Roscoe Butler, assistant director of Health for the Legion’s Veterans Affairs & Rehabilitation Division, presents testimony during a congressional hearing examining billing and reimbursement for care in the community under the Department of Veterans Affairs’ plan to consolidate non-VA care programs.

Legion: New Choice Program could improve, expand access to health care

The American Legion testified at a Feb. 11 congressional hearing examining billing and reimbursement for care in the community under the Department of Veterans Affairs’ plan to consolidate non-VA care programs. Roscoe Butler, assistant director of Health for the Legion’s Veterans Affairs & Rehabilitation Division, presented the testimony before the House Committee on Veterans’ Affairs Subcommittee on Health.

Dating back to 1945, VA's purchased care program afforded World War II veterans and other veterans with service-connected ailments opportunities to seek "hometown" medical and dental care at government expense. Under the Hometown Program, eligible veterans could be treated in their community by a doctor or dentist of their choice.

To date, the VA has implemented a number of programs to manage veterans’ health care when such care is not available in a VA health-care facility, could not be provided in a timely manner or is more cost effective. Programs such as Fee-Basis, Project Access Received Closer to Home (ARCH), Patient-Centered Community Care (PC3), and the Veterans Choice Program (VCP) were enacted by Congress to ensure eligible veterans could be referred outside the VA for needed health-care services.

After learning that VA facilities were falsifying appointment logs to disguise delays in patient care in 2014 Congress created the VCP.

“However, it quickly became apparent that layering yet another program on top of the numerous existing non-VA care programs – each with their own unique set of requirements – resulted in a complex and confusing landscape for veterans and community providers, as well as the VA employees that serve and support them,” said Butler.

On Oct. 30, 2015, VA presented its Plan to Consolidate Community Care Programs – a vision outlining improvements for how VA will deliver health care to veterans in the future. The plan seeks to consolidate and streamline existing community care programs into an integrated care delivery system, enhancing the way VA partners with other federal health-care providers, academic affiliates and community providers. It promises to simplify community care and gives more veterans access to the best care anywhere through a high performing network that keeps veterans at the center of care.

While addressing committee members, Butler outlined current systems in place, noting The American Legion’s support to consolidate VA’s multiple purchased-care programs into one new VCP that is seamless, transparent, and beneficial to enrolled veterans.

“We believe it has the potential to improve and expand veterans’ access to health care,” Butler noted.

The plan’s overall success will be directly attributed to how VA will work with its employees, Congress, veteran service organizations, private providers and other stakeholders as they move forward in developing and implementing the plan.

Additionally, efforts eliminating operational inefficiencies, including standardized billing and reimbursement, will make it easier and more appealing for community health care providers to partner with VA. The American Legion strongly believes VA must standardize its reimbursement rates but not set the rates too low, discouraging community partners from signing up as a participating provider in the new VCP.

“We are pleased to see that VA proposes to implement a claims solution able to auto-adjudicate a high percentage of claims, enabling VA to pay community health care providers promptly and correctly, and move to a standardized regional fee schedule,” Butler said. “However, we do not believe Congress should continue to provide VA an open check book without any assurance from VA that their plan will work. Much as further funding for the Joint Electronic Record is contingent on proving benchmarks are met, Congress can and should require progress benchmarks here.”

VA has identified a number of necessary legislative items that require action by Congress this year to best serve veterans going forward. The American Legion supports many of these, such as measured budget flexibility, the Purchased Health Care Streamlining and Modernization Act, flexibility for the federal work period requirement, and special pay authority to help VA recruit and retain the best talent possible to lead their hospitals and health-care networks.

Butler concluded his testimony by echoing the sentiments of Rep. Mark Takano earlier in the hearing, affirming a commitment to revitalize VA programs and ensure a robust health-care system.

“The American Legion believes that together we can accomplish these legislative changes before the end of this session of Congress,” Butler said. “We can’t let another year slip away. Our veterans deserve the same sense of urgency now that Congress has shown numerous times since the VA scandal first erupted in 2014.”

