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Ayotte, Shaheen seek answers from VA on ‘Choice Program’

Last modified: 11/26/2014 1:06:28 AM
New Hampshire’s senators are unhappy with the implementation of a part of the major Veterans Affairs reform package they championed specifically with the Granite State’s veterans in mind.

U.S. Sens. Kelly Ayotte and Jeanne Shaheen, within days of the rules’ release, sent a letter to Department of Veterans Affairs Secretary Robert McDonald questioning whether the guidelines governing where and how veterans access non-VA care undermine the “congressional intent” of the law.

The two requested a response by Nov. 14 but still have yet to receive “substantive” answers from the department – only an acknowledgement that their note was received – so they sent a follow-up letter yesterday emphasizing their concerns. In the follow-up letter, the senators also noted that eligibility cards sent to New Hampshire veterans contained inaccurate information, adding to confusion around the program.

“We have been hearing from veterans in our state who are confused by the roll-out of this important program,” Ayotte and Shaheen wrote, “and we remain concerned that it is not being implemented as Congress intended.”

As part of the Veterans Access, Choice, and Accountability Act – the major reform package designed to address, among other things, systemic delays at VA facilities across the country – Ayotte and Shaheen fought to include a provision to allow veterans to receive non-VA medical care if they live in a state without a VA hospital that offers a full range of medical services and live more than 20 miles from the nearest such facility. The provision to cover non-VA care also applies to veterans who live more than 40 miles from a VA medical facility or community-based outpatient clinic, as well as those who are encountering delays or other pre-defined difficulties accessing care at VA facilities, according to the law.

New Hampshire’s VA Medical Center in Manchester offers primary care, urgent care and other medical services, but it sends patients to Boston “for specialized procedures such as elective orthopedic and cardiac cases,” according to its website, and occasionally to White River Junction, Vt.

The VA has estimated that about 95 percent of New Hampshire’s veterans will be eligible for the new “Veterans Choice Program.” Only those who live within a 20-mile radius of the White River Junction VA Medical Center, which offers a full range of medical services, would be excluded.

When Congress passed the VA reform package, the New Hampshire senators touted the changes as an important, overdue step toward giving veterans more independence in determining where they could seek out medical care.

But the rules that were approved by the VA and published Nov. 5, the New Hampshire senators pointed out, stipulate some restrictions on the extent to which outside providers would be included in the program. As explained during a forum last week at the Manchester VA Medical Center, veterans are not able to automatically use newly distributed “Choice Cards” to access medical care at any location of their choosing.

Instead, veterans must call the outside contractor with whom the VA has partnered – Health Net, accessible by phone at 1-866-606-8198 – to request permission to receive covered treatment at a non-VA facility. From there, Health Net representatives will decide whether to authorize the outside care and will offer a list of pre-approved providers to the veteran.

If the veteran has another provider he or she would prefer to use, that outside provider must agree to “enter into an agreement” with the VA, according to the new rules. As explained at last week’s forum in Manchester, the agreement would require the provider to accept Medicare rates for the services performed and to acknowledge that “the VA own the Medical Record for the episode (of) care.” The provider would also have to agree “to prescribe medications based on VA formulary, and other provisions required by the act,” according to a presentation given at the Manchester forum.

The VA, on its website, also cautions veterans about potential limitations under its choice program.

“Unfortunately, not all providers will be covered so if your preferred provider is not available, we will recommend other providers in your area,” the VA says on a page explaining how to use the new program.

Ayotte and Shaheen, in their original letter to McDonald, maintain that the law “makes clear that veterans may choose from any eligible entity, not merely from those with whom VA happens to contract.”

“While we appreciate issues of administrability, the congressional intent of (the law) was to enable veterans to seek care from an eligible non-VA provider of their choice. . . . A limited list of non-VA providers makes the provision of care at VA’s choice, not the veteran’s,” the senators wrote. “This is unacceptable.”

Additionally, the senators take issue with potential delays in scheduling that could result from the VA’s approach to implementing the choice program.

“We strongly urge you to see that the implementation of this law ensures that scheduling and contracting burdens are not placed on veterans seeking non-VA care so as to diminish the effectiveness of the Choice Card program,” the senators wrote.

The VA said it will “consider and address comments (on the new rules) that are received within 120 days” of Nov. 5, the date the guidelines were published in the Federal Register.

A representative who answered the Department of Veterans Affairs phone line for “media inquiries” yesterday afternoon said a request for comment would need to be submitted via email. As of press time, the department had not responded to the Monitor’s emailed questions.

(Casey McDermott can be reached at 369-3306 or cmcdermott@cmonitor.com or on Twitter @caseymcdermott.)

Editor’s note: An earlier version of this story listed an incorrect phone number for Health Net regarding Choice Program authorizations, listed on a fact sheet from the company. According to the VA, the correct number is 1-866-606-8198.


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