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The Department of Veterans Affairs (VA) intends to add new regulations to title 38 Code of Federal Regulations to implement section 101 of Public Law 115-182 (hereafter referred to as the "Mission Act"), to establish the Veterans Community Care Program by June 6, 2019, under which VA will provide care to eligible Veterans through non-VA providers in the community. Also under the Mission Act, the current Veterans Choice Program to provide community care will lapse on June 6, 2019. To ensure this transition to the new Veterans Community Care Program occurs without a significant disruption in Veterans’ care, implementation must occur through an interim final rule to establish criteria for receipt of care or services upon VA’s authorization and the election of eligible veterans, primarily: (1) whether VA offers the care or service required; (2) whether VA operates a full-service medical facility in the State in which the Veteran resides; (3) whether the Veteran meets certain conditions related to eligibility under the 40 mile criterion in the Veterans Choice Program; (4) whether VA is able to furnish care or services in a manner that complies with designated access standards developed by the Secretary; and (5) whether the Veteran and the Veteran’s referring clinician agree that furnishing care and services through a community entity or provider is in the best medical interest of the Veteran based upon criteria developed by VA. This interim final rule will also establish criteria by which covered Veterans could receive care if VA determined a medical services line was not meeting VA’s standards for quality, with certain limitations. An interim final rule is necessary because VA requires additional time to develop the policy decisions necessary to interpret the legal criteria stated above (e.g., interpreting or defining the phrase does not offer the care or services, defining a full service medical facility, and developing the required access and quality standards), to implement the Veterans Community Care Program by June 6, 2019.

Overall Description of Deadline: VA is required to establish the permanent Community Care program under 38 U.S.C. 1703 by June 6, 2019.

Statement of Need:

An interim final rule is necessary because VA requires additional time to develop the policy decisions necessary to interpret the legal criteria stated above (e.g., interpreting or defining the phrase does not offer the care or services, defining a full service medical facility, and developing the required access and quality standards), to implement the Veterans Community Care Program by June 6, 2019. Also under the Mission Act, the current Veterans Choice Program to provide community care will lapse on June 6, 2019. To ensure this transition to the new Veterans Community Care Program occurs without a significant disruption in Veterans’ care, implementation must occur through an interim final rule to establish criteria for receipt of care or services upon VA’s authorization and the election of eligible veterans.

Summary of the Legal Basis:

Implement section 101 of Public Law 115-182 (hereafter referred to as the Mission Act).

Alternatives:

TBD

Anticipated Costs and Benefits:

TBD

Risks:

The Veterans Choice Program to provide community care will lapse on June 6, 2019.  If VA does not publish new regulations, it will not be able to implement the required Veterans Community Care Program, which would significantly disrupt Veterans’ healthcare. More specifically, specialty care for veterans with chronic illnesses would not be readily available, critical maternity services would not be available and emergency care services would be negatively impacted and overwhelmed.