VA MISSION Act: VA’s new urgent care benefit for Veterans


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Note: This article is part of a series on VA’s progress implementing the VA MISSION Act of 2018.

Sometimes a quick trip to a local walk-in retail health clinic or urgent care facility is a convenient alternative for minor injuries and illnesses.

As part of implementing the VA MISSION Act of 2018, VA will offer an urgent care benefit that provides eligible Veterans with greater choice and access to timely, high-quality care.

With urgent care, Veterans have a new option for care for the treatment of minor injuries and illnesses, such as colds, sore throats, and minor skin infections. The benefit is offered in addition to the opportunity to receive care from a VA provider, as VA also offers same-day services.

Eligible Veterans will be able to receive urgent care from an urgent care provider that is part of VA’s contracted network of community providers without prior authorization from VA. VA can pay for an urgent care claim only if:

  • The Veteran is eligible for the benefit;
  • The urgent care provider is part of VA’s contracted network of community providers; and
  • The services are not excluded under the benefit (excluded services include preventive services and dental services).

This benefit will be available when final Federal regulations are published and effective, on June 6, 2019.

Eligibility

To check their eligibility once the urgent care benefit has started, Veterans should contact their local VA medical facility.

To find an available urgent care provider in VA’s contracted network of community providers, Veterans will be able to use VA’s provider locator on VA.gov (https://www.va.gov/find-locations/) or contact their local VA medical facility. VA staff can inform the Veteran of available in-network locations and offer to find the closest locations. 

VA can only pay for care under this benefit if the Veteran is eligible, the services are not excluded under the benefit, and the provider is part of VA’s contracted network of community providers and is identified as an urgent care provider. If an eligible Veteran goes to an out-of-network urgent care provider, they may be required to pay the full cost of care.

Covered Services

The urgent care benefit covers treatment of non-emergent symptoms such as flu-like symptoms (coughs and colds), wheezing, sprains, sore throats, painful urination, bumps and bruises, ear pain, and mild skin irritations, which are typically addressed by urgent care facilities and walk-in retail health clinics. Excluded from the benefit are preventive and dental services.

Important: While urgent care is a convenient benefit for the treatment of non-emergent symptoms, Veterans should always consider talking with or seeing their primary care provider if they are concerned that the community provider will not understand the complexities of their medical history or medications.

In addition, if you believe your life or health is in danger, call 911 or go to the nearest emergency department right away.

Urgent care is not a replacement for an eligible Veteran’s preventive health care. Eligible Veterans should work with their primary care provider for this type of care. If an eligible Veteran goes to an urgent care provider and receives services that are not covered by this benefit, they may be required to pay the full cost of care.

Copayments

Eligible Veterans may be charged a VA copayment for urgent care that is different from other VA medical copayments. VA copayments for urgent care depend on the eligible Veteran’s assigned priority group and the number of times they visit an in-network urgent care provider in a calendar year.

  • Priority Groups 1-5. There is no copayment for the first three visits during a calendar year. For the fourth visit and all subsequent visits in a calendar year, the copayment is $30.
  • Priority Group 6. There is no copayment for the first three visits during a calendar year if the visit is related to special authority* or exposure. For the fourth visit and all subsequent visits in a calendar year, the copayment is $30. If the visit is not related to special authority* or exposure, the copayment is $30 per visit, regardless of which visit it is.
  • Priority Groups 7-8. The copayment is $30 per visit.
  • Priority Groups 1-8. No copayment for a flu shot-only visit. Visits consisting only of a flu shot do not count as a visit for the number of visits in a calendar year for eligible Veterans in priority groups 1-6.

*Special authorities include those related to combat service and exposures (e.g. agent orange, active duty at Camp Lejeune, ionizing radiation, Project Shipboard Hazard and Defense (SHAD/Project 112), Southwest Asia Conditions) as well as Military Sexual Trauma, and presumptions applicable to certain Veterans with psychosis and other mental illnesses.

When the benefit starts, Veterans can contact the VA Health Resource Center (HRC) for questions related to urgent care copayments at 1-877-222-VETS (8387). Veterans will also be able to contact their local VA medical facility for more information about urgent care copayments.

