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A year ago on June 6, Congress made permanent certain provisions for veteran access to community care when it passed the VA Mission Act. The Mission Act consolidates a handful of individual, temporary community care programs authorized by Congress in the wake of the Phoenix VA waitlist scandal, that were meant to enable eligible veterans facing long wait times and travel challenges to receive private, non-VA care in their local community. Due to the popularity of these programs, chiefly the Veterans Choice Program, federal funding quickly became an issue. But administration of the programs also became a problem, in part because the sense of urgency in implementing the programs led to VA quickly contracting with third party administrators (TPA) who fielded staff with little to no knowledge about VA, the Choice Program, or eligible community care providers.
In light of these complications, Congress gave VA one year to develop new community care access standards for the Mission Act, mandating they go into effect today, June 6, 2019. Among the most significant of these access standards: the new rule that veterans who live more than 30 minutes driving time from a VA medical facility or who face a wait of more than 20 days for most health care appointments, are eligible for private community care. For specialty care, veterans who face a 60 minute drive or 28 day wait are now also eligible for community care. As even a quick glance at our “VA Mission Act Access Map” reveals, these new access standards significantly expand the ranks of potential users of (private) community care. Not only are there significantly fewer VA medical facilities west of the Mississippi River, but the VA facilities that do exist there generally rank much lower than those in the eastern part of the US, according to VA’s own rankings.
Secretary Wilkie has repeatedly assured Congress that VA is ready for “implementation day.” Nonetheless, Congress and several veterans organizations remain skeptical, and for two reasons. The first has to do with the Community Care Network (CCN) contracts that VA has awarded — and has yet to award — to manage provider networks for their six separate community care regions across the US. While VA has awarded contracts to Optum Public Sector Solutions, Inc., for Regions 1, 2, and 3, it is currently relying on TriWest Healthcare Alliance to support veteran and provider care coordination “across the nation until CCN is fully implemented.” However, TriWest was one of the TPAs contracted to administer the initial Choice Program — with very mixed results, including overcharging VA to the tune of several millions of dollars.
The second cause of concern is VA’s historically poor record with IT systems. Earlier this year, the US Digital Service determined that the software tool to determine veteran eligibility for community care, which a contractor was developing for VA in light of the Mission Act, was so faulty it could “disrupt the health care of about 75,000 veterans every day.” This is in part due to the fact that the tool has to pull data from six separate VA systems, in addition to the anticipated high volume of demand for community care.
VA has estimated that nearly 40% of the nation’s approximately 18 million veterans will be eligible for community care under the Mission Act. Secretary Wilkie has said that the Mission Act will “revolutionize VA health care as we know it” — and indeed, by enabling veterans to have more flexibility to find the best fit for their needs from a range of options, the Mission Act goes a far way towards a much needed modernization of VA’s health care delivery for veterans. But by that same token, it remains unclear that VA has in any way revolutionized how it goes about implementing large scale, systemic changes — leaving veterans, at the end of the day, still stymied in their pursuit of the care they often are very much in need of.
Secretary Wilkie has repeatedly assured Congress that VA is ready for “implementation day.” Nonetheless, Congress and several veterans organizations remain skeptical.
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