Private Health Care Options, Including Urgent Care, Now Available to Veterans with Disability Benefits

On June 6, 2019, the MISSION (Maintaining Internal Systems and Strengthening Integrated Outside Networks) Act went into effect, providing service members with additional health care options and increasing the number of veterans who may qualify for private care through the Department of Veterans Affairs (VA).

The MISSION Act, which was signed into law one year ago, stipulates that the VA will pay for eligible veterans to receive primary care and mental health services outside the VA system or non-institutional extended care if the average time it takes to drive to a VA health care provider is 30 minutes or more, or if the veteran has to wait at least 20 days to see a VA health care provider.

The VA will also pay for specialty health care received from a non-VA facility, if the veteran cannot schedule an appointment with a VA health care provider that is within a 60 minute driving radius or if the veteran has to wait at least 28 days to see a VA health care provider.

In addition, the MISSION Act states that without prior authorization from the VA, eligible veterans will have access to urgent care providers that are part of the VA’s contracted network of community providers.

Urgent Care

In order for veterans to be able to take advantage of urgent care or other walk-in medical facility options, there are three (3) requirements to consider.

1.) The veteran must be eligible for the benefit.

2.) The urgent care provider is a member of the VA’s contracted network.

3.) Services such as preventive care or dental screening are not covered.

In the case of a veteran going to an out-of-network urgent care provider, the veteran could be required to pay the full cost of care, so veterans should check first before going out-of-network. If a copayment is required, they vary based upon the veteran’s VA-assigned priority group, but the payment should not exceed $30.

Community Care

The MISSION Act also combines existing community care programs into one single program. There are five (5) elements to consider when seeking private or community care:

1.) For primary or mental health care, veterans are eligible to seek community care if their drive is over 30 minutes to a VA health care facility or there is a 20-day wait for a VA appointment.

2.) For specialty care, veterans are eligible if their drive is over an hour or there is a 28-day wait for a VA appointment.

3.) The provider must be a part of the VA’s network of providers.

4.) There are no changes to how prescriptions are processed.

5.) A VA provider and VA medical facility staff member will assist in determining if a veteran is eligible under the new criteria.

Delays to Caregiver Assistance

The Program of Comprehensive Assistance for Family Caregivers, which provides a monthly payment to primary caregivers, is being expanded by the MISSION Act to include friends or relatives who provide assistance or care to veterans with everyday activities. Previously, the program was limited to veterans injured on or after September 11, 2001, but now the program extends to all veterans.

Recently, the VA stated that it is still encountering ongoing issues to update its IT infrastructure to support the expansion. The VA missed its first deadline in October 2018.

The Injured Veterans legal team at Gordon & Partners is here for military veterans and their families. Please contact us immediately, if you are having difficulty with your claim or you are not receiving the disability benefits to which you are entitled. Call us at 1-866-779-9990 or fill out the form on this website.

Read the full story here: https://www.sandiegouniontribune.com/caregiver/news-for-caregivers/story/2019-06-10/veterans-now-eligible-for-more-private-health-care-options