Veterans Access, Choice and Accountability Act of 2014 (“Choice Act”)
VA’s goal continues to be to provide timely,
high-quality health care for Veterans.
The Choice Act provides new authorities, funding, and other tools to help support and reform VA. Here are highlights of the Choice Act:
Mobile Vet Centers and Mobile Medical Centers
VA will improve access to telemedicine and other health care services through standardization and greater use of mobile Veteran centers and mobile medical centers.
Military Sexual Trauma
A Veteran can receive counseling and appropriate care and services required to overcome psychological trauma resulting from military sexual trauma (MST) that occurred while the Veteran was serving on inactive duty training (such as drill weekends for members of the Reserves and National Guard) at no cost to the Veteran.
Extension of Assisted Living Pilots
VA will extend the Assisted Living Pilot Program for Veterans with Traumatic Brain Injury for three years, through October 6, 2017. This program provides assisted living services to eligible Veterans with traumatic brain injuries to “enhance the rehabilitation, quality of life, and community integration of such Veterans.”
Publicly Available Data
Each VA medical facility will post on a website the wait times for scheduling an appointment at VA facilities for primary care, specialty care, and hospital care and medical services based on the general severity of the condition of the Veteran. Whenever the wait times change, VA will publish the revised wait times.
VA will develop a data set that will be made accessible to the public. This data set will include applicable patient safety, quality of care, and outcome measures for VA health care.
Veterans will have increased access to information about their doctors. The “Our Doctors” website will be updated and made more accessible on www.va.gov. Additionally, each Veteran undergoing a surgical procedure through VA will be provided with information on the surgeon performing the procedure.
Veterans Choice Program
VA will implement the Veterans Choice Program. The Program will operate for three years or until the Fund is exhausted. The Program will provide Veterans who were enrolled as of August 1, 2014, or eligible to enroll as a recently discharged combat Veteran with a Veterans Choice Card, and allow those Veterans who are unable to schedule an appointment within 30 days of their preferred date or the clinically appropriate date, or on the basis of their place of residence to elect to receive care from eligible non-VA health care entities or providers.
Initially, a Veteran must be enrolled in VA health care on or before August 1, 2014, or be eligible to enroll as a recently discharged combat Veteran within five years of separation. Additionally, a Veteran must also meet at least one of the following criteria.
a) The Veteran attempts to schedule an appointment with VA for hospital care or medical services but is unable to schedule an appointment within 30 days of the Veteran’s preferred date, or the clinically appropriate date.
b) The Veteran lives more than 40 miles from the VA facility that is nearest to the Veteran’s residence, including a community-based outpatient clinic.
c) The Veteran lives in a state without a medical facility that provides hospital care, emergency services, and surgical care, and the Veteran resides more than 20 miles from such facility.
d) The Veteran lives 40 miles or less from a VA health care facility but needs to travel by air, boat, or ferry, or faces an unusual or excessive burden of travel due to geographical challenges.
If an eligible Veteran has another health care plan, VA
will be secondarily responsible for costs associated with non-service connected
care and services furnished to eligible Veterans
through the Veterans Choice Program.
When a Veteran
receives care from an eligible non-VA health care entity or provider, the
entity or provider must
submit to VA a copy of any medical record information related to the care and services provided.
Frequently Asked Questions
Q: How will Veterans get their Veterans Choice Card?
A: VA is mailing the Veterans Choice Card to Veterans enrolled in VA health care as of August 1, 2014, and to recently discharged combat Veterans who enroll within the five-year window of eligibility. Not all Veterans who receive the Card will be able to participate in the Veterans Choice Program right away. Only eligible Veterans may participate.
Q: Is the criteria 40 miles or 30 days?
A: Eligibility for the Veterans Choice Program is based on the Veteran’s place of residence or the inability to schedule an appointment within the “wait-time goals” of VHA. A Veteran could be eligible under one or both of these criteria.
Q: What are the criteria used to determine the 40-mile radius? Is it similar to the Dashboard used to calculate mileage reimbursement?