28 Comments

  1. Savvy post ! I learned a lot from the points ! Does someone know if my assistant could possibly get access to a template VA 10-3542 example to complete ?
  2. American Legion have been organized for almost 100 years representing veterans, I respect their decisions. The VA healthcare system is dedicated to Veterans in a specialized and holistic way. They are great medical treatment and research centers. Expansion of Choice Care (private care) will open Veteran funding to further corruption, as well as undermine veterans disability claims (fraud at both sides). It will also further "washout" the low & middle class Americans. Veterans should improve their VA Healthcare system thru patient/VA/legislature reps & and support it. Veterans maybe elgible for travel pay to transport to their VA Medical Center and VSO (Veteran Service Organizations) will also provide free van/bus transportation. Most WWI - WWII - Korean - Viet nam Vets did not want dismantling of VA Healthcare system! Do not let the elite fool veterans !
  3. My eye surgeon at the Bay Pines VA was going on maturnity leave and could not get me in until Feb for cataract surgery. this was end of Sept 2015. I was loosing my vision as the cataracts kept growing. I complained to Health net employees, everytime I call I got a different clerk, promising me an appt right away. I complained on every VA website that I could. Finally got a email from a Secretary in DC. I let her know what I was wexperiencing, she notifified my VA hosp. I got a call with in a week for an appt 3 weeks down the road. I have had my surgeries now and done good. Need to go in for fine tune laser surgery. But the hassle cold of been avoided. Each hospital needs to have a contact person when in the choice program, that way the one person would be responsible for making appts etc and be knowledgable with the patient's needs.
  4. I’m classified as 100% disabled by the VA. In August, 2015 I was experiencing severe lower pelvic pain and “urinary issues”. I had been to the emergency room at a local hospital for it. The ER advised I see a urologist immediately, like the next morning. I happened to already have an appointment with my PCP at my local VA Clinic on 18AUG15. My wife pushed me inside in a wheelchair. My PCP advised I should go to ATL VAMC urology department; I concurred. Two weeks later I got a card in the mail for an appointment for 05NOV15. Yes, I was still experiencing lower pelvic pain and urinary problems; not quite as severe. In early SEP I enrolled in the VCP and picked out a private practice urologist (PPU). Thinking I would soon be seen by a PPU, I cancelled the appointment for 5Nov. To make a long story short, and after at least ten calls to the VCP and several calls to my PCP at the clinic, I had the appointment with the PPU on 05FEB16.
  5. Extremely POOR! WAS ON TELEPONE FOR SEVENTY MINUTES (ELPASO CENTER) WITH AN INAPT, UNTRAINED CUSTOMER SERVICE PERSONS WHO HAD A DIFFICULT TIME SPEAKING ENGLISH (ESL) SUPERVISOR RESOLVED PROBLEM IN FIVE MINUTE. RECEIVED A LETTER WHERE THEY ADMITTED THEIR FAULTS. THEN I WAS PROVIDED WORTHLESS APOLOGIZES WITHOUT RESOLUTION. NOW I HAVE THE SAME PROBLEM & THEY INDICATED THEY WOULD CONTACT ME A WEEK AGO. STILL WAITING IN PAIN, FOR THIS CALL TO AUTHORIZE TREATMENT. PATIENT ADVOCATE OFFICE IS UNABLE TO HANDLE ALL THE COMPLAINTS - WORTHLESS CATCH 22. OBUMMA ADMINISTRATION THREW MONEY INTO THIS PROGRAM WITHOUT ACCOUNTABLLE MMANAGEMENT. THIS PROGRAM IS DIFFINATELY "WASTE, FRAUD,ABUSE & D.A.'S"
  6. Extremely POOR! WAS ON TELEPONE FOR SEVENTY MINUTES (ELPASO CENTER) WITH AN INAPT, UNTRAINED CUSTOMER SERVICE PERSONS WHO HAD A DIFFICULT TIME SPEAKING ENGLISH (ESL) SUPERVISOR RESOLVED PROBLEM IN FIVE MINUTE. RECEIVED A LETTER WHERE THEY ADMITTED THEIR FAULTS. THEN I WAS PROVIDED WORTHLESS APOLOGIZES WITHOUT RESOLUTION. NOW I HAVE THE SAME PROBLEM & THEY INDICATED THEY WOULD CONTACT ME A WEEK AGO. STILL WAITING IN PAIN, FOR THIS CALL TO AUTHORIZE TREATMENT. PATIENT ADVOCATE OFFICE IS UNABLE TO HANDLE ALL THE COMPLAINTS - WORTHLESS CATCH 22. OBUMMA ADMINISTRATION THREW MONEY INTO THIS PROGRAM WITHOUT ACCOUNTABLLE MMANAGEMENT. THIS PROGRAM IS DIFFINATELY "WASTE, FRAUD,ABUSE & D.A.'S"
