The Veterans Choice program, which provides veterans with the ability to access non-VA facilities if they live more than 40 miles from or cannot schedule an appointment at a VA facility, initially defined 40 miles as a straight line distance from a veteran’s residence to a VA health care facility. This definition did not take into account the driving distance, which can be significantly longer than the straight-line distance based on road routes.

“Today’s announcement by the VA is a good first step towards ensuring the Veterans Choice program provides the access to care that Congress mandated,” Scott said. “Anyone who has driven in a car for more than five minutes realizes that roads do not always go in a straight line, and to calculate mileage based on how the crow flies simply does not make sense. I will continue working to ensure our veterans have access to the quality care they were promised.”

Scott also reiterated the importance of reassessing the facility on which the VA bases the 40-mile distance calculation. For example, if a veteran is within 40 miles of an outpatient clinic, but needs cancer services at a hospital more than 40 miles away, they are currently unable to access the hospital through the Veterans Choice program. Senator Scott has signed on as a cosponsor of the Veterans Access to Community Care Act (S. 207) to fix this issue.

The Veterans Choice Program was created last summer as part of a bipartisan VA reform package supported by Senator Scott.

The full text of the letter to the VA is below:

Dear Secretary McDonald:

Since November 1, 2014, the Choice Card, as provided under the recently enacted Veterans Choice, Access, and Accountability Act of 2014, has been distributed to approximately 8.5 million Veterans nationwide, yet less than one percent of recipients – 0.37 percent – have been authorized to access non-VA care through this program.   With this in mind, we write to convey serious concerns regarding your implementation of the Choice Card Program with respect to funding for the program in connection with the Fiscal Year 2016 Presidential Budget Request and your interpretation of the 40-mile rule as provided under the Act.  We ask you to address both of these concerns immediately.

First, we were dismayed to learn from the President’s Fiscal Year 2016 Budget Request that the Department of Veterans Affairs intends to submit a legislative proposal that would reallocate part of the funding for the Veterans Choice Program to other programs within the VA.  It is deeply disturbing that the Administration would try to reduce funding for this program before this program has even been allowed to work – being in existence for only a few short months – and as barriers to care continue to exist.  Instead, the Department should make certain that funding provided by Congress is being used to implement the Veterans Choice Program to the fullest extent possible.

Second, the VA is construing the eligibility criteria as it relates to the 40-mile rule so narrowly that it is excluding too many who are far away from the care that they need.  As you know, the Choice Program provides Veterans with the option to receive non-VA health care rather than waiting for a VA appointment if there is a significant delay in scheduling an appointment or a Veteran has to travel more than 40 miles to receive VA care.  While many Veterans are satisfied with care provided through the VA Health Care System, trips to VA medical centers can be difficult for rural Veterans, especially those who are elderly or ill.  Because long drive times are a hardship for these individuals and can present a significant barrier to accessing care, many Veterans anticipated using their Choice Cards when Congress established the Choice Program last year. 

The VA’s definition of the eligibility criteria is too narrow in two important respects. First, the VA does not consider the type of care available within 40 miles of where a Veteran lives.  In many areas across the nation, the effect is that those who need services only available at a VA medical center, but who live near a Community-Based Outpatient Clinic, are prevented from using the Choice Card to access specialty care in their local community.  While the Clinic may be within 40 miles, the VA hospital offering the required care is often more than 40 miles and hours of travel time away.

Second, the VA measures the 40 miles “as the crow flies” and not the actual distance that the Veteran would have to travel.  Congress’ intent was to establish a pilot program that would allow Veterans to access non-VA care when they face an obstacle to care, whether it be an unacceptable distance to care or wait time for care.  Given the clear intent of Congress to reduce barriers to care, it is perplexing that the VA is not using its authority to allow non-VA care for those who face a geographic challenge in accessing care, including long drive times or health conditions that make travel difficult.  The impact of such an interpretation is to exclude from the program many of the Veterans for whom Congress aimed to make health care more accessible.  For Veterans in remote and rural areas with limited transportation access, this could mean the difference between 30 minutes and half a day of travel. 

As Secretary, you already have the authority to modify the way that the distance criteria is calculated so that the Choice Program is implemented as Congress intended, and we urge you to rectify the overly narrow definition without delay.  Additionally, we urge you to stop any attempt to propose a reallocation of funds designed to kill the Choice Card program in its infancy.

 

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