VA Black Hills Health Care System
Veterans Access, Choice, and Accountability Act
VA has begun implementing the Veterans Access, Choice, and Accountability Act of 2014. As part of the rollout of the Choice Program, Veterans will begin receiving their Choice Cards in the mail along with a letter of explanation. The Choice Program is a temporary benefit allowing eligible Veterans to receive health care in their communities rather than waiting for a VA appointment or traveling to a VA facility. The Choice Program does not impact existing VA health care or another VA benefit they may be receiving. The Choice Card itself is not an authorization of Non-VA Care or a guarantee of payment. Veterans must first verify their eligibility and obtain pre-authorization by calling 1-866-606-8198. Veterans should not schedule their own appointments or visit a community provider and attempt to use the Choice Card to receive care without first obtaining preauthorization.
Initially, a Veteran must be enrolled in VA health care on or before August 1, 2014, or be eligible to enroll as a recently discharged combat Veteran within 5 years of separation. Additionally, a Veteran must also meet at least one of the following criteria.
a) The Veteran attempts to schedule an appointment with VA for hospital care or medical services but is unable to schedule an appointment within 30 days of the Veterans preferred date, or the clinically appropriate date
b) The Veteran lives more than 40 miles from the VA facility that is nearest to the Veteran’s residence, including a community-based outpatient clinic.
c) The Veteran lives in a state without a medical facility that provides hospital care, emergency services and surgical care rated by the Secretary as having a surgical complexity of standard, and the Veteran resides more than 20 miles from such facility.
d) The Veteran lives 40 miles or less from a VA health care facility but needs to travel by air, boat, or ferry, or faces an unusual or excessive burden on travel due to geographical challenges.
If an eligible Veteran has another health-care plan, VA will be secondarily responsible for costs associated with non-service connected care and services furnished to eligible Veterans through the Veterans Choice Program.
When a Veteran receives care from an eligible non-VA health care entity or provider, the entity or provider must submit to VA a copy of any medical record information related to the care and services provided. This information will be included in the Veteran’s medical record maintained by the Department.
Indian Health Service and Native Hawaiian Health Care Systems
VA will work with the Indian Health Service (IHS) to ensure that certain medical facilities operated by an Indian tribe or tribal organization is aware of the opportunity to negotiate reimbursement agreements with VA. This is in accordance with section 102 of the Choice Act.
VA will enter into contracts or agreements with certain Native Hawaiian Health Care Systems (NHHCS) for reimbursement of direct care services provided to eligible Veterans. This is in accordance with section 103 of the Choice Act.
Frequently Asked Questions
Q: How long will it take to implement the Veterans Choice Program?
A: In order to ensure Veterans receive high-quality and timely health care, VA is working to implement the Veteran’s Choice Act, including the Veterans Choice Program, as quickly as possible.
Q: How will Veterans get their Veterans Choice Card?
A: VA will mail the Veterans Choice Card to Veterans enrolled in VA health care as of August 1, 2014, and to recently discharged combat Veterans who enroll within the 5 year window of eligibility. Not all Veterans who receive the Card will be able to participate in the Veterans Choice Program right away. Only eligible Veterans may participate.
Q: Is the criteria 40 miles or 30 days?
A: Response: Eligibility for the Veterans Choice Program is based on the Veteran’s place of residence or the inability to schedule an appointment within the “wait-time goals” of VHA. A Veteran could be eligible under one or both of these criteria. Please note that Veterans who are eligible based on their place of residence may elect non-VA care for any service that is clinically necessary. Veterans who are eligible based on “wait-time” may select non-VA care only for an appointment for the service that cannot be scheduled within the “wait-time goals” of VHA.
Q: Does the 40 mile rule refer to whether the specialty need (for example, Orthopedic Surgery) is available within 40 miles, or 40 miles from any VA facility, whether or not the specialty, in this example Orthopedics, is available there.
A: The law indicates that what matters is the distance from the Veteran’s residence to any VA medical facility, even if that facility cannot provide the care that the Veteran requires. VA is developing an interactive tool that will be available on va.gov for Veterans to determine their potential eligibility for VA Choice based on their place of residence. Veterans will enter their address information into the tool. The tool will calculate their distance to the nearest site of VA care and return that mileage and information on their eligibility for VA Choice program.
Q: What are the criteria used to determine the 40 mile radius? Is it similar to the Dashboard used to calculate mileage reimbursement?
A: VA will calculate distance between a Veteran’s residence and the nearest VA medical facility using a straight-line distance, rather than the driving distance. VA is developing an interactive tool that will be available on va.gov for Veterans to determine their potential eligibility for VA Choice based on their place of residence. Veterans will enter their address information into the tool. The tool will calculate their distance to the nearest site of VA care and return that mileage and information on their eligibility for VA Choice program.
Q. How will eligibility be determined for those Veterans who receive a “Veterans’ Choice Card,” and are there limitations on what service they qualify for outside of the VA system?
A: Once a Veteran receives a Veterans Choice Card, they will be eligible to use the Program if they meet the specific eligibility criteria discussed above. Veterans who are eligible based upon their place of residence will be eligible to use the Choice Program for services in the medical benefits package that are clinically necessary. Veterans who are eligible because of the wait-time criterion will only be able to receive a non-VA appointment for the episode of care related to the service that cannot be scheduled within the “wait-time goals” of the Veterans Health Administration.