A: VA will calculate distance between a Veteran’s residence and the nearest VA medical facility using a straight-line distance, rather than the driving distance. VA is developing an interactive tool that will be available on www.va.gov for Veterans to determine their potential eligibility for VA Choice based on their place of residence.
Q. How will eligibility be determined for those Veterans who receive a Veterans Choice Card, and are there limitations on what service they qualify for outside of the VA system?
A: Once Veterans receive a Veterans Choice Card,
they will be eligible to use the Program if they meet the specific eligibility
criteria. Veterans who are eligible based upon their place of residence will be
eligible to use the Choice Program for services in the medical benefits package
that are clinically necessary. Veterans who are eligible because of the
wait-time criterion will only be able to receive a non-VA appointment for the
episode of care related to the service that cannot be scheduled within the
“wait-time goals” of the VHA.
Veterans and the Affordable Care Act
· Under the health care law, most Americans must have health care coverage that meets a minimum standard (called “minimum essential coverage”), qualify for an exemption, or make a payment if they have affordable options but remain uninsured.
· Veterans and their family members who are enrolled in VA health care programs (Veteran’s health care program, CHAMPVA, and Spina bifida health care benefits program) do not need to take additional steps to meet the health care law coverage standards.
· If a Veteran or family member is not enrolled in VA health care, they can apply for enrollment with VA at any time.
· If a Veteran or family member is not eligible for VA health care programs, they can apply for coverage through the Health Insurance Marketplace.
Open Enrollment for 2015
coverage through the Health Insurance Marketplace is November 15, 2014 to
February 15, 2015. Coverage can start as soon as January 1, 2015.
· For more information on Veterans and the Affordable Care Act, visit http://www.va.gov/health/aca/.
Managing Chronic Pain Safely and Effectively
Helping Veterans manage chronic pain safely and effectively is a priority at VA. Recently, VA Desert Pacific Healthcare Network issued a new policy that is meant to standardize and clarify good prescribing practices for pain medication, also known as opioids, and is in line with the VA and Department of Defense’s Clinical Guidelines for managing chronic pain.
One of the new key features within the policy is a required informed consent that patients must complete for long-term opioid therapy. As part of the consent process, patients receive educational information such as a guide titled, “Taking Opioids Responsibly for Your Safety and the Safety of Others.” The information helps Veterans understand the risks and benefits of taking opioids so that they can make shared decisions with their providers for pain management. As a safety measure, year-end drug screens ensure patients are not taking other illicit medication. Patients receiving hospice or long-term opioid care for cancer pain are not required to complete the consent.
“We’ve been tracking performance related to the opioid safety initiative, and there has been a downward trend in the percentage of patients that receive an opioid prescription,” said Dr. David Gray, PharmD, FASHP, VISN 22 Pharmacy Executive.
Opioids can help, but not every patient needs them because alternative treatments (such as pain classes, massage, acupuncture, chiropractic care, relaxation or stress reduction training, physical therapy, pain classes, or support groups) are available and should be used as complementary options.
By reducing the amount of opioids in a pain management plan, patients often comment that before the reduction they were mentally cloudy, that it was difficult to find words at times, and one gentlemen said it was hard to keep his eyes open during conversations. Now, many remark that they are mentally clear—like a fog has been lifted.
Changes outside VA, such as reclassification of medications by the Drug Enforcement Administration (DEA), also have an effect on Veteran’s prescriptions for long-term pain management.
Veterans who access My HealtheVet received messages and
letters regarding the recent changes. By informing Veterans of changes in
prescriptions and refills, providing education regarding risks and benefits for
pain management, and offering options or alternatives for complementary
treatment, VA continues to help Veterans manage chronic pain safely and
A Call Away
For Veterans in need of help or advice, VA provides help at their fingertips, with a variety of resources just a call away — 24 hours a day, 7 days a week.
