Arizona Republic - VA Loosens Eligibility Rule for Private Medical Care

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By Paul Giblin

The Department of Veterans Affairs will relax eligibility requirements for a program that allows veterans to use non-VA medical providers, a change that is expected to double the number of veterans eligible to use private-sector doctors.

VA Secretary Robert McDonald on Tuesday outlined the VA's new, looser interpretation of a "40-mile rule" for vets seeking to use the Veterans Choice Program.

The current policy emerged as a focal point during a roundtable discussion among President Barack Obama, McDonald, several federal lawmakers and veterans' advocates at the Phoenix VA hospital two weeks ago.

The Choice Card program is a temporary benefit that allows some veterans to receive health-care services from non-VA personnel if their residence is more than 40 miles from a VA facility.

The VA currently calculates the distance from point to point in a straight line. The new method will measure the distance according to road miles, a modification urged by many veterans living in rural areas.

The change will be implemented through regulatory action in coming weeks, McDonald said. Driving distance will be gauged using a commercial mapping product.

"VA has worked very quickly to implement the Veterans Choice Program and we appreciate the constructive feedback shared by veterans and our partners to help us improve service to veterans," McDonald said in a statement.

U.S. Sens. John McCain and Jeff Flake, both R-Ariz., criticized the 40-mile rule during a press conference immediately following the March 13 presidential roundtable discussion at the Carl T. Hayden VA Medical Center.

"It's clear that the VA's narrow interpretation of veterans' eligibility to use the Choice Card is preventing them from gaining the flexibility in care they need," McCain said at the time.

"They are now interpreting the 40 miles as the crow flies. Our veterans don't fly. Obviously, it should be 40 miles that they have to travel," McCain said.

Since the Choice program went into effect on Nov. 5, 2014, more than 45,000 medical appointments have been scheduled using it. The looser interpretation is expected to double the number of eligible veterans, according to the VA.

On Tuesday, McCain said he was pleased Obama and McDonald took action on the matter, calling it a step in the right direction.

Yet, he said he was still concerned that the new policy left intact a provision that imposes the 40-mile rule if veterans live within 40 miles of VA outpatient clinics, even if the clinics don't provide specialty services needed by the veterans.

Flake told The Arizona Republic that the new policy is a welcome change.

"This is the way they should have interpreted it in the first place. The bigger deal is the clinics," he said. "That's the bigger nut to crack, frankly, in terms of cost."

If non-specialty clinics are excluded from the 40-mile rule, VA officials estimate the Choice program's cost could jump by tens of billions of dollars, Flake said. He asked VA officials for a more detailed analysis of the potential cost, he said.

Other federal lawmakers and veterans service organization officials called the tweak to the 40-mile rule positive.

Rep. Kyrsten Sinema, D-Ariz., whose district includes the Phoenix VA hospital, said the change showed progress.

"It's ridiculous that the VA originally measured distance as the crow flies, instead of the distance that veterans actually have to drive to get care. I brought this concern to the VA multiple times and am glad to see that common sense has prevailed," Sinema said.

Rep. Ann Kirkpatrick, D-Ariz., said she too welcomed the change, particularly because it will benefit rural and tribal veterans. "It's just common sense -- something I hope we see more of from the VA," she said.

Iraq and Afghanistan Veterans of America Political Director Bill Rauch credited VA executives for welcoming constructive criticism and recommendations from veterans association officials.

"Today's change is yet another example of how the new VA under Secretary McDonald's leadership is listening to its customers," he said.

The Choice program was authorized by a sweeping VA-reform measure called the Veterans Access, Choice and Accountability Act last year.

Veterans generally have been slow to use it. A recent poll of the Iraq and Afghanistan veterans association showed that only 9 percent of members use the program, while 25 percent tried to use it but were denied access. Of those, more than half were denied because of distance issues, according to the association.

McCain also said he's concerned that the president has proposed to reallocate funding meant for the Choice program to other VA programs.

"I believe shifting that $10 billion away from this program would signal the administration is not serious about implementing the fundamental reform needed at the VA," McCain said in a statement

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