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Washington Highlights

VA Implements Veterans Choice Act, Authorizes Care at Non-VA Facilities

November 7, 2014—The Department of Veterans (VA) Nov. 5 published an interim final rule to implement the Veterans Access, Choice, and Accountability Act of 2014 (P.L. 113-146, “Veterans Choice Act”), passed by Congress before the August recess [see Washington Highlights, Aug. 1]. The rule, titled “Expanded Access to Non-VA Care Through the Veterans Choice Program,” authorizes care for certain veterans at non-VA facilities through Aug. 7, 2017, or until the $10 billion Veterans Choice Fund is exhausted. Comments on the interim rule are due March 4, 2015.

To qualify as an eligible non-VA facility, hospitals must participate in the Medicare program, be “accessible” as defined by the VA, and enter into an agreement with the VA. As an operational matter, VA will use existing sharing agreements, existing contracts, and other processes available at VA medical facilities prior to using provider agreements under the new program. Providers who are also VA employees cannot be acting within the scope of such employment while providing hospital care or medical services through the program.

The rule creates a claims processing system managed by the Veterans Health Administration’s Chief Business Office. VA will only pay for hospital care or medical services authorized by VA. In general, payment will be a negotiated rate set forth in the agreement between the VA and the non-VA provider, not to exceed the applicable Medicare rate except in defined “highly rural” areas. Non-VA providers are responsible for first billing any veteran's private healthcare plan, if the care provided is related to a nonservice-connected disability.

VA will notify eligible veterans of the scope of the authorization for care by non-VA providers.  Only recently discharged combat veterans or veterans enrolled in the VA health care system by Aug. 1 are eligible. Veterans who reside more than 40 miles from the nearest VA medical center, including VA community-based outpatient clinics, may start receiving non-VA care starting Nov. 4. Veterans who are unable to schedule an appointment within the VA system within 30 days may start receiving non-VA care no later than Dec. 5

The VA Office of Academic Affiliations began the graduate medical education expansion mandated by the Veterans Choice Act with a request for proposals (RFP) for the 2015-2016 academic year [see Washington Highlights, Oct. 3]. The RFP closed Oct. 17.


Matthew Shick, JD
Director, Gov't Relations & Regulatory Affairs
Telephone: 202-862-6116


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