VA Bill Makes Community Choice Program Permanent, Expands Authority to Practice Telemedicine

| Brittany McCullough
Veterans and Doctor shaking hands

It’s been four years since the Department of Veterans Affairs’ (VA) highly publicized excessive wait times issue. In response to this crisis, Congress enacted the Veterans Access, Choice, and Accountability Act of 2014 (Choice Act), but funding for the provisions of the Choice Act that expanded access are set to expire in the coming weeks. I encourage you to read this post by my colleagues for background on the Choice Act if you aren’t familiar.

Last week, the House Committee on Veterans’ Affairs passed the VA MISSION Act out of committee, which aims to ensure access to timely care by streamlining the existing community care programs, increasing the use of telemedicine, and promoting innovative pilot programs to test alternative payment models. The legislation also allows VA healthcare providers to practice telemedicine across state lines.

With its strong bipartisan support, the VA MISSION Act has been touted by some as “Congress’s chance to do right by veterans.” Legislators have indicated they hope to have the bill to the President’s desk by Memorial Day and he has already indicated that he will quickly sign it into law.

To support the goal of maintaining sufficient access to care, the Secretary of Veterans Affairs will continue to contract with private providers to establish a network of community providers as detailed here under the VA MISSION Act.

As noted by my colleagues in a previous post, VA facilities continue to have capacity issues and there is not a single solution. But, the VA MISSION Act appears to be a good faith, bipartisan effort to help permanently enhance the successful elements of the Choice Act with the goal of improved access and care for veterans.

Here are some key provisions:

  • Extends funding for the Choice Act which is expected to run out by early June according to reports
  • Establishes a permanent community program whereby veterans can access care in their community
    • Includes hospital, physician and extended care services
      • Examples of extended care services: adult day care, home health care, long term services and supports, and hospice care
  • Ensures no disruption in the continuity of care by requiring care coordination between providers, especially if care is rendered outside of a veteran’s regional network
  • Sunsets the current VA community care program a year following enactment of this legislation
  • Directs VA Secretary to implement quality and access standards
    • Must issue report to Congress within 270 days detailing which standards will be used
    • Standard elements should address timeliness of care, effectiveness of care, safety of care (including complications, readmissions and deaths) and efficiency
  • Directs VA Secretary to establish competency standards for non-VA providers to ensure that veterans are receiving the same quality of care whether they access care inside a VA facility or in their community
  • Requires VA Secretary to perform market area assessments at least every four years
    • Will evaluate the capacity of VA facilities, contracted community providers and other Federal delivery systems that provide health care to veterans
    • Will inform the Department’s budget and help develop recommendations to improve quality and access standards

The VA MISSION Act provides legislative authority for VA healthcare providers to practice telemedicine within the scope of their licensure across state lines. Within a year after telemedicine services are implemented, the VA Secretary must issue a report to Congress on its effectiveness.

The VA’s support of telemedicine isn’t new (read this interview with Kevin Galpin, M.D., executive director of VA Telehealth Services). The VA’s telehealth program has  been largely successful in helping veterans to “continue to live independently” as described here in this January 2018 VA blog. One veteran noted how the use of telehealth has greatly improved his care coordination and is a much more convenient option considering the nearest VA facility is over an hour and a half away. Another VA blog notes how telemedicine helps “address barriers [that prevent] rural and veteran populations from accessing quality care.”

Brittany McCullough

Brittany McCullough, Health Policy Associate.

Brittany McCullough, URAC's health policy associate, focuses on tracking and analyzing legislation and regulations of importance to URAC stakeholders. Brittany considers herself an early careerist but most of her policy and research work has been centered on the ACA, Medicaid, CHIP, and mental health. She holds a B.S. in Neuroscience and a Master of Health Administration.

Views, thoughts and opinions expressed in my articles belong solely to me, and not necessarily to my employer.

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