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1 The Veterans Community Care Program: Background and Early Effects 1 (October 26, 2021)

handle is hein.congrec/vscycepm0001 and id is 1 raw text is: he Veterans Health Administration (VHA), part of the Department of Veterans Affairs (VA), provides health care to eligible veterans using a combination of VHA and non-VHA providers and facilities. Until a few years ago, VHA generally allowed patients to seek community care (that is, it referred patients to outside providers) on an excep- tion basis.1 In recent years, however, major legislative and VA-led changes to VHA's policies have increased oppor- tunities for veterans to seek community care at VHA's expense. Currently, the Veterans Community Care Program (VCCP) allows veterans to see outside providers on the basis of several factors, including the local avail- ability of VHA care and the circumstances of individual veterans. In this report, the Congressional Budget Office examines some of the effects of VCCP. Between 2014 and 2019, about two million veterans, or almost one-quarter of VHA enrollees, were authorized to use community care under VCCP's predecessor, the Veterans Choice Program. The VA MISSION Act (Public Law 115-182), which was enacted in 2018, created VCCP to replace the Veterans Choice Program as well as most agreements that VA medical centers had with local private providers; it also consolidated other community care programs. The MISSION Act diverges from previous VA policy that used community providers as a last resort. Now, eligible veterans may choose community care even if a VHA provider is available as long as they meet specific requirements. 1. The use of outside providers has been known by many names and has fallen under many VHA programs; in this report all such care, including long-term care, is referred to as community care unless otherwise indicated. In examining the effects of VA's changing policies toward community care, CBO determined that since 2014, the number of veterans using community care has increased and average wait times in VHA facilities have declined and remained generally below those in the private sector. CBO estimates that VHA's costs for community care grew from $7.9 billion in 2014 to $17.6 billion in 2021. (All dollar values are expressed in 2021 dollars unless otherwise stated.) In addition, CBO found that prioritizing veterans' access to community providers may affect other aspects of patient care and VHA's ability to deliver it: It is more difficult for VHA to coordinate care outside of its own facilities, and VHA has little control over the quality of care that veterans receive from community providers. Finally, increasing access to community care may reduce utilization of VHA facilities that have sufficient capac- ity, which could lead to higher costs per veteran if VHA cannot close or consolidate them. What is the Veterans Community Care Program? VCCP permits veterans who meet specific requirements to see outside health care providers who are paid by VHA. Although VHA has always used community providers for veterans under certain circumstances, the legislation that created VCCP consolidated and replaced many of VHA's existing community care agreements with one program and expanded the number of veterans eligible to seek care outside of VHA facilities. VHA Health Care Services VHA operates a direct care network of 170 medical cen- ters and more than 1,000 outpatient clinics, rehabilitation Notes: In discussing the Veterans Health Administration's costs for community care, this report cites data provided by VHA regarding obligations recorded by that agency for such care. Legislation provides agencies with the authority (called budget authority) to spend money for their programs; then, those agencies make commitments (called obligations) to spend that money; and lastly, the Treasury spends the money as outlays to fulfill those obligations. In any given year, obligations and outlays tend to be similar because most obligations result in outlays during the same fiscal year. To remove the effects of inflation, dollar values are adjusted with the gross domestic product price index from the Bureau of Economic Analysis. All dollar values are expressed in 2021 dollars unless otherwise stated.

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