Enhanced VA Options under MISSION Act: Fast Facts

Re-Essa Buckels

Thursday, July 25th, 2019

Veterans Affairs is working to provide enhanced options under the new law, called the MISSION Act. The Carl Vinson VA Medical Center held a special town hall at the American Legion Post 30 to share information on how the VA is strengthening its ability to provide veterans and retirees with state-of-the-art care and service, July 9.

According to Veterans Affairs, last June President Donald Trump signed landmark legislation, known as the VA MISSION Act of 2018, that makes dramatic improvements to how veterans receive community care – healthcare provided outside of VA. While the law affects many other VA programs, the changes to community care are among the most complex and far-reaching in recent history. Beginning June 6, 2019, veterans will have more ways to access healthcare.

Carl Vinson VA Medical Center CEO and Director, David Whitmer, held the town hall to inform veterans and retirees in Southwest Georgia on the new options that are available to them.

“It’s especially important for veterans in this community because many of them live so far away from where we deliver care in Dublin,” Whitmer explained.

How to access care

Eligible veterans can use VA healthcare services nationwide, including through mobile health clinics that serve rural areas and via telehealth which is care through a phone or computer. It’s a big change for recent Marine retiree, Staff Sgt. Paul Delekto Jr.

“It is very surprising that they’re actually starting to try to catch up on technology especially the telecommunications, because even (for) myself, a couple of my appointments I’ve set up, they’re actually telecommunications with somebody that’s not even in the state. And that kind of brings more expertise in and allows faster care,” Delekto remarked.

The VA provides a comprehensive medical benefits package to all veterans who are enrolled through an annual patient enrollment system that categorizes veterans based on different priority groups, according to Veterans Affairs.

What’s changing and what to expect

Veterans may be able to receive care from a provider in their local community if they meet specific criteria. Veterans must be enrolled with VA to receive care, although some are not required to enroll to receive care. Eligibility further depends on individual healthcare needs or circumstances. Meeting any one of these criteria for specific care means veterans can elect to receive care either through direct-VA care or a community provider in VA’s network.

  • The specific care needed is not provided by VA at any facility

  • The veteran resides in a U.S. state (AK, HI, or NH) or territory (Guam, American Samoa, Northern Mariana Islands, or U.S. Virgin Islands) that does not have a full-service VA medical facility

  • “Grandfathered” eligibility based on residence and the 40-mile eligibility criterion from the Choice program

  • The specific care needed is not available within designated access standards including average drive time to a VA medical facility that can provide the care needed; and appointment wait time at that VA medical facility

  • The veteran and their referring clinician decide if it’s in the veteran’s best medical interest to receive specific care in the community

  • VA has designated the VA medical service line delivering specific care needed as not providing care that complies with VA’s standards for quality

Whitmer believes the ability for clinicians to decide the best medical care for the veteran is a great change.

“We think that empowers our doctors to deliver what they feel is the best care for veterans,” Whitmer added.

The VA will offer an urgent/walk-in care benefit for minor injuries and illnesses, such as pink eye or ear infections. To be covered for this benefit, veterans 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.

Like other healthcare providers, VA may charge a copayment for healthcare. The copayment amount may be based on your enrollment priority group, the type of healthcare service that veteran receives and their financial situation. If a VA copayment applies, the veteran is responsible for that amount whether care is furnished directly by VA or through a community provider. VA may bill the veteran’s health insurance for medical care, supplies and prescriptions. As a result of the MISSION Act, VA no longer requires permission to bill the veteran’s health insurance carrier for healthcare related to a sensitive diagnosis.

The VA is also establishing designated access standards based on the type of care needed, how long veterans have to wait to receive care and the average driving time to receive that care. It’s also creating standards for quality that focus on timely care, effective care, safe care and veteran-centered care.

The VA also has different processes for clinical and non-clinical appeals, and the patient advocate can ensure concerns are handled appropriately.

In addition to increasing access to VA care, the MISSION Act:

  • Authorizes VA to develop a plan to expand eligibility for the Program of Comprehensive Assistance for Family Caregivers.

  • Strengthens VA’s ability to recruit and retain the best medical providers.

  • Strengthens VA’s ability to align its footprint with the needs of America’s veterans.

“I think in combination of the improvements that we’ve made internally, the improvements that we’ve made to our network outside that we know we can deliver outstanding care to those veterans. And we ask them to allow us to be their trusted provider,” Whitmer concluded.