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1 1 (July 12, 2017)

handle is hein.crs/govcexy0001 and id is 1 raw text is: &~ ~ riE SE ~$rCh &~ ~ ~ Updated July 12, 2017 Implementation of the Veterans Choice Program (VCP) In response to wait time manipulation allegations and access issues at many Department of Veterans Affairs (VA) hospitals across the country, Congress passed the Veterans Access, Choice and Accountability Act of 2014 (VACAA). On August 7, 2014, the bill was signed into law (P.L. 113- 146, as amended). Background Resources * For wait time issues, see VA Office of Inspector General (0IG), Administrative Summaries of Investigation Regarding Wait Time (http://bit.ly/2gLEnAr) * For a detailed provision-by-provision explanation of the act, see CRS Report R43704, Veterans Access, Choice, and Accountability Act of 2014 (HR. 3230; P.L 113-146) * For a more in-depth discussion on implementation of the VCP see CRS Report R44562, The Veterans Choice Program (VCP): Program Implementation Section 101 of VACAA authorized the Veterans Choice Program (VCP) -a temporary program that provides veterans the flexibility to receive medical care in the community if that is their preference. The VCP generally covers all medical care services, including diagnostic and laboratory tests, among others. Emergency care, dialysis care, and long-term nursing home care are not covered. The VCP is in addition to several existing statutory authorities that allow the VA to provide care outside of its health care system. Generally, these statutory authorities fall into three broad categories: (1) contracts to purchase care, (2) non-contracted medical care purchased on a fee for service basis from providers in the community, and (3) emergency care when delays may be hazardous to a veteran's life or health. The VCP was to end either when the $10 billion in mandatory funding included in VACAA was fully obligated or no later than August 7, 2017. Enacted on April 19, 2017, P.L. 115-26 eliminated the sunset date of August 7 and authorized the VA to continue the VCP until the $10 billion was fully obligated. At the time of enactment of P.L. 115- 26, the VA had indicated to Congress that about $1 billion of the funding for VCP could remain unobligated by August 7. However, in mid-June 2017, VA notified Congress that due to the increased authorization of appointments, there had been higher rate of usage of VCP funds, and VCP would not be able to continue past August 15, 2017, since all the remaining funds for VCP would be fully obligated by then. As of June 9, 2017, $9.2 billion of VCP funds had been obligated and $7.1 billion had been expended. According to the VA, at least $3.5 billion in new mandatory budget authority would be needed to continue VCP through FY2018. (The VA estimates that approximately $252 million per month is obligated for VCP.) To% prons t fud shortf u1 To prolong the funds for VCP, on June 12, 2017, the VA provided guidance to VA medical facilities on optimizing funding for VA community care. Among other things: * Veterans who are eligible based on statutory criteria (see below) will continue to be eligible to use VCP. * Choice First criteria-that is, care not offered at the veteran's primary VA medical facility-will no longer apply. In May 2015, the VA provided guidance to VA medical facilities that VCP should be the primary program to be used when patients are waiting for care or need care that cannot be provided at the veterans' primary facility. * Veterans who do not qualify for VCP because their required care is not offered at the veteran's primary VA medical facility will be referred to another VA medical facility or a federal facility such as a Department of Defense medical facility, Indian Health Service (IHS), or Tribal Health Facility, or to other community care providers not participating in VCP. VCP igi,.,i i, ', To participate in the VCP, a veteran must be enrolled in the VA health care system and meet one of the following criteria: * the veteran cannot schedule an appointment within 30 days of the veteran's preferred date or a date determined clinically appropriate by a VA provider; or * the veteran resides more than 40 miles from his or her closest VA medical facility with a full-time primary care provider; or * the veteran resides 40 miles or less from a VA medical facility and faces an unusual or excessive burden in accessing such a facility due to geographical challenges; or * the veteran resides in a state without a full-service VA medical facility that provides hospital care, emergency services, and surgical care and resides more than 20 miles from such a facility (this criterion applies only to veterans residing in three states: Alaska, Hawaii, and New Hampshire). w , VCP Adr', s: The VACAA provided 90 days from the date of enactment to establish the temporary VCP. VA awarded contracts to two existing VA contractors-Health Net Federal Services, LLC and TriWest Healthcare Alliance Corporation-to serve as third-party administrators (TPA) of the VCP. In their TPA role, TriWest serves the western United States and mid-South regions; Health Net serves the remainder of the country. .O 'T p\w -- , gnom goo mppm qq\ a , q 'S I 11LULANJILiN,

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