The centerpiece of the Veterans Access, Choice and Accountability Act of 2014, signed into law on August 7, is a special $10 billion Veterans Choice Fund. Over the next three years, VA is to use the fund as needed to buy care from non-VA care providers for veterans if they face long waits for VA care – defined initially as more than 30 days – or if they reside more than 40 miles from VA care.

The intent is to eliminate VA patient wait lists that some VA health administrators and staff conspired to hide in recent years, thus compromising the integrity of performance reports and putting patients’ health at risk.The legislation mandates use of a new Veteran’s Choice Card, but it isn’t a golden key to private-sector care. It will be more like an informational insurance card to be presented to non-VA health care providers to identify the veteran and to verify eligibility for episodes of care. The administrative challenges ahead for VA in coordinating a vast expansion of private sector care, monitoring outside care quality and integrating those medical records back into VA health care will be profound.Here’s more on how non-VA care will grow:VETERANS CHOICE CARDEnrolled veterans must be provided by the VA with a "Veterans Choice Card," which would be presented to non-VA health care providers to prove the veteran's eligibility to receive VA-reimbursed medical services, and which would contain identifying information and contact information for authorization and claims procedures. The card must also include information for veterans regarding the care and services that are available through use of the card.The VA must issue the cards to enrolled veterans within 90 days of enactment. In their statement of managers, conferees say they do not intend for any delays that may occur in the production of the Veterans Choice Cards to delay the implementation of the non-VA health care program.ELIGIBILITY – The hurdles to gain easy access to non-VA care go beyond how far veterans reside from a VA clinic or how long their wait for care. To be eligible, veterans must have enrolled in VA health care by Aug. 1, 2014 or, if they enroll later, they must have served on active duty in a theater of combat operations within five years of enrolling. These restrictions address cost concerns that fiscal conservatives had after the Congressional Budget Office projected that up to two million more veterans would drop current health insurance and enroll with VA if given the chance to use current doctors and have VA foot the bill.NO FIRM 30-DAY GOAL – Architects of the new law, Sen. Bernie Sanders (Vt.) and Rep. Jeff Miller (Fla.), would like non-VA care offered to any vet who can’t get a VA appointment within 30 days. But their legislation allows VA to set a different wait-time goal if they can defend it. What VA finally decides will be part of interim rules for implementing the law, to be published within 90 days after the signing of the bill into law, i.e., around November 7, although this deadline might slip.The bill would require that if VA can’t offer a timely appointment then it must inform the veteran electronically or, if the veteran chooses, by mail, and explain that outside care is authorized. 40 MILES AS CROW FLIES – Veterans who reside more than 40 miles from a VA medical facility or who must travel by air, boat or ferry to access VA care are to be offered non-VA care instead. VA is to use “geodesic distance” or the shortest route between two points on Earth, or, if you like, “as the crow flies.”  VA’s early estimate is that 500,000 vets will qualify.However, House-Senate conferees in their explanatory report on HR 3230, say they do not intend the 40-mile criteria “to preclude veterans who reside closer” to a VA facility “from accessing care through non-VA providers, particularly if the VA facility…provides limited services.”So VA will have to clarify in regulation what 40 miles really means.PROCESS TO RECEIVE NON-VA CARE - To receive medical services at a non-VA health care facility, eligible veterans would select an accessible provider from among the Medicare system, federally qualified health centers, the Defense Department or the Indian Health Service and notify the VA. The VA would be required to ensure that an eligible veteran receives an appointment at the non-VA facility within the wait-time goals.If a veteran is eligible for such non-VA care, he or she would be informed electronically by the VA about the care or services he or she is authorized to receive. The veteran also could choose to be notified by letter.The law requires veterans to disclose to the VA any information on other health care plans prior to receiving non-VA coverage, and it provides that other health care plans would be primarily responsible for non-service-connected care. In these cases, providers would be responsible for seeking reimbursement from the non-VA health care plans.LIMIT ON FOLLOW-UP CAREUnder the non-VA care system created by the agreement, follow-up care generally would be limited to 60 days per episode of care. Conferees, however, in their statement of managers say they recognize that certain chronic conditions may require episodes of care beyond 60 days and that they expect the VA to authorize additional episodes of care sufficient to complete the veteran's needed treatment or to maintain a quality of life during a terminal illness.Concluding thought: Congress has given the VA some very tight deadlines in this law. At this point it is unclear whether VA will be able to meet them, but The American Legion is working very closely with both the Congress and VA to help ensure the earliest and smoothest implementation possible.Sincerely,Jeff Steele, Assistant DirectorThe American Legion Legislative Division