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Washington Update for February 22, 2019

 TREA Members — Important Update to February 1, 2019, Newsletter to access use link.



Friday, February 22, 2019 — VA Publishes in Federal Register


MISSION ACT — Veterans Community Care Network — Access Standards


TREA advised you on February 1, 2019 of the Department of Veterans Affairs (VA) plans to publish new

eligibility criteria for eligible veterans to use private sector care providers. Today, VA formally published the

proposed rule outlining who will have access to community care without preapproval, what type of care, and how it will be paid for.


A 30-day public comment period exists and ends on March 25, 2019. TREA wants to

hear from you and will consolidate comments received and submit them to VA by the March 25 deadline. Please provide your comments to TREA by March 19, 2019.


TREA members should access the link at the top of this page to view the February 1, 2019, Newsletter. The summary that follows will also assist you.


Eligibility for care under the new access standards will not be open to every veteran. Only those veterans who are enrolled in VA’s healthcare system (Priority Group 1-8) in the preceding 24 months and used care during that time will be eligible. New enrollees and veterans who had not accessed VA healthcare in more than two years must go to a VA medical facility or get VA pre-authorization in order to receive VA-funded care.


Not all healthcare will be funded by VA without preauthorization. Eligible veterans must consider other factors and meet specific criteria to trigger entitlement to care under the new access standards.


While the 30-day public comment period ends on the March 25, 2019, the access standards will not be

implemented until June 2019. Many questions exist. Will veterans be issued insurances card? How will

participating private sector be identified? What impact will weather, city or rural traffic patterns have on average drive times?


These are all valid concerns and underscore why these new access standards are

important to TREA members. TREA is working to assure that the Mission Act is fully funded and by

addressing the above issues and educating you, our members on implementation of the Mission Act.


Below is the actual text of the summary and supplemental information of the proposed rule.


DEPartment of Veterans AFFAIRS                                                               8320-01

38 CFR Part 17

RIN 2900-AQ46

Veterans Community Care Program

AGENCY:  Department of Veterans Affairs.

ACTION:  Proposed rule.


SUMMARY:  The Department of Veterans Affairs (VA) proposes to amend its medical regulations to implement its authority for covered veterans to receive necessary hospital care, medical services, and extended care

services from non-VA entities or providers in the community.  Section 101 of the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Network Act of 2018 directs VA to implement a program to furnish such care and services to covered veterans through eligible entities and providers.  This proposed rule would establish the criteria for determining when covered

veterans may elect to receive such care and services through community health care entities or providers, as well as other parameters of this program.




Purpose of This Regulatory Action:  We propose to create new regulations to define and implement the Veterans Community Care Program authorized by section 1703 of title 38, United States Code (U.S.C.), as that statute will be amended by section 101 of the John S. McCain III, Daniel K. Akaka, and Samuel R. Johnson VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act of 2018, effective upon VA’s issuance of implementing regulations.  The Veterans Community Care Program will permit eligible veterans to elect to receive hospital care, medical services, and extended care services from eligible entities and providers.  The Veterans Community Care Program would replace the Veterans Choice Program and would be used as the exclusive authority that determines eligibility under which VA would authorize covered veterans (as defined later in this rulemaking) to receive community care through eligible entities or providers.


Summary of the Major Provisions of this Regulatory Action:  This proposed rule—

?    Would establish the exclusive authority under which VA would authorize covered veterans to receive care in the community from eligible entities or providers at VA expense when such veterans meet established eligibility criteria.

?    Would define key terms used throughout the regulation.  Many of these terms would be substantively similar to those defined in the Veterans Choice Program.

?    Would define eligibility criteria, including conditions under which covered veterans could elect to have VA authorize non-VA care through eligible entities or providers, subject to the availability of appropriations.  In general, covered veterans would have to be enrolled in the VA health care system (or be eligible for care and services without enrolling) and would have to require care or services from an eligible entity or provider, as

proposed to be defined in sections 17.4005 and 17.4030 of title 38, Code of Federal Regulations (CFR),

because VA determined at least one of the following six conditions was met: 

o    VA does not offer the required care or services;

o    VA does not operate a full-service medical facility in the State in which the veteran resides;

o    the veteran was eligible to receive care under the Veterans Choice Program and is eligible to

receive care under certain grandfathering provisions;

  • VA is not able to furnish care or services to a veteran in a manner that complies with VA’s

designated access standards;

o    the veteran and the referring clinician determine it is in the best medical interest of the veteran to receive care or services from an eligible entity or provider based on consideration of certain criteria VA proposes to establish; or

o    the veteran is seeking care or services from a VA medical service line that VA has determined is not providing care that complies with VA’s standards for quality.

