WASHINGTON—VA has released its proposed new access standards, defining new eligibility criteria for veterans seeking care by non-VA providers. The standards are part of the VA MISSION Act signed into law in June 2018, and their release has added fuel to concerns that VA’s expansion of access to non-VA providers will come at the expense of VA’s critical infrastructure.

“VA’s current patchwork of seven separate community care programs is a bureaucratic maze that’s hard to navigate for veterans, their families, and VA employees,” VA Secretary Robert Wilkie said in a statement prior to the release of the proposed standards last month. “Our new access standards will form the basis of a federal regulation that will consolidate VA’s community care efforts into a single, simple-to-use program that puts veterans at the center of their VA healthcare decisions. Strict and confusing qualification criteria like driving distances and proximity to VA facilities that don’t offer needed services will be replaced by eligibility guidelines based on what matters most: the convenience of our veteran customers.”

VA’s proposed access standards are:

  • A 30-minute average drive time standard for primary care, mental healthcare, and non-institutional extended care services.
  • A 60-minute average drive time standard for specialty care.
  • A wait time standard of 20 days for primary care, mental health care and non-institutional extended care services
  • A wait time of 28 days for specialty care from the date of request with certain exceptions

In addition to these new access standards, veterans will also be allowed access to community care providers if VA does not have the services they require; they are residents of a state without a full-service VA medical facility; they have been taking advantage of the 40-mile access standard used in the CHOICE program; or its been deemed in their best medical interest.

The VA CHOICE Act of 2014 was VA’s last extensive attempt to expand access to non-VA providers. It was later determined to have had inadequate infrastructure in place when it was stood up, and had little impact on veteran wait times.

No Advance Look

According to several legislators, Congress was not given an advance look at the standards before their public release by VA—something they consider problematic. Members of Congress have requested updates on the Mission Act as it moves forward.

“VA needs to be more transparent and work more collaboratively with Congress,” Sen. Jon Tester (D-MT) told VA officials at a hearing last month. “I don’t know anybody in Congress who knew what was in those access standards before they were announced. If these access standards are bad or have unintended consequences, it could result in the privatization of VA.”

At the same hearing, Sen. Brian Schatz (D-HI) expressed concern about the lack of data on how these standards will impact VA’s budget and utilization rates. “Members of the majority and minority have made repeated requests to hear from VA what information the department relied on to inform its decision-making and the potential budget implications for VA,” he pointed out.

“It cannot come at the expense of VA’s internal healthcare system,” Schatz declared. “We don’t have any analysis or projection about how the proposed access standards will affect utilization rates [or] how it will interact with core VA services.”

The same general concerns were expressed by VA service organizations.

“We need more detailed information about how these proposed access standards affect veterans who choose and rely on VA for their care, whether they are realistic and feasible, and whether sufficient new funding will be provided without diverting resources from existing VA programs or modernization plans,” said Disabled American Veterans Director Joy Illem.

VA officials have responded to those concerns in the past by noting that access to community care does not guarantee utilization and that the percentage of veterans choosing community care over VA care has dipped slightly over the last two years.

As for fears about privatization, Wilkie preemptively dismissed those in his statement.

“Some will claim falsely and predictably that [these standards] represent a first step toward privatizing the department,” he said. “Since 2014, the number of annual appointments for VA care is up by 3.4 million, with over 58 million appointments in fiscal year 2018. Simply put, more veterans are choosing to receive their health care at VA. Patients’ trust in VA care has skyrocketed—currently at 87.7 percent—and VA wait times are shorter than those in the private sector in primary care and two of three specialty care areas. In other words, VA is seeing more patients than ever before, more quickly than ever before, and veterans are more satisfied with their care than they have been previously.”

The MISSION Act requires VA to stand up the new access standards by July 6, 2019.