VA Adjusts Policy for Veterans to Receive Non-VA Health Care

The Department of Veterans Affairs (VA) has updated its process for referring veterans to non-VA healthcare providers. Taking effect immediately, veterans and their VA healthcare providers no longer need to wait for a second VA doctor to approve a referral to community care. 

The VA says this change follows the passing of the Dole Act and is part of an effort to get veterans quicker access to care when it’s in their best medical interest — particularly in cases when care at a VA facility isn’t available or timely.

What VA Policy Changed?

This new rule follows the Dole Act, which addresses how the VA delivers care through community providers.

This change is part of a shift in VA health care policy since 2019 when the MISSION Act allowed eligible VA-enrolled veterans to receive treatment or care from non-VA providers at VA expense if certain conditions were met. A part of that process involved a VA doctor referring a veteran to a doctor’s office or care facility outside the VA. However, it also required a second VA clinician to review and approve the decision.

Now, that second review step is gone.

This means you and your VA clinicians can make the decision together, and the referral will move forward immediately if your care needs meet the eligibility criteria. 

“Now, we’re making it even easier for Veterans to get their health care when and where its most convenient for them,” said VA Secretary Doug Collins when addressing the policy. Adding the change aims to reduce delays and increase flexibility for those who need care.

Impact on Veterans Healthcare

If you’re a Veteran already enrolled in VA health care, you now have one less barrier to getting care outside the VA system. To be eligible for care outside the VA healthcare system, but only if you meet any of the following criteria:

• It is in your best medical interest
• The service you need isn’t available at your local VA facility
• You live in a state or U.S. territory without a full-service VA medical center
• The VA can’t meet standard wait times (More than 20 days for primary or mental health care, 28 days for specialty care)
• The VA can’t meet standard drive times (You must drive more than 30 minutes for primary or mental health care, or more than 60 minutes for specialty care)
• The VA service doesn’t meet quality standards
• You qualify under grandfathered distance rules from the old Veterans Choice Program

What Happens Next?

The VA will provide updated training to healthcare employees across the Veterans Health Administration to better facilitate this policy.

If you think you’re eligible for community care, talk to your VA provider or patient advocate about your options.