Prescription Medication

VA will pay for or fill prescriptions for urgent care. For routine prescription medication, the prescription must be submitted to VA to be filled.

For urgent prescription medication of a 14 day or fewer supply, Veterans can either fill the prescription at a contracted pharmacy in the VA network or the prescription can be filled at a non-contracted pharmacy. If a non-contracted pharmacy is used, Veterans must pay for the prescription and then file a claim for reimbursement with their local VA medical facility.

Some Veterans may be required to make a copayment for medication. Information about copayments can be found at https://www.va.gov/COMMUNITYCARE/revenue_ops/copays.asp.

Going Forward

This benefit will be available when final Federal regulations are published and effective, on June 6, 2019. The new urgent care benefit is consistent with President Trump’s commitment to provide Veterans with more choices and greater access to healthcare they’ve earned through their service to our country.

Resources

  • Fact Sheet – Veteran Community Care – Urgent Care (VA MISSION Act of 2018)
  • Fact Sheet – Veteran Community Care – Eligibility (VA MISSION Act of 2018)
  • Fact Sheet – Veteran Community Care – General Information (VA MISSION Act of 2018)

Written by VHA Office of Community Care

Author

VAntagePoint Contributor

— VAntage Point Contributors provide insight and perspective on a wide range of Veterans issues. If you’d like to contribute a story to VAntage Point, learn how you can submit a guest blog at http://www.blogs.va.gov/VAntage/how-to-submit-a-guest-post/

Comments

  1. K Wenzel    

    I was scammed by VA and the clinic although not on purpose, it’s business as usual. The VA gave me the name of the clinic to use for urgent care. The clinic said they knew of this program and could send the bill to the VA. They called me a day after I was seen to say I needed to get pre-authorization or they would send me a bill. They said I should have known this. It takes me 5 calls minimum to get anything done so I don’t use pre-authorization or community care. I just suffer because I so hate healthcare, I thought this program might be for me. I was wrong. No one can improve any US health care including VA, nice try though.

  2. Hilary Michael Kunz III    

    Hi, when will you have repeat meetings? I just tried to attend a meeting this morning on the MISSION act, but it was standing room only, and I can’t stand that long. Could you please schedule a meeting in Lake Havasu City, Arizona In a large room where more people can fit? I am a Choice user, I need the information. There have been many improvements in the VA, but getting the word out hasn’t been one of them. Please schedule more meetings, right away. I don’t want to feel like I’m out on the secret. The article was ok at letting me know that MISSION existed, but no explanation of much of anything.

    Please please please work harder on this.

  3. Bradford Scales    

    I have several orthopedic issues. My primary said I needed to see the VA Clinic inhouse ortho doc for referrals outside. He tells me my primary has to submit the consult!!

  4. Mike hofmann    

    How does one know what primary group one is in

  5. Harrison Barton    

    I live in Athens, Georgia, a 2 hour drive from VA hospital in Augusta, Georgia. My body is one that cr4ates polyps on a regular basis, with none being cancerous through the years. Even though we have an outstanding VA outpatient clinic in Athens, I must travel to Augusta for endoscopies and colonoscopies, normally seeing a different provider every trip since the VA Hospital is staffed with resident and fellowship doctors, with minimal permanent staff doctors. How do I find out if I can use a local provider for such procedures under the new VA program starting today, 6 June 2019?

  6. Ernst Rogers    

    So, how do we determine what Priority group we belong to?

    1. Maritza Polanco    

      This is he same question I have. What determines our Priority group?

      1. Kathleen Ryan    

        Check with your local VA eligibility clerk. They can tell you. Also, Google VA Priority Groups and see where you fit. For example: Priority Group 6 are vets with environmental hazards exposure, like Agent Orange. PG 3 are Purple Heart recipients, etc.

  7. Scott Jeffe    

    I for one appreciate President Trump, and his administrations efforts to improve medical care for veterans. Since taking office I’ve noticed quite a few improvements in the care I receive, courtesy towards myself and other veterans, quick response time to concerns and, or questions I might have about medication, treatment, symptoms. This new VA Mission Act program probably won’t solve every concern disabled veterans have (I’m 100% total and permanent service connected disabled), but I truly have notice improvements in care, and response times, so this new VA Mission Act allowing access to participating Urgent Care providers in our communities should reduce my waiting time I currently suffer going to the VA walk-in clinic for same day treatment.

