VA launches new health care options under MISSION Act


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The U.S. Department of Veterans Affairs (VA) launched its new and improved Veterans Community Care Program on June 6, 2019, implementing portions of the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (MISSION Act), which both ends the Veterans Choice Program and establishes a new Veterans Community Care Program.

The MISSION Act will strengthen the nationwide VA Health Care System by empowering Veterans with more health care options.

“The changes not only improve our ability to provide the health care Veterans need, but also when and where they need it,” said VA Secretary Robert Wilkie. “It will also put Veterans at the center of their care and offer options, including expanded telehealth and urgent care, so they can find the balance in the system that is right for them.”

Under the new Veterans Community Care Program, Veterans can work with their VA health care provider or other VA staff to see if they are eligible to receive community care based on new criteria. Eligibility for community care does not require a Veteran to receive that care in the community; Veterans can still choose to have VA provide their care. Veterans may elect to receive care in the community if they meet any of the following six eligibility criteria:

  1. A Veteran needs a service not available at any VA medical facility.
  2. A Veteran lives in a U.S. state or territory without a full-service VA medical facility. Specifically, this would apply to Veterans living in Alaska, Hawaii, New Hampshire and the U.S. territories of Guam, American Samoa, the Northern Mariana Islands and the U.S. Virgin Islands.
  3. A Veteran qualifies under the “grandfather” provision related to distance eligibility under the Veterans Choice Program.
  4. VA cannot furnish care within certain designated access standards. The specific access standards are described below:
  • Drive time to a specific VA medical facility
  • Thirty-minute average drive time for primary care, mental health and noninstitutional extended care services.
  • Sixty-minute average drive time for specialty care.

Note: Drive times are calculated using geomapping software.

  • Appointment wait time at a specific VA medical facility
  • Twenty days from the date of request for primary care, mental health care and noninstitutional extended care services, unless the Veteran agrees to a later date in consultation with his or her VA health care provider.
  • Twenty-eight days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with his or her VA health care provider.
  1. The Veteran and the referring clinician agree it is in the best medical interest of the Veteran to receive community care based on defined factors.
  2. VA has determined that a VA medical service line is not providing care in a manner that complies with VA’s standards for quality based on specific conditions.

In preparation for this landmark initiative, senior VA leaders will visit more than 30 VA hospitals across the country to provide in-person support for the rollout.

The VA MISSION Act:

  • Strengthens VA’s ability to recruit and retain clinicians.
  • Authorizes “Anywhere to Anywhere” telehealth across state lines.
  • Empowers Veterans with increased access to community care.
  • Establishes a new urgent care benefit that eligible Veterans can access through VA’s network of urgent care providers in the community.

VA serves approximately 9 million enrolled Veterans at 1,255 health care facilities around the country every year.

For more information, visit www.missionact.va.gov.

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Comments

  1. Eldon E. Lackey    

    been waiting since May 24 for a new c-pap machine hows that for service LOL except it is not funny when you cant breath at night when your machine quits for no reason, VA response oh we are running a little behind, you think. Try to find someone to help update your disability claims good luck with that. Fractured vertebra in my back 1970, knees getting so bad walking is very hard most of the time.Diabetes from agent orange, and more things they wont tell us from this chemical. So yes this new program is nothing new except a different name. Hell the illegals get better care most of the time what a shame we are treated like second class citizens!!!!!!!!

  2. Eldon E. Lackey    

    same old lies over and over nothing ever changes just a new name.

  3. Wilbur l Bass    

    The mission Act doesn’t help us it made things worse, I no longer desire to be treated by the VA but what options do I really have zero, this sucks.

  4. Sheila Wilson    

    The CBOC in Lynchburg VA is a joke, except for one clinic – mental health. The only clinic you can reach (if you have their extension) is the mental health clinic.
    You can never speak to an actual human being when calling the CBOC. There was even a young man working behind the desk that was “moved to the back because of always being rude and then had the audacity to cuss at a veteran and yelled at him. The veteran was having none of it. And a yelling argument started. It was time for me to go home.

    My dad has a 90% hearing loss and can’t reach anyone; because he can’t hear all the ridiculous numbers to push for this and that just to get a recording to leave a message.

    The VA in Salem is great except the Nuerology department. The clerks are great, but since Dr. Harpo retired you get someone telling you, “you walk in and you’re asked; at a scheduled appointment, “what can I do for you today?” I don’t know, you’re the doctor, you scheduled this appointment for me to come back, how about reading your notes. Good grief!
    The dental program has been falling short over the years, but thank goodness they outsourced me to an outside dentist.

  5. Dwight A Nemeth    

    It seems that this ‘mission act’ was created to help veterans healthcare, NOT the veteran. I’ve lost my provider under the ‘choice’ program and have to go back to waiting for weeks to get an appointment and then hours of sitting in the waiting room to see the provider. What the hell was wrong with the ‘choice’ program?????????????

