Veterans Affairs to Expand Eligibility for Non-VA Care

The Department of Veterans Affairs issued a proposed rule in the Nov. 27 Federal Register that would increase eligibility for veterans to receive health care services from non-VA providers. The VA proposes to amend its regulation governing payment for non-VA outpatient care. The proposed regulation reflects statutory authority that permits the VA to expand its payment policy for non-VA medical services.

Under the current regulation a veteran who received VA inpatient care for treatment of non-service-connected conditions for which treatment was begun during the period of inpatient care is eligible for non-VA medical services. The regulation restricts payment for non-VA care to those veterans whose care began while they were an inpatient.

The proposed rule would revise the regulation to permit “veterans who have been furnished hospital care, nursing home care, domiciliary care, or medical services, and who require medical services to complete treatment incident to such care or services, be eligible for non-VA medical services under the non-VA care authority.” By expanding veterans’ eligibility for non-VA care, VA would be able to better utilize resources and enhance patient care at the local level. This regulation would give VA greater flexibility to refer patients for care in the least restrictive and most convenient setting.

The VA also proposes to clarify the time period during which veterans are eligible to receive non-VA care to complete their treatments. Each authorization for non-VA care needed to complete treatment may continue for up to 12 months, and that VA may issue new authorizations as needed.

The revised regulation could expand the use of home health agencies by the VA since home health care is typically contracted out to non-VA providers. The proposed rule does not address the payment structures or amounts for non-VA medical services.

To view the proposed rule click here.


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