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The U.S. Department of Veterans Affairs issued a proposed regulation creating new standards governing access to non-VA providers through the Veterans Community Care Program. The proposed regulation would enhance and supplant the existing Veterans Choice Program. The access criteria include drive and waiting times for treatment by VA providers, in addition to other authorization factors such as the “medical best interest” of the veteran, local VA performance on quality standards for individual service lines, and the provider entering into a contract with VA to provide community-based care.

 

To assist NRHA members in understanding the implications of the proposed rule, the Missouri Hospital Association and Hospital Industry Data Institute created the interactive map below. It shows how the proposed “drive-time” standards would apply to Missouri communities and others across the nation. The proposed standards are 30 minutes for primary and behavioral care and 60 minutes for specialty care from the veteran’s residence. The proposed rule does not provide detail on the planned methodology for drive time calculations. It states the VA “cannot be more specific in naming the system software or describing its methodology because it is proprietary.” This may result in differences between the information presented below and the actual drive time proximities employed by VA, should the rule become final.

 

 

The data used to inform this analysis were last updated by the U.S. Veteran’s Administration on Dec. 20, 2018. Because the proposed rule does not formally define which VA clinics and hospitals are included in the various levels of care affected by the proposed rule, the following categories based on VA facility definitions were used to inform this analysis.

  1. Primary Health Care Clinics (30-minute drive time): Health care centers defined as providing “primary care, mental health care, on-site specialty services, and performs ambulatory surgery and/or invasive procedures, which may require moderate sedation or general anesthesia” (n=23); multi-specialty care with names indicating clinics (n=8); multi-specialty community-based outpatient clinics defined as providing “primary and mental health care and two or more specialty services on site” (n=211); primary care community-based outpatient clinics defined as providing “both medical (physically on site) and mental health care (either physically on site or by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray. The clinic may be operational 1 to 7 days per week. Access to specialty care is not provided on site, but may be available through referral or telehealth services” (n=518); and VA medical centers (n=172).The data used to inform this analysis were last updated by the U.S. Veteran’s Administration on Dec. 20, 2018. Because the proposed rule does not formally define which VA clinics and hospitals are included in the various levels of care affected by the proposed rule, the following categories based on VA facility definitions were used to inform this analysis.

  2. Mental Health Care Clinics (30-minute drive time): Health care centers defined as providing “primary care, mental health care, on-site specialty services, and performs ambulatory surgery and/or invasive procedures, which may require moderate sedation or general anesthesia” (n=23); multi-specialty community-based outpatient clinics defined as providing “primary and mental health care and two or more specialty services on site” (n=211); primary care community-based outpatient clinics defined as providing “both medical (physically on site) and mental health care (either physically on site or by telehealth) and may offer support services such as pharmacy, laboratory, and x-ray. The clinic may be operational 1 to 7 days per week. Access to specialty care is not provided on site, but may be available through referral or telehealth services” (n=518); and VA medical centers (n=172).

  3. Specialty Health Care Clinics (60-minute drive time): Health care centers defined as providing “primary care, mental health care, on-site specialty services, and performs ambulatory surgery and/or invasive procedures, which may require moderate sedation or general anesthesia” (n=23); multi-specialty community-based outpatient clinics defined as providing “primary and mental health care and two or more specialty services on site” (n=211); and VA medical centers (n=172).