· Nurses are available for health care advice at 1-877-252-4866
· The Veterans Crisis Line aids Veterans in crisis (as well as their families and friends) at 1-800-273-8255, by texting 838255, or online at www.veteranscrisisline.net
The National Call Center for Homeless
Veterans hotline provides homeless or at-risk Veterans access to trained counselors at 1-877-4AID VET (877-424-3838) or online at www.va.gov/homeless/nationalcallcenter.asp
Are You Ready for Flu Season?
If you have already received your seasonal flu shot, we thank you for keeping yourself and others healthy! But if you have not, now is the time!
Flu season is here again, and we have great news about how we are making it more convenient to get your annual flu shot. The U.S. Department of Veterans Affairs (VA) is launching a national program with Walgreens¹ to make it easier than ever for you to stay healthy. Now, protecting your health with a flu shot is as close as your local VA or neighborhood Walgreens*! Here’s where you can get your flu shot:
· VA medical centers and clinics, as always, provide free flu shots during any scheduled VA appointment or at one of the walk-in flu stations. To learn more, contact your VA medical center.
· Walgreens², with whom the VA is pleased to partner in the VA Retail Immunization Care Coordination Program, offers flu shots, and your VA medical center health record will be automatically updated. There may be a cost to you for your flu shot.
· Other non-VA providers and pharmacies are also options, and some employers provide flu shots. They’re offered at health fairs and local clinics or events, too.
Influenza, or flu, is a contagious virus that spreads through coughing or sneezing, and it is related to thousands of hospitalizations and deaths every year. Getting immunized is the single best way to protect yourself and your loved ones from getting sick this flu season.
For more information visit www.ehealth.va.gov/Immunization.asp.
¹ Vaccine subject to availability. State-, age- and health-related restrictions may apply.
²If your local pharmacy is not participating in the VA Retail Immunization Care Coordination Program, it may participate in the future as the program expands.
References to Walgreens or other non-VA pharmacies do not constitute or imply
Is the high-dose influenza vaccine the best choice for you?
If you are 65 years of age or older, or if you are an immunocompromised patient, you may want to consider this option. As we age or our immune systems become compromised due to disease, we are at higher risk for complications from influenza (flu).
According to the Centers for Disease
Control (CDC), “The high-dose vaccine was 24.2 percent more effective in
preventing flu in adults 65 years of age and older relative to a standard-dose
vaccine.” In addition, Dr. David Looney, Infectious
Disease Physician said,
“In my opinion, it would be reasonable to consider the high dose vaccine for Veterans of any age with HIV, cancer, serious chronic cardiopulmonary diseases, and rheumatologic or gastrointestinal conditions or other diseases.”
Speak with your health care provider if you feel the high-dose Influenza Vaccine is the best choice for you or visit www.cdc.gov/Features/FluHighRisk/ for more information.
your shot at fighting the flu
Stop by your
local VA medical center to get your annual flu shot, and help the flu end with
you. Learn more at www.cdc.gov/flu.
The Best Women’s Health Care Anywhere
Did you know there are 37,583 Women Veterans enrolled for health care services in VA Desert Pacific Healthcare Network?
With more than double the number of female Veterans accessing care since 2000, what is VA doing to ensure each woman who served is receiving quality care, tailored specifically for her needs?
We have comprehensive women’s health clinics where women can go for primary care from one provider, in one location, to receive a complete range of personalized services that include:
· Care for acute and chronic illness
· Gender-specific primary care
· Preventative health services
· Reproductive health services
· Mental health services
· Coordination of care
“We have a large contingency of Women Veterans in the Southern California region, and the facilities are continuing to improve access and quality for Women Veteran-focused care,” said Lisa Roybal, WHNP-BC, Women Veteran Program Manager. All the sites have gynecology services, which is an important aspect of health care for women of all ages. Women Veterans who are of childbearing age (18 to 44) make up 43 percent of women VA health care users. To meet the needs of this rapidly growing population, VA increased initiatives focused on maternity care coordination and reproductive health. Healthy aging is a focus for women 45 to 64 years of age (who make up the largest majority of women Veterans at 46 percent) and women over 65 (who make up 12 percent of the woman Veteran population).