?    Would describe the process VA would use to identify medical service lines that are underperforming and that could be the basis for eligibility to receive non-VA care.

?    Would describe how non-VA care could be authorized through the election of a covered veteran who is eligible to receive non-VA care.  Eligible veterans could also identify a specific entity or provider to furnish such care.  VA would be able to authorize emergency care under certain conditions within 72 hours of such care being furnished.

?    Would describe the effect of the Veterans Community Care Program on other benefits and services available to covered veterans.  In general, no provision in this section would be construed to alter or modify any other provision of law establishing specific eligibility criteria for certain hospital care, medical services, or extended care services.  VA would continue to pay for and fill prescriptions written by non-VA health care providers to the extent such prescriptions were immediately required and were covered by the VA medical benefits package.  VA would continue to calculate veterans’ VA copayments under applicable regulations. 

?    Would establish those non-VA health care entities and providers that would be permitted to furnish care under the Veterans Community Care Program.  The types of eligible entities or providers would be substantively identical to those presently permitted to participate under the Veterans Choice Program or in VA’s other existing community care program.

?    Would clarify payment rates and methodologies for care and services furnished by non-VA health care entities and providers through the Veterans Community Care Program, to include rates for Critical Access Hospitals as allowable under 42 U.S.C. 1395m, and other types of providers, including Federally Qualified Health Centers. 

?    Would designate access standards that would be a basis for eligibility for non-VA care.


You can access the complete proposed rule using the link below.


Thank you in advance for taking the time to provide your feedback and comments.





H.R. 1163 VA Hiring Enhancement Act Hiring top-quality Physicians to care for Americas Veterans


TREA is supporting bipartisan legislation to make the Veterans Health Administration (VHA) more competitive in recruiting top-quality physicians to care for America’s veterans.  VHA continues to face recruitment and retention challenges of highly qualified medical providers, with VHA reporting more than 40,000 vacant positions in 2018.


TREA believes the bill is needed for VA to attract the best providers by removing barriers, like non-compete agreements and bureaucratic on-boarding processes. Introduced by Rep. Vicky Hartzler (MO-04), if enacted, the bill puts VHA on a level playing field with the private sector when it comes to hiring and recruiting timelines. Further, the legislation allows physicians who want to transition from the private sector to VA, to easily do so.


TREA is working for you and believes: Veterans deserve the best care from the best providers and this bill will improve the quality of care our veterans receive.


Highlights of H.R. 1163 include:


  • Allows VA to release physicians from non-compete agreements, provided they commit to VA service for at least one year;
    • Places VA on a level playing field by allowing VA to hire from private practices in the same manner that private sector offices hire from VA; and
    • Boosts VA ability to hire local doctors, since non-compete contracts are often designed to prevent doctors from competing with their previous employer in the same local area.
    • Authorizes VA to make job offers up to 2 years prior to completion of residency;
      • Increases VA’s competitiveness with private sector recruiters and improves post-residency job security for top medical residents that want to serve veterans;
      • Ensures quality care by making job offers contingent on meeting all VA requirements and enables VA to target needed specialties; and
      • Allows for rapid on-boarding of doctors, since the hiring process starts sooner, doctors can start caring for veteran’s sooner.
    • Updates statutory minimum requirements for VA physicians to include medical residency;
      • Enforces federal law that already establishes minimum requirements for VA physicians by ensuring the right minimums are in place and that completion of residency is synonymous with “fully trained” for United States physicians; and
      • Guarantees that veterans are only cared for by doctors who have completed a full residency that leads to board eligibility in their medical specialty.


Thank you in advance for taking the time to provide your feedback and comments.


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