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This bill — known as the VA MISSION Act — would establish the Veterans Community Care Program to improve veterans’ access to care through non-VA, community providers when comparable Dept. of Veterans Affairs would be deficient in quality, timeliness, or cause a hardship to the veteran. It would also start a multi-year process for reviewing VA facilities and infrastructure to modernize and realign the VA’s services with the needs of veterans.

Caring for Veterans

This section of the bill would require the VA to establish the Veterans Community Care Program to provide care in the community to veterans who are enrolled in the VA healthcare or otherwise entitled to VA care. The VA would be required to coordinate veterans’ care and ensure the scheduling of medical appointments in a timely manner, ensure the continuity of care and services, coordinate coverage for veterans using care outside their region of residence, and ensure veterans don’t experience a lapse in healthcare services.

Access to community care would be required if the VA doesn’t offer the care or services the veteran needs or operate a full-service medical facility in the state, or if the veteran was eligible for care under the Veterans Choice Program’s 40-mile rule, or if a veteran and their referring clinician determine community care would be in the veteran’s best interest based on:

The distance between the veteran and the facility providing the care they need and any geographical or environmental factors impeding access;
The nature of the care and services required and whether there’s a compelling reason the veteran should receive care or services from a non-VA medical facility.;
The frequency that care or services need to be furnished and timeliness of appointments;
Any other considerations considered appropriate by the VA.

The VA would also be authorized to furnish care to veterans in the community when quality or timeliness measures are deficient. Deficient imeliness would be gauged by a comparison with the same service line at different VA facilities. Deficient quality would be measured based on a comparison with two or more distinct and appropriate quality measures at non-VA medical service lines.

The bill would establish a prompt payment process for providers that’d require VA to pay for, or deny payment for, services within 30 calendar days of receiving a clean electronic claim or 45 days of receiving a clean paper claim. In the event of a denial VA would have to explain the denial to the provider and review any additional information returned by the provider.

Additionally, this section would:

Require that a veteran not pay more for utilizing non-VA care than the veteran would pay for comparable care or services at VA.
Give enrolled veterans access to walk-in care if they’ve used VA healthcare services in the previous 24 months from community providers.
Sunset the Veterans Choice program after one year, as the Community Care Program would be its successor.

VA Asset & Infrastructure Review

This section would establish a nine member Asset and Infrastructure Review (AIR) Commission, which the president would need to nominate commissioners for by May 31, 2021. The AIR Commission would meet during calendar years 2022 and 2023 and terminate on December 31, 2023 and all proceedings would be open to the public.

Over that period, the AIR Commission would make recommendations to Congress about several aspects of the VA including:

The proposed criteria to be used in making decisions about modernization or realignment of VHA facilities, including the veterans preference (Due February 1, 2021);
The final criteria in making decisions about modernization or realignment of VHA facilities (Due May 31, 2021);
Publish a report making recommendations about modernizing or realigning VHA facilities to improve care, whether existing federal property could be repurposed or reconfigured to meet VHA’s needs, or whether infrastructure or facilities should be acquired and how those acquisitions align with VA’s mission (Due January 31, 2022);
Provide the president with a report and analysis of the Commission’s and VA’s recommendations. The Commission could make changes to the VA’s recommendations if the VA deviates from its criteria, and would be required to explain all changes (Due January 31, 2023).

The president would be required to submit a letter approving or disapproving of the Commission’s report by February 15, 2023. If the president disapproves, the commission would have until March 15, 2023 to respond to the president’s revised recommendations. The president would then have to certify their approval to Congress by March 30, 2023 or the modernization & realignment process would terminate.

Miscellaneous

To improve recruitment of healthcare professionals, VA would be authorized to provide scholarships to medical students in exchange for service to VA; the VA Education Debt Reduction Program maximum would raised from $120,000 to $200,000 over five years and from $24,000 to $40,000 annually; and establish other similar programs.
The VA would required to develop criteria for designating certain VA medical facilities as underserved facilities and create a pilot program to send medical deployment teams to underserved facilities.
VA would be required to submit an annual report to Congress on performance awards and bonuses to high-level VA employees.

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VA MISSION Act: Establishing the VA Community Care Program & Modernizing VA Infrastructure