The Department of Veterans Affairs has changed its process for veterans to get medical care from non-VA providers, removing a requirement that a referral to community care be reviewed by another VA doctor.
The VA announced Monday that it is enacting a provision of the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act that will help ease veterans' access to medical services from private providers.
The law, signed in December by then-President Joe Biden, prohibits VA administrators from overriding a VA doctor's referral for a patient to get outside care.
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"Now, we're making it even easier for veterans to get their health care when and where it's most convenient for them," VA Secretary Doug Collins said in a statement Monday. "We are putting veterans first at the department, and that means placing a premium on customer service and convenience. This important change will help us do just that."
The VA Choice Act of 2014, passed in the wake of a scandal over medical appointment wait times at VA medical centers nationwide, gave veterans broader access to medical care at non-VA facilities if they faced long waits for care at a VA hospital or clinic.
The Mission Act, signed by President Donald Trump in 2019, expanded the benefit to include veterans who face more than a 30-minute drive for primary care or an hour or more for specialty care, or those who can't get an appointment within 20 days for primary care and 28 days for specialty care.
Under the Mission Act, eligible veterans could consult with their VA physicians to receive referrals to community care. The VA required these referrals to be reviewed internally by an administrative staff member.
During congressional debate over the Elizabeth Dole Act, Republicans said the review process intentionally hampered access to community care, while Democrats argued that it was proper government oversight and that removing it was part of an overall effort to privatize VA health care.
According to the law, the ban on the administrative review will remain in place for two years, after which the VA must report on its effects to Congress.
An investigation last year by Military.com into the challenges faced by veterans seeking mental health treatment found that VA schedulers were pressured by hospital administrators to keep veterans at VA facilities rather than send them to community care.
The Elizabeth Dole Act, first introduced in 2023, largely addressed at-home care for senior veterans and programs for the homeless. It also made changes to several VA education programs and health services.
It was hotly contested, however, for the efforts to change the referral approval process and another provision that would have established new access standards for veterans to go to non-VA residential mental health and substance abuse programs.
That provision was dropped during the final bill deliberations. During a hearing March 25, however, Rep. Mariannette Miller-Meeks, R-Iowa, said a change is needed to ensure that veterans can access private residential substance abuse treatment centers.
Miller-Meeks said that, in some cases, veterans who decide they need to go to a rehab facility have been told to wait because the VA can get them into a VA facility within the 20-day mental health treatment requirement set by the Mission Act.
In another case, a veteran experiencing alcohol withdrawal symptoms wanted to go to a rehab in his community but was denied the referral because the VA had a bed available at a facility 100 miles away, she said.
"VA claims that there is no wrong door for veterans seeking care, yet we continue to hear about doors locked, doors hidden, and doors that simply do not exist," Miller-Meeks said in a hearing of the House Veterans Affairs health subcommittee, which she chairs.
Rep. Julia Brownley of California, the subcommittee's ranking Democrat, said during the hearing that any veteran who seeks residential treatment should get it, but she added that the VA has not developed a fee schedule for community treatment centers and, in at least one case, the department was charged up to $6,000 a day for one patient.
Brownley also said the VA doesn't track the timeliness or quality of medical care in community residential treatment facilities.
"We have no way of knowing the level of treatment or support they are getting," Brownley said. "I have said before, we must find a balance between community care and VA direct care. In my opinion, we have not found that balance when it comes to residential rehabilitation treatment facilities."
In Monday's announcement, the VA said it would begin training employees to ensure that the community care referral process is followed in compliance with the Dole Act.