  6. Kevin Baird    

    Why does this blog require censorship. Tried to post and says “awaiting moderation

  7. Kevin Baird    

    The geomapping is probably rigged in favor of the VA. Time will tell

  8. Harlan Melvin Tilton    

    My audiologist and ENT doctors at VAOPC in Martinez, Ca have determined that I should have a Cochlea implant. The nearest VA facility that can do it or even do the prior surgery CT scan and most likely any follow up appointments is more than 50 miles from home and is more than an hours drive time due to the heavy traffic between Antioch, Ca. and San Francisco VA hospital. I am 100% disaailiy rated and am 72 years old.

    Since I also have medical coverage through my retirement plan with Kaiser Permanente (KP) and have the “senior citizen” medicare coverage as a separate insurance can I utilize them rather than VA do the surgery and related procedues/appointments
    .
    Would I need prior approval from VA under the Veterans Choice Program or Mission Act?

    Since it is a second health plan would KP bill VA for any part of their services or would VA even enter into it at all?

  9. Rodney J LaChapelle Jr    

    Yes, once again in a failed attempt to help veterans, the Red Tape has become Redder!!! They use drive time distance by geomapping, What a joke!!. No consideration about actual driving time. Once I get off I-87, I have to contend with numerous speed limits, traffic lights and traffic. Did they geomap that!!! Urgent care is another joke!! I have a civilian urgent care less than 5 miles from my house but it is not in the network. That means to get free urgent care I have to drive almost 30 miles to an approved network provider. Thanks but no thanks!! We are the veterans but we can’t just go anywhere for care yet those who never served have a lot better choices. Go figure.

  10. Greg Marsh, Disabeled VET    

    These folks need to write their congresspeople.

  11. WILLIAM TRAIL    

    Here’s my Navy Vietnam veteran’s story. I’m posting it only because I think it highlights another side to all of these sad stories.

    I worry about my familial cancer situation; dad had bladder cancer just before he died in 2004, older brother died couple years ago @ 72 from leukemia (I’m 71), youngest sibling (sister) died 9 years ago of ovarian cancer.

    VA bloodwork indicated blood in my urine several times in 2 years however VA did not offer or suggest anything.

    After couple weeks this last time in September 2018 I drove the 50+ one way miles from my home in Macon, GA to Carl Vinson VA Hospital, Dublin, GA and waited to be seen by my “Blue Team” nurse… the actual doctor is never there. I’ve only seen/met him once in three years.

    I requested a complete urological study. They scheduled me for kidney ultrasound there at the VA in Dublin – another 100-mile plus round trip weeks later.

    Well I did not ever hear anything – no result in the promised one week… even after a month. Doctor was supposed to call – what doctor. Aren’t any.

    So I drove the round trip 100+ miles for a third time and asked for a copy of the scan result. They did give me a copy as well as “burned” a DVD copy of the actual imaging scans for me.

    After reading what looked to like a questionable result I realized I needed help and asked that I be referred to a urologist which meant a civilian doctor because VA Dublin GA has no urologist.

    That process of Community Care approval took about three weeks. However the request was granted.

    The civilian urologist did a full workup including an abdominal CT scan which “accidentally” showed a mass on my right rear hip just below the belt line. No urological issues however… good news there.

    So the civilian urologist immediately referred me to a local surgeon. I Googled & Yelp’ed the surgeon and unfortunately found almost nothing on him or about him so I began asking all my friends who might me a good alternative. The same surgeon’s name continued to surface.

    I used Secure Messaging to request the change away from VA’s recommended “mystery surgeon” to the other more prominent and better known (probably more expensive) surgeon.

    In the meantime a fast initial appointment with this new surgeon became available so I went ahead.

    He ordered an immediate CT-guided biopsy and discovered a soft tissue sarcoma cancer tumor about the size, he said, of a “large chicken breast”.

    He fast tracked me for surgery to remove the tumor June 10 just a few days ago.

    I continued to call and use Secure Messaging to try to find out if this was going to be covered.

    IMMEDIATELY – before the end of the old Community Care program on June 6 (on June 5th) I got a call from VA Dublin and was informed that VA was going to pay for everything even though the program was morphing into this new incantation… including any required followup radiation or chemo or meds.

    So I had the cancer tumor removal surgery on Monday June 10.

    The pathology lab quickly confirmed June 13 “clear margins” and I have a followup appointment in another week with the surgeon.

    Even though it took seven or eight months from the time I started making noise and demanding help I just have to say that – all in all – I think VA came through for me as best as they could. Thanks to the fact that my Dublin, GA VA permitted me to go to a civilian urologist where my cancer was accidentally discovered I believe my overall health is remarkably improved as are my chances for a longer and healthier life.

    Also: I don’t know any of the details about the Veteran who committed suicide in the parking lot of my Dublin VA hospital late last year. It was a horrible tragedy and my heart goes out to that family.

    But maybe my story proves that things are better there… and improving.

    We do, however, definitely, need several full time doctors. As I mentioned I met my “doctor” once – 3 years ago – when I first started going to VA Dublin, GA. That was it. Only nurses or PA’s ever since. I honestly don’t think that doctor really even works there. They just say his name every now and then to keep his memory alive!

    Still, in all, THANK YOU to Carl Vinson VA, Dublin, GA, for the help you have given me with my cancer.

