VA Choice program and the Patient Centered Community Care program (PC3), and that TPAs could be conducting more outreach to non-VA providers to engage them in CCN.

    Several members voiced concerns about tracking the CCN budget and health care provider vacancies. In response to questioning, Dr. Stone testified that very high-cost specialists, such as neurosurgeons and gastroenterologists, are difficult to hire because of VA salary caps and more competitive salaries being available in the private sector.

    Sen. Tillis (R-N.C.) described a recent heart transplant case involving a veteran receiving care through the VA, in which the procedure was performed at Duke University as an academic affiliate of the local VA Medical Center. VA MISSION Act Lead Jennifer MacDonald highlighted the partnerships with academic affiliates as a continued draw for veteran patients. Regarding the process and timing for finalizing provider participation in the new CCN, OptumServe CEO Lt. Gen. Patricia Horoho noted that it is taking longer to integrate academic affiliates into the network compared to other community providers.

    While no official next steps are required, several members expressed an interest in more frequent updates from the VA on the new CCN implementation, including on costs and a utilization analysis.