Find-A-Code Focus Newsletter

Veterans Choice Program

May 05, 2017

New Law

On April 19, 2017, President Donald Trump extended the Veterans Choice Act which allows veterans to more easily access private care. The Veterans Choice Improvement Act addresses some of the shortcomings of the previous law to further assist the veterans seeking medical care. Some of the key elements of the new law are:

  • require the VA to cover co-pays and deductibles directly for private care rather than reimbursing veterans for paying up front
  • allow patients to seek care from private doctors if they want to go outside of the VA system as long as they meet specific requirements
  • eliminate the Choice Program expiration date of August 2017
  • make the VA the primary payer (currently the VA is the secondary payer) for medical care relating to non-service connected disabilities

Eligibility

Providers wishing to treat veterans must be a contracted provider with either Health Net Federal or TriWest Healthcare Alliance (depending on your location). You do NOT need to join PC3 to be a contracted provider for the Veterans Choice Program (VCP), but you will need to meet all Medicare conditions of participation. Reimbursement is at Medicare rates. The Choice Program is NOT a replacement for TRICARE, CHAMPUS/CHAMPVA or Patient-Centered Community Care (PC3). Rather, it is a supplement to the PC3 program. In fact, all PC3 providers are automatically eligible to participate in the Choice Program which requires pre-authorization prior to care.

Even if the provider is a contracted provider, to be eligible, at least one of the following additional criteria must be met:

  • A Veteran is told by his/her local VA medical facility that they will not be able to schedule an appointment for care:
    • Within 30 days of the date the Veteran’s physician determines he/she needs to be seen; or
    • Within 30 days of the date, the Veteran wishes to be seen if there is no specific date from his/her physician.
  • The Veteran lives more than 40 miles driving distance from a VA medical facility with a full-time primary care physician.
  • The Veteran needs to travel by air, boat, or ferry to the VA medical facility closest to his/her home.
  • The Veteran faces an unusual or excessive burden in traveling to a VA medical facility based on geographic challenges, environmental factors, a medical condition, the nature or frequency of the care needed, and whether an attendant is needed. The staff at the Veteran’s local VA medical facility will work with him/her to determine if he/she is eligible for any of these reasons.
  • The Veteran lives in a State or Territory without a full-service VA medical facility which includes: Alaska, Hawaii, New Hampshire (Note that Veterans are not eligible under this criterion if they live in New Hampshire and live within 20 miles of the White River Junction VAMC), and the United States Territories (excluding Puerto Rico which has a full-service VA medical facility).

Additional Information

CLICK HERE to use the VAs health benefits checker tool. Veterans may also call the Choice Program Call Center at 866-606-8198 for more information, to verify eligibility.

CLICK HERE to review the VAs information sheet. Note that this page was created before the new law was signed into effect. Check back for updates.

Note: All Veterans have been mailed a Veterans Choice Program card. Use the information on that card (not the card for any other VA program) for benefit verification and claims submission.

 


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