According to new health care legislation that forms part of the MISSION Act’s community care guidelines, as of June 6, 2019, United States veterans can apply for medical care at facilities other than those run by the Department of Veterans Affairs (VA) if they’ve had to wait more than 20 days for an appointment. Current figures from the VA show that more than 548,000 providers are currently participating in the private health care network, and they expect to have more than 8,000 new urgent care clinics.
In 2018, Congress agreed to the adoption of a new policy known as the MISSION Act, which aims to streamline health services for veterans and improve access to care for the 9 million ex-service personnel enrolled with the VA. Up to now, veterans who had to wait more than 30 days to get an appointment at a local VA facility were entitled to seek private medical care, but the new policy reduces the wait time to 20 days, with a scheduled cut to 14 days in 2020.
As a result of the change in policy, far more services in the private sector will be available to veterans, including access to walk-in clinics, and the number of veterans using private medical services is set to rise significantly. To facilitate these changes, the VA has systems in place that it plans to use in the integration of patient data, ensuring secure access to patients’ medical records for private providers.
The VA has sent letters to all veterans who are enrolled in VA health care to tell them about the new legislation. Members of VA staff have also been personally contacting veterans to help spread the news. Only veterans who are on the VA health care register can apply to use private medical facilities, and their eligibility is dependent on their health care needs and personal circumstances.
Veterans need to get confirmation of their eligibility to use community care facilities from the VA before making an appointment with a private provider, and the provider must be in the VA’s network. After receiving care, the provider bills a third-party administrator or the VA. Veterans who use private medical services without receiving confirmation of eligibility would be liable to pay for any medical bills themselves.
Full details of the new MISSION Act and how it affects veterans’ access to medical care are available on the VA MISSION Act website.
You may be able to receive care from a provider in your local community if you meet specific criteria. Generally, Veterans must be enrolled with VA to receive care, although some Veterans are not required to enroll to receive care. Eligibility further depends upon your individual health care needs or circumstances. It is important to remember that under the Veterans Community Care Program, in most instances VA must authorize your care before you receive it.
VA will offer an urgent/walk-in care benefit for minor injuries and illnesses, such as pink eye or ear infections. To be covered by this benefit, you must be enrolled in the VA health care system and have received care from VA within the 24 months prior to seeking this care to be eligible for this benefit. Eligible Veterans can seek this care from an urgent care facility or walk-in retail health clinic that is part of VA's community provider network, but not all urgent care facilities or walk-in retail health clinics are in VA's network. VA will provide additional information on this benefit.
Like other health care providers, VA may charge a copayment for health care. The copayment amount may be based on your enrollment priority group, the type of health care service you receive, and your financial situation. If a VA copayment applies, you are responsible for that amount whether your care is furnished directly by VA or through a community provider. VA may bill your health insurance for medical care, supplies, and prescriptions. As a result of the MISSION Act, VA no longer requires your permission to bill your health insurance carrier for health care related to a sensitive diagnosis. If you would like to submit a request to restrict this process, please contact your local VA facility's privacy officer. If you have other forms of health care coverage (such as Medicare, Medicaid, TRICARE, Indian Health Service, and tribal health), you can use VA health care benefits along with these plans. To learn more, contact your local VA medical center or visit www.missionact.VA.gov.