  7. Extremely POOR! WAS ON TELEPONE FOR SEVENTY MINUTES (ELPASO CENTER) WITH AN INAPT, UNTRAINED CUSTOMER SERVICE PERSONS WHO HAD A DIFFICULT TIME SPEAKING ENGLISH (ESL) SUPERVISOR RESOLVED PROBLEM IN FIVE MINUTE. RECEIVED A LETTER WHERE THEY ADMITTED THEIR FAULTS. THEN I WAS PROVIDED WORTHLESS APOLOGIZES WITHOUT RESOLUTION. NOW I HAVE THE SAME PROBLEM & THEY INDICATED THEY WOULD CONTACT ME A WEEK AGO. STILL WAITING IN PAIN, FOR THIS CALL TO AUTHORIZE TREATMENT. PATIENT ADVOCATE OFFICE IS UNABLE TO HANDLE ALL THE COMPLAINTS - WORTHLESS CATCH 22. OBUMMA ADMINISTRATION THREW MONEY INTO THIS PROGRAM WITHOUT ACCOUNTABLLE MMANAGEMENT. THIS PROGRAM IS DIFFINATELY "WASTE, FRAUD,ABUSE & D.A.'S"
  8. so the latest is not working 900 bucks out of pocket for me to use pt choice. so let's invent something new. how about back up to what was working. the biggest problem with a government program is it has no back up gear. we just keep inventing new ways to pour money down the rat hole
  9. I was told in November of 2015 that I would have to wait until March 2016 and even longer for an availability for two medical procedures. While we have a clinic in Bozeman, it has limited capability and neither of these procedures were within their capability. I asked about Veterans Choice as an alternative. The person I spoke to said I will have to get it authorized. Never heard a peep. I called two weeks ago and asked where the approval was. I was told a date was never set for either procedure, so sorry you cant use Veterans Choice. The program has some problems if the personnel at the nearest VA Hospital (100 miles away one way) knew it would be Feb-April of the following year before I could get an appointment and yet denied Veterans Choice as an option. I believe the situation met both the distance and non availabilty requirements. Seems like the VA should be able to do better than this!
  10. I was told in November of 2015 that I would have to wait until March 2016 and even longer for an availability for two medical procedures. While we have a clinic in Bozeman, it has limited capability and neither of these procedures were within their capability. I asked about Veterans Choice as an alternative. The person I spoke to said I will have to get it authorized. Never heard a peep. I called two weeks ago and asked where the approval was. I was told a date was never set for either procedure, so sorry you cant use Veterans Choice. The program has some problems if the personnel at the nearest VA Hospital (100 miles away one way) knew it would be Feb-April of the following year before I could get an appointment and yet denied Veterans Choice as an option. I believe the situation met both the distance and non availabilty requirements. Seems like the VA should be able to do better than this!
  11. MY LOCAL VA [CHALMERS P WYLE/COLUMBUS VA] APPROVED ME TO USE OHIO STATE UNIVERSITY (OSU) FOR MY SURGICAL NEEDS IN SEPTEMBER 2015. AFTER NUMEROUS CONTACTS WITH HEALTH NET [ OUR CHOICE CARD PROVIDER ] I GOT MY FIRST VISIT WITH OSU ON DECEMBER 17th. IT IS NOW FEBRUARY 18th HAVE YET TO BE ALLOWED A SECOND VISIT FROM HEALTH NET. I HAVE LOGGED OVER 23 HOURS ON THE PHONE WITH HEALTH NET (MOST OF IT ON HOLD) WITH NO RESOLUTION. TIME IS RUNNING FOR ME TO FIX THIS PROBLEM. AS USUAL THEY ARE WAITING FOR ME TO DIE WHICH WILL SOLVE THE PROBLEM FOR THEM
  12. I would like to no how a Vet can get help when your own local VA or local Legion won't Evan help you get bentifits that you are intitelied to.
  13. It took about 1 month and the help of a Dr and others at the Huntington, WV VA Hospital, to get permission, to see a Dermatologist! I got the approval thru the Veterans Choice Card Program and the paperwork was faxed to the provider and I was called for an appointment! I had 5 visits, a BCC cancer removed from my ear and others from my face and arms! I received a letter from the HWV VA denying my claim! I called the liaison person at the WV VA and he gave me a long Reference Number to give the provider and to rebill the claim! It did not work, I got another nasty letter from the WV VA H denying the claim! I have notified both of my US Senators, but as of today, I have no help from them yet either! The VCCP is a Sham, I called several times during the week , one week! I spent as much time on the phone as 12 min with one of their clerks and then the next day, when I would call back, they would have NO record of your last 12 minute phone call! The politician had a good idea and the third party (The Veterans Choice Card Program is making millions, but NO service to the Veterans!
