About 1 million veterans are eligible for the Veterans Choice Program, intended to decrease wait times for medical care. You can help make sure they get the care they need when they need it by enrolling in the program—learn how.
A recent analysis estimates the U.S. Department of Veterans Affairs (VA) has about 41,500 job vacancies for doctors, nurses and other medical professionals, which has translated into long appointment wait times and access-to-care issues for veterans. According to the most recent VA data, nearly 8 percent of appointments were not able to be scheduled within the 30-day time frame. That’s about 469,000 appointments.
To address these wait times, the agency last year started the Veterans Choice Program. The program enables the VA to enter into agreements with non-VA physicians to deliver care to veterans who are either unable to receive care within a 30-day wait period or who live too far from a VA facility. At the time of the program’s launch last year, about 500,000 veterans were eligible. Now, with some relaxed criteria, that number is closer to 1 million, a VA official said on a recent AMA webinar.
If you’re considering enrolling, here’s what you need to know about the program:
- The program is facilitated by either TriWest or Health Net, depending on your location. Use this map to determine which contractor manages your area. You can apply to join TriWest or Health Net online.
- Medicare payment rates set the floor on payments to physicians participating in the Veterans Choice Program, but this safeguard does not apply to other VA programs.
- It is a managed care plan that only covers authorized services, meant for planned care. Anything that isn’t authorized will not be paid.
- Physicians must return medical documentation to their contractor before submitting a claim, or the claim will be denied.
- Physicians also are required to notify the contractor when a veteran is a no-show or cancels or reschedules an appointment. Physicians can’t bill for missed or cancelled appointments.
- If a physician wants to provide additional services and can’t give those services in the specific episode of care, the physician must notify the contractor so the new provider or new location can be authorized. For example, if a physician needed a veteran patient to undergo outpatient surgery at an ambulatory surgical center, the physician would need to alert the contractor so that surgical center could be authorized.
Changes to program in the works
The U.S. Congress recently passed legislation that will modify the original Veterans Access, Choice and Accountability Act—a law the AMA helped shape that gave rise to the Veterans Choice Program. One change removed a Veterans Choice Program enrollment deadline, which VA officials expect will add more than 300,000 more veterans to the program.
Another provision will require the VA secretary to develop a plan by Nov. 1 to consolidate the VA’s seven community care programs into a single program. The VA must submit this plan to Congress by Nov. 1.
Read more information for physicians on the Veterans Choice Program website. You also can get additional resources at the AMA’s veteran health Web page.