“We need to make sure we are taking care of women through the span of their lifetime, and the VA is moving in the right direction,” Lisa said.
Recruiting and training providers in women’s health is also a focus at VA. Since 2008, some 2,000 providers have been trained nationally through mini-residency programs that were developed by Women’s Health Services (WHS), and similar programs were developed for nursing and emergency medicine clinicians. In addition, WHS hosts monthly webinars and live training broadcasts, and offers over 50 on-demand courses on a variety of women’s health topics.
In the past, health care was a predominately male dominated, but VA is making great strides for women. At VA, it’s our job to give women the best care anywhere.
You can find information for women’s services available along with contact information for each of the facilities at the following links:
· Loma Linda: http://www.lomalinda.va.gov/services/women/index.asp
· Greater Los Angeles: http://www.losangeles.va.gov/services/women/index.asp
· Long Beach: http://www.longbeach.va.gov/services/women/index.asp
· San Diego: http://www.sandiego.va.gov/services/women/index.asp
· Southern Nevada: http://www.lasvegas.va.gov/services/women/index.asp
The Women Veterans Call Center
(WVCC)—available by phone at 1-855-VA-WOMEN—was established to receive and
respond to questions regarding services and resources available for women
Veterans. For outreach, the call center made nearly 80,000 calls and
successfully contacted 50,000 women Veterans.
If You Have Questions About Ebola Virus, VA Has Answers
The Department of Veterans Affairs (VA) is part of a strong nationwide public health system that includes federal partners such as the Department of Health and Human Services (HHS), the Centers for Disease Control and Prevention (CDC), and the Department of Homeland Security (DHS), along with many state and local medical and health professionals. We are prepared to give Veterans the best care possible and protect health care workers’ safety.
The following Q&A’s regarding Ebola address VA’s preparedness to provide care for Veterans with suspected or actual Ebola Virus Disease (EVD) in a manner that protects employees, patients, volunteers, visitors, and family members, as well as surrounding communities.
Q: What is Ebola?
A: EVD, previously known as Ebola hemorrhagic fever, is a rare and deadly disease caused by infection with the Ebola virus.
Q: What are the symptoms?
A: Symptoms of EVD include fever, severe headache, muscle pain, weakness, diarrhea, vomiting, abdominal (stomach) pain, and unexplained hemorrhaging (bleeding or bruising). Symptoms may appear anywhere from 2 to 21 days after exposure to Ebola, but the average is 8 to 10 days.
Q: How does it spread?
A: EVD is spread through direct contact (for example, broken skin or mucous membranes in the eyes, nose, or mouth) with blood or body fluids (including but not limited to urine, saliva, sweat, feces, vomit, breast milk, and semen) of a person who is sick with EVD. It is also spread through direct contact with objects (like needles and syringes) that have been contaminated with the virus or through contact with infected animals. Ebola is not spread through the air or by water, or in general, by food.
Q: What should I do if I think I have Ebola?
A: It is unlikely that you have Ebola unless you have had contact with the blood or body fluids of a person sick with EVD, contact with objects that have been contaminated with the blood or body fluids of a person sick with EVD, or contact with infected animals. Diagnosing EVD in a person who has been infected for only a few days is difficult, because the early symptoms, such as fever, are nonspecific to EVD infection and are seen often in patients with more commonly occurring diseases, such as flu, malaria, and typhoid fever.
Q: Is VA prepared to handle Ebola cases? How will they protect patients?
A: To date, no EVD case has been reported at any VA facilities. However, VA is prepared to care for Veterans with suspected EVD in a manner that will protect VA patients, employees, volunteers, visitors, and family members. All VA hospitals have infectious disease control units, and VA staff systemwide have experience caring for patients with infectious diseases. Based on CDC guidance, clinical staff throughout the VA system is receiving additional support and guidance on evolving clinical protocols and the appropriate level of personal protective equipment.
Q: Where can I get more information?
A: The CDC is the best source of up-to-date information
on Ebola in the United States. The CDC fact sheet at
may be helpful.
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Address changes should be sent to your local VA medical center.