  14. I spent a good part of 2015 researching the Choice program. I was retiring, loosing my old insurance and going to have to depend more on the VA. I applied and was approved to continue my cancer (caused by Agent Orange in Vietnam)treatments with my local oncologist. When I went in for my treatment in January, the doctor's office told me they were not contracted with the VA. I called the Choice program and found there are no oncologists in northwest Indiana that are. Why? Because the VA does not pay the bills.
  15. THE CHOICE PROGRAM REALLY SUXS, WHEN YOU CALL THEY PUT YOU ON HOLD AND NEVER GET BACK. ANY INFO BY MAIL IS 4 TO 5 DAYS LATE, AND NOT COMPLETE OR UO TO DATE..VERY UNHAPPY!!!!!
  16. I have tried and tried to get access to VA care. I served four years voluntarily during the Viet Nam era (from Aug 63 to Aug 67), and was honorably discharged. Other than exercising my privilege for tuition assistance, I have made no claims against my VA benefits up to now. I now am over 70, in need of dental, eyesight, and hearing attention. I am fully retired, while my 5-year younger wife still works as a secretary. VA insists that I have to be 'evaluated' on the basis of means. I have only my social security benefit, which is reduced because I had to begin claiming benefits 1 month early in order to help balance our budget. VA insists that my wife's full salary MUST be included in the computation, and that puts us over an arbitrary and unannounced/unpublished limit VA has set for allowing ANY benefits to an honorably-discharged soldier. This is at odds with the terms of the benefits guaranteed to me on the back of my enlistment form in 1963, but VA does not care. I can not even get a VA ID card issued, because my local VA hospital claims that doing so somehow 'authorizes' me to get treatment. That also is a sham, used to turn Vets with valid claims away in the hopes that they just will give up and go away. Before we start spending millions on upgrading the system we have, let's make the system available for all honorably-discharged vets, as we were assured was our guarantee when we enlisted. Congress and the VA should not be allowed to make post-facto changes to that guarantee be retroactive in order to mask their failure to properly budget and fund the VA. Cut the legendary waste instead.
  17. Have Been Going To Durham VA For My Hearing Problems. Tried To Get Pay For Mileage Since It Is 110 miles Round Trip. Besides Paying a $50.00 Deductible Each Time I Go They Told Me The Cut Off For Mileage Is $12,000.00 Per Year To Live On. Are You Telling Me Somebody Out There Who Served Their Country From 1968-1970 Vietnam ERA Veteran Has To Make $1000.00 A Month Or Less To Get Mileage For Trips To VA And Not Pay A Deductible This Is Crazy! Also Got The Choice Card Last Year On October 12th,2015 Name Was Wrong On Card. Called The 800# And Like Other Vets Was On The Phone For 40mins And Still Don't Have The Card Back With The Correct Name On It. Have Called At Least Once A Month To Nothing But Put On HOLD. GOD BLESS
  18. You need to be at least 30% disabled and send in form VA FORM 10-3542. IT WORKS
  19. Not sure about your name being wrong on your choice card, is it correct in VA's system? As for travel pay you have to have service connected disability of 30% or greater or be at or below the pension level, that 12k you mentioned, it's actually a little more than that but not much. The copays for dr and hospital go away with service connected disability of 10% and greater or with income below about 32k for a single Veteran more if you have dependents. Hope this helps you understand how things work a little better.
