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VA issues rule enabling veterans to seek treatment from non-VA providers

Monday, December 01, 2014
Physicians looking to broaden their patient base and increase their revenue now have a new way to do that: treating American service veterans when the Department of Veterans’ Affairs (VA) can’t do so. 

The VA has amended its medical regulations to provide veterans with more flexibility in obtaining care by allowing them to seek treatment from non-VA providers in certain circumstances, such as to avoid overlong wait times at the local VA hospital or to provide care for veterans who live more than 40 miles from a VA facility.

The new rule, published and effective Nov. 5, implements the Veterans Access Choice and Accountability Act signed in August, which temporarily expands veterans’ access to care until the VA can improve its own ability to provide more of it.   In fiscal year 2013 the VA provided non-VA care to over one million veterans at a cost of $4.8 billion; the new law earmarks an additional $10 billion for a “Veterans’ Choice Fund” to pay for veterans’ care by non-VA providers. 

The program, which is part of a $17 billion overhaul of the VA health care system, is authorized to run for three years or until funds are exhausted. 

VA to pay Medicare rates
The rule defines the eligibility criteria for veterans and non-VA providers to participate in the program, sets reimbursement rates, outlines how the program will operate, and explains the claims submission process. For instance, veterans will need to obtain pre-authorization from the VA before receiving treatment from a non-VA provider; without such authorization the treatment will not be reimbursed. 

Most treatment will be at no more than Medicare rates, except for providers in “highly rural” areas. Veterans will not be responsible for copayments at time of service. 

Interested? Consider these five tips:
  1. If you want to proceed, don’t wait to sign up. Get in on the ground floor. Go to the website (see below) and register. The sooner you’ve  completed the paperwork and are part of the network the sooner that veterans can make appointments and VA facilities can contact you about sending referrals. 
  2. Be prepared for additional rules. There will be requirements unique to the program, such as enrolling in the VA’s payment system and coordinating benefits for care not covered by the VA, like workers’ compensation benefits.  Providers will need to sign a contract with the VA and participate in Medicare, a Federally Qualified Health Center, Department of Defense or Indian Health Service. There are also rules similar to other federal health care programs, including a prohibition against contracting with providers excluded from participating in federally funded programs and a bar on billing veterans for amounts above the payment received from the VA for covered services.
  3. Understand you’ll be sharing your records with the VA. The legislation requires non-VA providers to provide the VA with copies of the veterans’ medical records regarding your treatment, and in electronic format to the extent possible. 
  4. Make sure that your practice can handle this influx of patients and unique patient population. Veterans often have multiple, complex health care issues, including orthopedic, vestibular, amputee, post-traumatic stress disorder and neurological issues. 
  5. Expect to coordinate care with other providers. In addition to the VA, you may need to communicate with other non-VA providers, since veterans often are treated by several different providers due to their more extensive medical needs.

New rule

How to contact The VA about signing up as a non-VA provider

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