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VA Releases Community Care Access Standards Proposed Rule

March 1, 2019

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PRESS CONTACTS
Kate Ogden, Physician Payment & Quality Specialist

The Department of Veterans Affairs Feb. 22 released a proposed rule on access standards for the new community care program. The community care program regulations, including this proposed rule, stem from the VA MISSION Act of 2018 (P.L. 115-182) [see Washington Highlights, May 25, 2018].

The VA previously announced some detail on these access standards [see Washington Highlights, Feb. 1] and this proposed rule provides more complete information and an opportunity to comment. The proposed rule states that in order to access care in the community outside of the VA system, a veteran would need to meet at least one of the following six conditions:

  • The VA does not offer the required care of services (for example, full obstetrics care).
  • The VA does not operate a full-service medical facility in the state where the veteran resides.
    • Currently, Alaska, Hawaii, New Hampshire, and most U.S. territories do not have a full service medical facility.
  • The veteran was previously eligible to receive care under the Veterans Choice Program.
  • The VA is not able to provide care or services to a veteran in a manner than complies with the VA’s access standards:
    • For primary, mental health, and noninstitutional extended care services: 30-minute average drive time, or appointment wait time of 20 days.
    • For specialty care: 60-minute average drive time, or appointment wait time of 28 days.
  • The veteran and referring clinician determine that it is in the best medical interest of the veteran to receive care or services from a community-based provider.
  • The veteran is seeking care of services from a VA medical service line that the VA has determined is not providing care that complies with VA standards of quality.

The VA also noted that it has not yet published standards or measures of quality but will be submitting a report to Congress on quality measures by March 4. The rule also discussed emergency care provisions in the context of the community care program.

The AAMC will submit comments on this proposed rule, which are due by March 25.

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