In response to the VA wait-time scandal, Congress passed The Veterans Access, Choice, and Accountability Act of 2014. The law requires the VA to create a procedure to allow Veterans to see non-VA care. Today, the VA issued a proposed rule to determine veteran eligibility to see non-VA doctors and to get off the VA’s electronic waitlist.
The VA will determine a veteran’s eligibility to elect to receive non-VA care through the Program using a two-step process. First, the veteran must have enrolled in the VA health care system or the veteran must be eligible for hospital care and medical services under 38 U.S.C. § 1710(e)(1)(D) and be a veteran described in 38 U.S.C. § 1710(e)(3). A veteran is eligible if the veteran attempts, or has attempted, to schedule an appointment with a VA health care provider, but VA has been unable to schedule an appointment for the veteran within the wait-time goals of the Veterans Health Administration. A veteran is eligible if the veteran resides more than 40 miles from the VA medical facility that is closest to the veteran’s residence. A veteran is also eligible if the veteran’s residence is in a state without a full-service (meaning that it provides, on its own and not through a joint venture, hospital care, emergency medical services, and surgical care having a surgical complexity of standard) VA medical facility and the veteran lives more than 20 miles from such a facility. Finally, a veteran who resides in a location other than one in Guam, American Samoa, or the Republic of the Philippines that is 40 miles or less from a VA medical facility can be eligible under two scenarios. First, if the veteran must travel by air, boat, or ferry to reach such a VA medical facility, the veteran is eligible for non-VA care under the Program.
Eligible veterans may choose between scheduling an appointment with a VA health care provider, being placed on an electronic waiting list for a VA appointment, or receiving authorized non-VA hospital care or medical services from an eligible entity or provider. This proposed rule authorizes the VA to schedule an appointment with the VA for the eligible veteran if the veteran chooses a VA health care provider, regardless of how long the wait will be. These veterans will be placed on the VA’s electronic waitlist.