Posted on Jun 20, 2019
What are the limitations of the VA Mission Act for local care?
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I am a disabled veteran (100% rated, permanent and total). I am not clear on some of the provisions of the VA Mission Act. I have a VA clinic nearby (15 miles) where I see my primary care provider. But I also have to drive to the Seattle VAMC, 60 miles (1 ½ - 2 hours of grueling traffic) for many of my tests & specialist consultations.
Can I go to a local provider using VA Choice for these consultations and tests since that's over the 40 mile limit under the VA Mission Act? Or do I need to just bite the bullet and be thankful that I can get health care somewhere, even if it takes a full day and a lot of frustration?
Any advice would be appreciated! Thanks!
Can I go to a local provider using VA Choice for these consultations and tests since that's over the 40 mile limit under the VA Mission Act? Or do I need to just bite the bullet and be thankful that I can get health care somewhere, even if it takes a full day and a lot of frustration?
Any advice would be appreciated! Thanks!
Disability
Benefits
Medical
Department of Veterans Affairs (VA)
Posted 5 y ago
Responses: 2
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A1C Donald Propp These are the two things I found. They are copy & paste. In either scenario, you would need a referral from your physician for Community Care.
https://www.va.gov/COMMUNITYCARE/programs/veterans/General_Care.asp#Eligibility
Mileage Criteria/VCP:
For this element, there are a few different ways that a Veteran could be eligible for community care. Initially, there are two requirements that must be met in every case:
1. Veteran was eligible under the 40-mile criterion under the Veterans Choice Program on the day before the VA MISSION Act was enacted into law (June 6, 2018), and
2. Veteran continues to reside in a location that would qualify them under that criterion.
If both of these requirements have been met, a Veteran may be eligible if one of the following is also true:
1. Veteran lives in one of the five states with the lowest population density from the 2010 Census:
North Dakota, South Dakota, Montana, Alaska, and Wyoming, or
2. Veteran:
a. lives in another state,
b. received care between June 6, 2017, and June 6, 2018, and
c. requires care before June 6, 2020.
For example, if you are a Veteran who has lived in Kansas since 2012, your home is 41 miles driving distance to the nearest VA medical facility with a full-time primary care physician, and you received VA care between June 6, 2017, and June 6, 2018, you would be eligible for community care until June 6, 2020.
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Scheduling Criteria:
In this situation, VA is unable to schedule an appointment that is within both average driving time standards and wait time standards. For average drive time to a specific VA medical facility, the access standards are:
1. 30-minute average drive time for primary care, mental health, and non-institutional extended care services (including adult day health care)
2. 60-minute average drive time for specialty care
For appointment wait times at a specific VA medical facility, the access standards are:
1. 20 days for primary care, mental health care, and non-institutional extended care services, unless the Veteran agrees to a later date in consultation with their VA health care provider
2. 28 days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with their VA health care provider
For instance, if you are a Veteran and live 10 miles from the nearest VA primary care provider, but it takes you over an hour to drive there on average due to heavy traffic, you would be eligible for community care.
https://www.va.gov/COMMUNITYCARE/programs/veterans/General_Care.asp#Eligibility
Mileage Criteria/VCP:
For this element, there are a few different ways that a Veteran could be eligible for community care. Initially, there are two requirements that must be met in every case:
1. Veteran was eligible under the 40-mile criterion under the Veterans Choice Program on the day before the VA MISSION Act was enacted into law (June 6, 2018), and
2. Veteran continues to reside in a location that would qualify them under that criterion.
If both of these requirements have been met, a Veteran may be eligible if one of the following is also true:
1. Veteran lives in one of the five states with the lowest population density from the 2010 Census:
North Dakota, South Dakota, Montana, Alaska, and Wyoming, or
2. Veteran:
a. lives in another state,
b. received care between June 6, 2017, and June 6, 2018, and
c. requires care before June 6, 2020.
For example, if you are a Veteran who has lived in Kansas since 2012, your home is 41 miles driving distance to the nearest VA medical facility with a full-time primary care physician, and you received VA care between June 6, 2017, and June 6, 2018, you would be eligible for community care until June 6, 2020.
--------------------------------------------------------------------------------
Scheduling Criteria:
In this situation, VA is unable to schedule an appointment that is within both average driving time standards and wait time standards. For average drive time to a specific VA medical facility, the access standards are:
1. 30-minute average drive time for primary care, mental health, and non-institutional extended care services (including adult day health care)
2. 60-minute average drive time for specialty care
For appointment wait times at a specific VA medical facility, the access standards are:
1. 20 days for primary care, mental health care, and non-institutional extended care services, unless the Veteran agrees to a later date in consultation with their VA health care provider
2. 28 days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with their VA health care provider
For instance, if you are a Veteran and live 10 miles from the nearest VA primary care provider, but it takes you over an hour to drive there on average due to heavy traffic, you would be eligible for community care.
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A1C Donald Propp
Thanks, Sgt. for your help. This is why it's confusing: According to the mileage criteria I am NOT qualified because I live within 40 miles of my VA primary care provider (PCP). But under the scheduling criteria I AM eligible being more than 60 minutes driving time from my specialty care providers. Sad to say I am still not certain if I can ask my PCP for an outside (non-VA) provider.
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SGT Javier Silva
A1C Donald Propp - The 40-miles only applies to those are grandfathered in based on the distance. If you were not eligible under distance before the MISSION Act, you would not be eligible now. However, if you're eligible under the MISSION Act based on average driving time, you would be able to request community care. The request would be made through your PCM.
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PFC Sandra Wade
I feel like its the same program I have been participating in for last couple of years. Could not be happier. Thank you VA
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Same, I really don't want to go to Seattle, yet, I do love my VA doctors and professionals. Most of mine are at American Lake and I don't mind going there from Gig Harbor. I have had PT and MT here locally. as well as others.. Would like the option to go too urgent care here if I am sick and not drive too AL thou.
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