The VA Mission Act

The VA Mission Act is designed to improve access for veterans to healthcare at the VA. It addresses in-network and non-VA healthcare issues, veterans' homes, access to walk-in VA care, prescription drug procedures, and much more.

There have been some updates with the Mission Act. Beginning June 6, 2019, veterans will have more ways to access health care. This access not only includes providers within the VA's network but also with approved non-VA medical providers in your community, called "community care providers."

Health Care Eligibility

Based on different priority groups, the VA provides a comprehensive medical benefits package to Veterans enrolled through an annual patient enrollment system. Eligible veterans can use VA health services nationwide through mobile health clinics that serve rural areas and via telehealth (care through a phone or computer).

Community Care Eligibility

Veterans may be eligible to receive care from a local provider if they meet specific criteria. Generally, Veterans must be enrolled with the VA to receive care, although some Veterans are not required to enroll and receive care. Under the Veterans Community Care Program, in most instances, the VA must authorize your care before you receive it.

Under the Mission Act, there are six different eligibility criteria for community care:

• The specific care you need is not provided by the VA at any facility.
• You reside in a U.S. state (AK, HI, or NH) or territory (Guam, American Samoa, Northern Mariana Islands, or U.S. Virgin Islands) that does not have a full-service VA medical facility.
• "Grandfathered" eligibility based on residence and the 40-mile eligibility criterion from the Choice program.
• The specific care you need is not available within designated access standards.
• You and your referring clinic decide it is in your best medical interest to receive the specific care you need in the community.
• The VA has designated the VA medical service line delivering the specific care you need as not providing care that complies with the standards of the VA for quality.

Urgent/Walk-In Care

The VA will offer an urgent/walk-in care benefit for minor injuries and illnesses, such as pink eye or ear infections. To be covered by this benefit, a Veteran must be enrolled in the VA health care system and have received care from the VA within 24 months prior to seeking this care. If you are eligible, you can seek this care from an urgent care facility or walk-in retail health clinic that is part of the VA's community provider network.

Copayments and Insurance

Similar to other health care providers, the VA may charge a copayment for health care. The amount may be based on your enrollment priority group, the type of health care service you receive, and your financial situation. The Veteran is responsible for any copayment amount whether the care is furnished directly by the VA or through a community provider.

As a result of the Mission Act, the VA no longer requires the permission of the Veteran to bill the health insurance carrier for health care related to a sensitive diagnosis. If you would like to submit a request to restrict this process, you will have to contact your local VA facility's privacy officer.

Access Standards and Standards for Quality

The VA is establishing designated access standards based on the type of care you need, how long you have to wait, and average drive time to receive that care. They are also establishing standards for quality that focus on timely care, effective care, safe care, and Veteran-centered care. The VA is working to take these standards for access and quality of care and apply them to care at the community providers. The VA will provide additional information as it continues to develop and refine these standards.

Complaint and Appeals Process

The VA is committed to delivering excellent care and experiences every time. However, concerns still arise. Patient advocates at each facility can assist with almost any problem. The VA has different processes for clinical and non-clinical appeals, and the patient advocate can ensure your concern is handled appropriately.

Helpful Links/Resources

• Apply to enroll in VA Healthcare today.
• Schedule a health care appointment.
• Find a VA location or approved community care provider.
• Benefits for Caregivers and family members.
• VA MISSION Act of 2018 (PDF)
• VA Health Care Options for Veterans booklet (PDF)
• Enhanced VA Options under the MISSION Act brochure (PDF)
• Office of Academic Affiliations Educational Initiatives (PDF)
• All MISSION Act Fact Sheets related to Community Care