ADVOCACY SPOTLIGHT


ASCs Care for Veterans Long wait times for claims reimbursement, however, pose a problem BY JEFF EVANS


In 2014, the US Congress passed the Veterans’ Access to Care Through Choice Accountability and Trans- parency Act, commonly


referred to as the Choice Act. Precip- itated by several health care scandals within the US Department of Veterans Affairs (VA), this important legislation established the Veterans Choice Pro- gram (VCP), which increased veter- ans’ access to care providers outside of the VA. Since 2014, community care appointments have increased 61 percent overall, according to a 2016 VA report. VCP is a relatively new program, but


the VA has offered community care ser- vices to veterans for more than 70 years, according to the VA website. These pro- grams help veterans access care when services are not available at a VA facil- ity or when distance makes services inaccessible. VCP broadened eligibility criteria for veterans to receive care in the private sector by allowing veterans to join the program if they have waited 30 or more days for an appointment in a VA facility. ASCs have served veterans for


years but have experienced a marked increase in veterans’ services since the VCP was established. As the need rose for non-VA providers to serve veter- ans, ASCs met the challenge and are part of the reason that 30 percent of all VA-eligible appointments occur in the private sector. That said, non-VA pro- viders that offer care through the pro- gram frequently encounter untenable wait times for claims reimbursement. ASCA members report delays of 12 months or more. Many ASCs are small businesses that depend on timely reim- bursement to remain viable in a fluid health care environment. Moreover, this alarming trend impedes veterans as they


seek the prompt, patient-centered care that ASCs provide.


Since passage of the Choice Act, VCP and similar programs have been updated through various, mostly small, pieces of legislation. Two legislative proposals currently exist, however, that would fundamentally reform the VA and its community care programs and help ASCs get reimbursed on time. In the US House of Representatives, Congressman Phil Roe, MD (R-Tenn.), who chairs the VA Committee, intro- duced the VA Care in the Community Act (HR 4242), which would, among many provisions, require claims be reimbursed within six months of sub- mission. According to a House VA Committee one-pager (https://veterans. house.gov/uploadedfiles/community_ care_bill_one_pager.pdf), this legisla- tion would “consolidate VA’s existing community care programs into one


26 ASC FOCUS JUNE/JULY 2018 |www.ascfocus.org


cohesive program and would modernize VA’s medical claims processing system to ensure that community providers can expect to be paid on time for the care they provide to veterans on VA’s behalf. It would further require VA to con- duct periodic local capacity and mar- ket assessments to identify how gaps in care can be addressed through improve- ments to both internal and external capacity, standardize the rates VA pays to community providers and autho- rize VA to enter into provider agree- ments for needed care when contracts are not available or achievable.” While this legislation is far-reaching, ASCA is encouraged that lawmakers are paying attention to payment timeframes. The House VA Committee agreed to the bill and sent it to the entire House of Rep- resentatives. When this article went to print, a date for consideration had not been set.


On the other side of the Capitol,


Senate VA Committee Chair, Senator Johnny Isakson (R-GA) introduced the Caring for Our Veterans Act (S 2193) (https://www.tester.senate.gov/ files/documents/Choice%202.0%20 One%20Pager%20FINAL.pdf). Just as with Congressman Roe’s VA Care in the Community Act, the Senate VA Committee


successfully


voted


S 2193 through to the Senate. This bill includes numerous provisions to bolster health care within the VA, but includes several notable provisions to streamline community care, such as: ■■


“Establishing a sole community care program that allows veterans and their doctors to choose where to receive health care;


■■


Streamlining the process for a com- munity provider to partner with the VA to provide care to veterans;


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