    I hope in time all disabled veterans like myself, will start experiencing positive change to the VA Health system, and like me, appreciate President Trumps efforts to drive positive change for those that served.

    God bless

  8. Gwyneth Holladay    

    Emergency care, urgent care, VA care…How about some dental care? I’m down to about 10 teeth left but they don’t match up for chewing anything without making sores. When will the VA include dental care for all vets?

  9. Ted    

    Why are we only getting 3 visits with no co pay and after that we are being charged 30.00 If we are over 50 percent we are not suppose to being charged period.

  10. Ted    

    Why are we only getting 3 visits with co pay and after that we are being charged 30.00 If we are over 50 percent we are not suppose to being charged period.

  11. Tim Connor    

    Great concept, no providers in network.

  12. Daniel Ridlon    

    I tried to get my choice provider extended for services and was told the new procedure is to get an appointment with your primary provider first, then they will approve or disapprove the appointment. My appointment with my primary care is scheduled for three weeks out. What kind of urgent care is this? The whole reason this was implemented was that VA clinics are overwhelmed.

  13. Tammy I Barlet    

    “To find an available urgent care provider in VA’s contracted network of community providers, Veterans will be able to use VA’s provider locator on VA.gov (https://www.va.gov/find-locations/) or contact their local VA medical facility. VA staff can inform the Veteran of available in-network locations and offer to find the closest locations.”

    What if its after hours and no one picks up the phone?

  14. Tamm    

    Where is the link to the VA Network Pharmacies

  15. Christopher T. Parker    

    Victory for the veteran. However, does this cover Dermatology?

  16. LOREN C MANUEL    

    So far Is this mission act is as clear as Mud in your eye. We loose choice and get some kind of urgent care that is to far for most of us to travel to in less than three hours. sound like a loose loose proposition to me.

    1. Richard A. Strohm    

      You are right! I am in Ohio and my closest urgent care is in Pennsylvania…????

      1. Danielle Selby    

        Richard, when I looked online for a zip code within Ohio…I saw many Minute Clinics on the list just for Ohio. Urgent cares are fewer between, but one of the objectives of the Mission Act is to allow folks who need to be seen for more “sick call” related situations to be seen quickly and more conveniently than relying on the VA alone. So I’m not sure where you were looking for your nearest Minute Clinic or Urgent Care (basically the same thing but with a few extra perks), but hopefully this site will make it easier to locate:

        https://vaurgentcarelocator.triwest.com/Locatorto find the nearest participating community clinic/Urgent Care.

        Participating pharmacies can be found going to http://www.express-script.com. CVS is a participating pharmacy near me.

      2. Chuck Giambra    

        Same here, I’m in Western NY & nearest urgent care facility listed in their network is Erie PA at 96 miles from here.
        What’s the point?!

  17. Daniel Grammer    

    Yes sir…..the questions on receiving benifits continue. Simplification for those in need is an important step for the administrators of these laws/benifits especially those you mentioned. Thanks for your service and thank you for thinking of our fellow vets in need. Now is they would just contact all war veterans and advise them that they may qualify for wartime veterans pensions, a lot of folks could live out there lives a little more comfortably than they are now is they fall into the catagories of need.

    It is a shame that I have found four on my own that qualified and never even knew they had the option.

    Thankfully, President Trump has opened SOME of the awareness and is making health clinics available to vets that are not able to do like you and me with the medicare and the supplement.

    Cheers to you my fellow vet.

    Daniel Grammer, class of Agent Orange US Navy

  18. Steve Friedlander    

    There needs to be an expansion of Veteran Dental services. Poor Dental health leads to overall poor health and an increase in Heart attacks. Currently, if you’re not Retired Military you need a 100% Service-Connected Disability to receive Dental benefits. This needs to be expanded immediately! I am currently 60% Service-Connected and am desperately in need of Dental Care.

    Steve Friedlander (0584)

    1. Craig Brockman    

      VAdip is only about $20 a month if you’re VA eligible. Great program. All preventive included along with some restorative costs partially covered. Delta dental. Call your VA. You’re eligible.