  12. Gilbert A. Lerma    

    I have been using the VA, hospital and out patient clinic for a number of years and have no complaints.

  13. Kenneth Goldstein    

    How is this going to help a 100% Permanent and totally disabled veteran that lives in the Philippines. The FMP doesn’t allow for all my medicine to be covered or the same services I normally would have. The VA clinic is extremely limited in their services other than service connection and my travel time exceeds 2 hrs to Manila and 4+ hours to Guam. What is this going to do for me and other veterans in the same situation.

  14. Phillp C Thomas    

    is there a provision in the Mission Act which provides for emergency care for a veteran and what are the conditions.

  15. Michael Rogala    

    Why does the VA not offer dental care? I was told it had to be service related, does that mean your teeth had to be knocked out by a gun butt?

  16. Steven S. Palmer    

    I am under care with the VA, Oregon. I asked for a primary care near my home and was put on a waiting list 2013 for a new clinic that opened 20 miles from me, and this was in 2013/2014 they opened the new clinic. They only let me go to the clinic or hospital that are located 150 mile round trips. They told me I don’t have to renew my request for the new clinic. I have been waiting sine it opened in Salem Oregon 2014. I have pancreas and liver disease, and it is very difficult to travel hundreds of miles. There is no one that can help. I tried so many times. My doctor is retiring in a couple months at the clinic they have me going to 150 miles round trip. Communication is horrible with the va, especially Oregon, I lived in San Diego VA for six months as an in patient after a failed pancreas operation. Each VA treats vets differently, and the VA says we are suppose to have a team to help us, no word on any teams. Please, help me fix these problems.

  17. Michael Godwin    

    I tried to use the new Mission Act, and still got bogged down in the Telephone transfer bounce-around that has been pretty regular in the VA System. I had a Physciatry Appointment scheduled for late July, and needed it pretty much immediately, so I finally got to the right person inside the VA that could set up the referral, except for the fact that they couldn’t actually set it up; all they could do it s cancel my previous appointments and send a request for another department to call me back and discuss if I could (or actually needed to be referred) to care outside of the VA, under the Mission Act. They could not give me a time frame, but said it could take a few weeks for them to get in touch with me. If that happens, I’ll be running into a tight schedule to get a new outside the VA Appointment, and if they decide I can’t be referred (for whatever reason), I’ll be in a much more difficult position because I’ll have to reschedule the original VA Appointments, which could be 1.5 to 2 or more months out from the original appointments. I’m just wondering if this new way of doing the old VA Choice Program will be any more of an improvement.

  18. Robert W YORK    

    I have been receiving community based care from a non-va pulmonologist in the city closest to my home for about 3 years now. This has been covered by the Choice program in the past. I recently had an emergency that hospitalized me for 3 days that is related to my pulmonary issues (spontaneous pneumothorax). The attending pulmonologist ordered a follow-up with my regular pulmonary care physician but the authorization (under the Choice program) will expire prior to my follow-up. Currently I cant find any instructions on how to continue the care needed under the Missions Act.

    Any place I can go or anything I can do to facilitate my treatment and follow-up? Or am I just screwed like Mr. Ross?

  19. Alfonso Granata    

    I live in Illinois. Trying to fine a provider under the VA policy in my area. Can’t find any thing on the va web site. Looking for a provider in the LaSalle, Illinois area? Shouldn’t their be a list!

    1. Tom Wallace    

      Every VA Hospital should have a Care Coordinator now that will assist you. Call the nearest VA Hospital operator to you and request to be connected to that to that number. If that office has not been established yet, request to be connected to the patient Advocate office. That office will probably be busy and follow the message to the LETTER!
      Call two or three times a day 0800 thru 1600 Mon thru Fri and leave the same message each time. Be persistent and polite. You will recieve assistance.

  20. Jon    

    I have had to go to the local hospital…40 miles away for twice for emergency situation . Ruptured appendix and pancreatitis. Never had to pay for anything…

  21. Luther Palmer    

    Sounds like my situation. Guess we’re both screwed.

  22. Raymond D.Ross, Jr.    

    The Problem I have is that I Don’t want to Drive to West Haven VA Hospital which is 56 Miles from my House. I have a VA Outpatient Clinic about 10 Miles or less and that Cancelled out the Choice Program. My Primary Doctor is at the Outpatient Clinic, the Only thing they do at the Clinic is Physical Exams, Medication Renewals and Pneumonia Shots. Everything Else happens at West Haven VA. If I have a problem I have to go to the Emergency Room at the Local Hospital and then I’m stuck paying Co-Pays for the Hospital and Doctors. How is the new system going to Help Me? Am I able to see Doctors on the Outside? I’m 72, and don’t want to Drive on I-95 for an Hour in traffic for a 10 minute appointment. Please Give Me Good News, or Am I Screwed. I’m Permanent and Total. Thank You for your response.

    1. Phillp C Thomas    

      I am in the same situation. I have an Emergency room (i.e. hospital) close to my home and a VA outpatient clinic even closer. However, if I need emergency care due to my health, I am unsure what the rules are governing my care in those situations. The main VA medical facility is over 30 miles away.

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