  20. Your post is so full of inaccuracies I don't know where to begin. Dental is not covered under VA health care unless you have a dental disability are 100% disabled or are a former prisoner of war there are some exceptions like the first 180 days after separating from active duty. Once enrolled in VA health care you can purchase the VA dental insurance from Delta dental or Mett life. Hearing Aids will not be provided for normal hearing loss due to aging you have to have service connected hearing loss. Eye glasses you have to have service connected disability. As for enrollment in VA health care the income thresholds are established by congress and are published, its about 32k for a single Veteran and around 40 k for a Veteran with 1 dependent. Not all Veterans have to meet the income threshold i.e. Veterans with service connected disability Veterans who served on the ground in Vietnam and several other enhanced priority groups. The Veterans health identification card is issued for use within the VA medical facilities when you are enrolled in VA health care.
  21. Your post is so full of inaccuracies I don't know where to begin. Dental is not covered under VA health care unless you have a dental disability are 100% disabled or are a former prisoner of war there are some exceptions like the first 180 days after separating from active duty. Once enrolled in VA health care you can purchase the VA dental insurance from Delta dental or Mett life. Hearing Aids will not be provided for normal hearing loss due to aging you have to have service connected hearing loss. Eye glasses you have to have service connected disability. As for enrollment in VA health care the income thresholds are established by congress and are published, its about 32k for a single Veteran and around 40 k for a Veteran with 1 dependent. Not all Veterans have to meet the income threshold i.e. Veterans with service connected disability Veterans who served on the ground in Vietnam and several other enhanced priority groups. The Veterans health identification card is issued for use within the VA medical facilities when you are enrolled in VA health care.
  22. I have choice program in NC, it is a joke. I have been waiting over 8 months for Choice to pay the Dr bill. They always have an excuse why they are not paying.
  23. I am using it now for Pt on my back at the gym I go to. VCP called me after my VA doctor OK it.I asked them if I could go to my gym and they told me they was in the VCP Program and they said sure. In 5 days it was all set up and VCP called me back and said you are all set to go.
  24. My follow up call to 'Choice'on appointment status was given to a young man in Tenn. Within two days he had the eye care center confirm an appointment. Thank you Salvis. Not all efforts for service are negative.
  25. My follow up call to 'Choice'on appointment status was given to a young man in Tenn. Within two days he had the eye care center confirm an appointment. Thank you Salvis. Not all efforts for service are negative.
  26. when i tried to get an eye exam appointment at the Eye Clinic in Phoenix, AZ., I was told that I now have to utilize the TriWest process of obtaining an appointment outside of the VA. I would need to contact my primary doctor, who would then contact TriWest to initiate the process of getting the appointment. At the time I tried to get the appointment, I was told that this process would take from 30 to 40 days before I was seen. This TriWest process was established to eliminate the wait for an appointment if one could not be seen by a VA doctor before 30 days. So, how has this helped?? While attempting to contact my primary doctor, I was routed to the Call Center because no one answered the phone in the clinic. The call center rep told me the same thing, going through the TriWest process would result in the 30 to 40 days before being seen. When I objected, and said my condition was such that I could not wait 30 to 40 days, I was then told to visit the ER.
  27. I have been accepted in the choice program but I have been waiting for Over 40Days for 5 different docs so to me this program does not work
  28. The excisting VCP program is a joke, i have documented many times in the last 2 years where i have had to wait 30 days or longer to see a VA doctor. So when I tried to get on VCP they told me that the Doctors who can not see me must enter me into VCP. After many documented requests they still refuse to see and treat me in a timely matter or allow me to be seen outside the VA. Wade Park VA is a joke.
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