    2. Jerry Otis    

      I totally agree with Steve! And delta dental will not help with the costs involved with gum and teeth problems associated with diabetes and heart problems

  19. Joe Lauerman    

    Eddie,

    I commend you on not wanting to add the cost of medical services to the VA healthcare expenses, but please be advised you would have a hard time doing that. You see under Community Services IE: Hospitalization VA covers the expense. Well….they are suppose to cover it, but getting the bills paid is another deal. From my experience (about 8 trips to the ER) private hospitals don’t want to treat veterans covered by VA. The billing process is difficult and they would rather not bother instead of getting their claims rejected by VA for the 1st time. After this the private hospitals send you a bill for thousands of dollars claiming its your responsibility to pay. So with urgent care, the same type of situation would present itself-who is going to pay? VA is supposed to cover it, but its a long process. I have refused to pay the hospital bills and have bill collectors calling me for payment. I keep referring them to VA but after 45 days VA closes the claim and then you are stuck with the bill. So don’t get your hopes up about this new urgent care because although it looks good on paper, it will definitely be a challenge.

    1. Susan Dejohnette    

      In March, via emergency room services, I was hospitalized at a local hospital. I had previously went to the local VA clinic to seek care, but left after realizing, they didn’t really have an effective sickcall program in place. Feeling my condition deteriorating, I phoned the VA hospital that provide authorization to seek emergency care at the local hospital near me. Then upon arriving at the hospital ER, I notified the admission/intake individual of my Veteran status, and the name of the individual who approved me to seek care there. I was admitted to the hospital for 3 days. The individual that submits paperwork to VA came to see me & asked a few questions in a condescending manner, but in the end, VA took care of the bill.

  20. Richie Paul Gammons    

    I received a letter in mail about the mission act and stated I was eligible with 0 co-payment. I would like to speak with someone about this.

  21. ROGER G. HARBAUGH    

    I HAVE READ THIS A COUPLE OF TIMES AND STILL DON’T UNDERSTAND MUCH OF IT

  22. ROGER G. HARBAUGH    

    I HAVE READ THIS A COUPLE OF TIMES AND STILL DON’T UNDERSTAND ALL OF IT.

  23. Dennis R. Tennyson    

    I live in Olney Ill.My wife doesn’t like to drive all that well.Our closest VA hospital is in Marion Ill. Which is 2hr. awayI also have to go to St. Louis john Cochran for my arthritis which is 2hrs.I go to Effingham which is 45min.How will this help me on thing s like a colonoscopy.Thank You.

  24. Eddie W. Varney    

    If an eligible Veteran for benefits has Medicaid and a supplemental Blue Cross Blue Shield, how will a VA urgent/walk-in facility process a claim to the Veteran’s health insurance company? May I correctly assumed a private insurance company’s payment to the VA will be accepted as a portion of the charge of medical services received?

    I am an eligible Veteran for VA healthcare but have used Medicare and my supplement for my medical services because I did not want to add the cost of my medical services to the VA healthcare expenses. However, if a local VA walk – in facility for Veterans’ health care needs, I would enroll for this new Outside Networks Act (Mission Act) of 2018..

    How would an eligible Veteran for medical service, not currently enrolled in VA medical care services, receive certification for services provided by the Mission Act of 2018? I believe there are thousands of eligible Veterans like myself who would want to use these walk – in clinics which have never been participating in the VA healthcare system, thus, a brief document with instructions and a short form application for qualifications for this program would bring many new enrollments of Veterans to VA healthcare services.

    I encourage you to create such a document to facilitate Veterans now wanting to reenter or for the first time start participating in the program of healthcare by the VA for veterans. You may ask why this request for a new simplified enrollment form for VA healthcare services being expanded to the local communities, is necessary. I am an 85-year-old overseas US Army veteran, but one of the lucky ones who at this time is capable of handling most of my own paperwork and driving my car to places to receive medical services. Others, probably millions, in my age group need help completing the necessary paperwork, transportation to and from VA services, and financial help paying private healthcare facilities. Please, try your best to make this as simple and convenient for many older and often Veterans.

    Best regards, Eddie W Varney US 52403125.

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