2 Lawmakers Trying to Expand Access to Outside Doctors for Vets Despite VA Push to Rein in Costs

A pair of senators is pushing to expand the program that allows veterans to see doctors outside of the Department of Veterans Affairs despite moves by VA officials to rein in the program's costs after years of efforts to privatize some VA-funded care.

Sen. Jerry Moran, R-Kan., the Veterans Affairs Committee ranking member, and Sen. Kyrsten Sinema, I-Ariz., are introducing a bill that would codify existing guidelines for when patients can seek non-VA care so the department cannot skirt its own rules, as critics allege it is doing.

The current guidelines mean vets can see non-VA doctors if they face long wait times or a long drive for an appointment. The new bill would expand that list to include access to private residential mental health and drug rehabilitation clinics.

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"Veterans deserve access to timely, high-quality care and a greater ability to choose when, where and how to use the health care benefits that they earned through their service and sacrifice," Moran said in a statement. "Despite the steps Congress has taken to increase access to care for veterans in VA and in the community, I continue to hear from far too many veterans in Kansas and across the country who are not being given the choices they are owed from VA."

In 2018, Congress passed a bill known as the Mission Act that overhauled the department's private-sector health care programs for veterans. The bill said that eligibility for community care should be based on "access standards," but left it to the department to set the exact standards.

But the VA has said the expanded community care required by the Mission Act has caused its medical costs to balloon. A report from the nonpartisan Rand Corp. released last year also said that existing data, while limited, suggests that "access to community care may be no better than access to care at VHA [Veterans Health Administration] facilities."

Any effort to expand community care is likely to meet resistance in the Senate while it is controlled by Democrats, who view such efforts as creeping privatization and argue that the VA is best equipped to treat veterans' unique needs.

"I'm open to hearing recommendations for how to improve community care," Senate Veterans Affairs Committee Chairman Jon Tester, D-Mont., said at a September hearing on the community care program. "We're all here working for the veteran. Veterans deserve programs that work. But the only solution cannot just be sending more folks into the community."

Under the guidelines the VA wrote to follow the Mission Act, veterans are eligible to see an outside doctor if they face drive times of at least 30 minutes to a primary or mental health appointment or 60 minutes for specialty care. They are also eligible for community care if they have to wait 20 days or more to be seen for primary care or 28 days for specialty care.

Moran and Sinema's bill would put those standards into law, according to a copy of the bill obtained by Military.com ahead of its release.

The bill would also ban the VA from considering the availability of telehealth appointments when deciding whether access standards are met. And it would require a change in VA wait time calculations such that, if the VA cancels a veteran's appointment, numbers would be based on when the patient originally requested an appointment, not when the appointment was canceled.

The 52-page bill also contains several provisions meant to ensure the VA better informs veterans of their eligibility for outside care and more broadly publicizes community care options.

The Mission Act and a predecessor bill known as the Choice Act were meant to cut down the time veterans have to wait to see a doctor after years of scandals about excessive delays in veterans getting appointments at the VA.

Republicans and conservative-leaning veterans groups have been accusing the VA of sabotaging the Mission Act.

"The VA has continued to ignore the intent of Congress by undermining the Veterans Community Care Program since its creation in 2019," Russ Duerstine, executive director of the conservative Concerned Veterans for America, said in a statement released by Moran's office. "By manipulating wait times, dissuading veterans from using their benefits outside the VA, and overruling doctors' recommendations, VA administrators have looked out for their bureaucratic interests at the expense of millions of veterans' well-being."

Moran and Sinema's bill is also backed by the Veterans of Foreign Wars, Wounded Warrior Project, the American Legion, America's Warrior Partnership, The Independence Fund and the National Defense Committee, according to Moran's office.

-- Rebecca Kheel can be reached at rebecca.kheel@military.com. Follow her on Twitter @reporterkheel.

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