VA releases proposed access standards for community care

The Department of Veterans Affairs has released its proposals for key criteria that will determine whether a veteran gets treatment from the VA health system or the private sector under the VA's newly expanded community care program due to roll out in June.

Known as the "designated access standards," these criteria foddered the most controversy as Congress discussed the VA Mission Act, signed into law last June by President Donald Trump.

Under the proposal released Wednesday, the VA wants to set a 30-minute average drive time standard, or a 20-day wait-time standard, for primary care, mental health and non-institutional extended care.

The wait time for routine care is longer than the standard set for the military healthcare system's TriCare Prime HMO model, which the VA was reportedly considering as a model. The VA's proposed criteria have been held up at the White House Office of Management and Budget over cost concerns, according to sources close to discussions.

For specialty care, the drive time standard would be a 60-minute average and a 28-day wait standard from the day of the appointment request, with some exceptions.

And for urgent care, veterans can receive certain treatment from any provider in the community care network, with the possibility of a co-pay charge.

The department said the criteria are based on VA analysis of "all of the best practices both in government and in the private sector and tailored to the needs of our veteran patients."

"Most Americans can already choose the healthcare providers that they trust, and President Trump promised that Veterans would be able to do the same," VA Secretary Robert Wilkie said in a statement. "With VA's new access standards, the future of the VA healthcare system will lie in the hands of veterans—exactly where it should be."

The VA's draft measures were applauded by the Concerned Veterans for America, a conservative group that played a key role in the Mission Act legislation, as largely in line with what they were hoping for.

"These proposed access standards will ensure veterans have better access to healthcare and will give them more choices in how they receive their care. These standards are simple and straightforward, eliminating much of the confusion created by the Veterans Choice Program and the VA's other community care programs," Dan Caldwell, the group's executive director, said in a statement.

Caldwell added that the group would have preferred a shorter wait time standard for primary care, but praised the new proposals as "a significant step forward in giving veterans more control over their healthcare and making the VA more veteran-centric."

The group, which is part of the Charles and David Koch network, will deploy its grassroots efforts to "ensure these standards are properly implemented and rolled out with the new community care program on June 6," Caldwell said.

The release comes two days after a group of Democratic senators, led by Senate VA Committee Ranking Member Jon Tester of Montana, demanded more transparency into how the department has been developing the access standards.

"At recent briefings, VA leadership officials have indicated the department now intends to designate all clinical services as making a veteran nearly-automatically eligible for community care," the senators wrote in a letter delivered on Monday to Wilkie. "This will significantly increase the overall cost and amount of care VA will send to the community. Given that the administration opposes increasing overall federal spending, these increased costs for community care will likely come at the expense of VA's direct system of care. And that is something we cannot support."

This is the first time the public has seen the draft proposals, which will be subject to a public comment period once they are published in the Federal Register.

Besides these access standards, the VA community care program relies on additional eligibility criteria. These include the best medical interest of the veteran and whether or not a veteran lives in a state with a full-service VA medical facility.