Health Care Providers to Get Greater Ability to Care for Veterans Under the Veterans Access, Choice, and Accountability Act of 2014

by Foley & Lardner LLP
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Last Thursday, President Obama signed into law the Veterans Access, Choice, and Accountability Act of 2014 (the “Act”). The Act will enable eligible veterans to obtain their health care from non-VA providers on an expanded basis.

The Act presents an opportunity to health care providers to provide needed services to our veterans while at the same time increasing their patient volume. It also, however, will entail additional regulatory requirements and another government body regulating providers.

Some highlights from the Act are:

$10 Billion Veterans Choice Fund. The Act establishes a Veterans Choice Fund (“Fund”) to pay for care outside of the VA health system and authorizes appropriation of $10 billion to be deposited in the Fund. The amount appropriated is to remain available until expended. The Fund is intended to be a supplement to, but distinct from, the Department of Veteran Affairs (the “Department”) current and expected level of non-Department care that is currently part of the Department’s medical care budget. Congress expects that the Department will maintain at least its existing obligations of non-Department care programs in addition to, but distinct from, the Veteran’s Choice Fund for fiscal years 2015-2017.

Eligible Veterans. Veterans who may elect to receive their care outside of the VA health system, under the Act, would be those who are enrolled in the VA’s patient enrollment system as of August 1, 2014 or otherwise are eligible for hospital care and medical services and either cannot obtain an appointment within the VA health system within the wait time goals (generally 30 days) or face geographic burdens from accessing qualified care as delineated in the Act.

Authorized Providers. Eligible veterans will be able to obtain care outside of the VA health system from:

  1. Medicare providers;
  2. Federally qualified health centers;
  3. The Department of Defense; and
  4. The Indian Health Service.

Provider Requirements. There will need to be agreements in place between the authorized providers and the VA, which likely will be similar to Medicare participation agreements. Provider qualifications will be the same as those applicable to providers of the VA. Providers will need to submit credentials and licensing verification at least annually. Also of note, providers will need to submit medical records to the VA on the completion of care or services to the veteran. Importantly, during the contract period, providers will not be considered Federal Contractors by virtue of their furnishing care or services per this legislation, and thus will not be subject to the requirements specific to Federal Contractors.

Rates. The Department’s Secretary is to negotiate rates and reimburse providers at the rates negotiated. However, the Act specifies that the rates generally are not to exceed Medicare rates. An exception to this limitation is care furnished to a veteran who resides in a “Highly Rural Area.” “Highly Rural Area” is defined as an area located in a county that has fewer than seven individuals residing in that county per square mile. It will be interesting to see whether the rates will be sufficient for providers to enter agreements with the VA.

Implementation. The Act dictates that not later than 90 days after enactment, the VA shall implement an efficient, nationwide system for processing and paying bills or claims.

The Act looks like a step in the right direction to help veterans access the health care they need and presents an opportunity for health care providers to help veterans while at the same time expanding patient volume. There will be additional contracting and regulatory hurdles for providers.

The legislation can be accessed by clicking here and typing in Veterans Access, Choice, and Accountability Act in the search box. It is H.R. 3230.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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