VA drops secondary review rule for community care medical appointments

The move was mandated by Congress last fall as a way to simplify VA’s community care procedures, which allow veterans to use taxpayer dollars to receive private medical care. About 40% of all medical appointments paid for by the department are conducted by private-sector doctors, a number that has risen steadily over the last decade.

But some veterans advocates have expressed concerns that as more patients — and federal funding — leave the VA health care system, the changes could weaken the department’s medical centers by leaving them with fewer resources.

In a statement, VA Secretary Doug Collins said implementing the congressional mandate is “making it even easier for veterans to get their health care when and where it’s most convenient for them.”

Collins and conservative lawmakers have criticized President Joe Biden’s administration for adding extra layers of bureaucracy to the community care program, complicating access even as the number of appointments continued to grow.

“Veterans should always have access to the best health care that meets their individual needs — whether that’s inside or outside VA — and without a paperwork nightmare to make that happen,” House Veterans’ Affairs Committee Chairman Mike Bost, R-Ill., said in a statement following Monday’s announcement.

House Veterans’ Affairs Committee ranking member Mark Takano, D-Calif., called VA’s announcement Monday “accomplishing the bare minimum” since the move had already been ordered by Congress.

Similarly, Senate Veterans’ Affairs Committee ranking member Richard Blumenthal, D-Conn., accused the administration of “trying to take a victory lap for finally implementing a provision … they were required by law to put in place more than a month ago.”

VA leaders said the change is effective immediately. Since 2019, veterans ruled eligible for community care appointments have been able to work with referring clinicians to find outside care, but those decisions were not considered final until they were reviewed by a second VA doctor.

Veterans can qualify for community care eligibility if they live more than 30 minutes away from a VA health care facility or if their nearby clinic has a wait time of more than 20 days for primary care services or 28 days for speciality care. Current rules also provide several other exceptions for eligibility.