VA Mission ACT Veterans Choice Program

Senate Passes $55 Billion Veterans Health Reform Bill, VA Mission ACT

Lawmakers at a vote of 92-5 passed key Veterans Health Reform legislation today costing taxpayers $55 billion called S. 2372 VA Mission ACT of 2018. The bill is now on its way to the White House for signing, and the President said he would sign it.

The bill seeks to address community care to replace VA Choice, expand benefits to family caregivers, and to initiatea review of VA infrastructure to shut down unnecessary facilities.

The most difficult part of the bill to pass was the replacement to Veterans Choice Program. The updates remove certain hang-ups such as the 40-mile rule. Now, certain veterans can use community care if approved.

Of course, the Department of Veterans Affairs has sole purview over who does and does not get community care. Those unhappy with decisions can use the sham process of VHA Directive 1041, VA Clinical Appeals, which does not allow higher review of a decision past the VISN. The VA Healthcare system does a horrible job adjudicating appeals and often violate due process rights of veterans by ignoring evidence veterans supply in support of their claim.

Many examples of these failures are evidence in expulsion of veterans’ caregivers from the Caregiver Program. Spouses seeking appeals of wrongful decisions rarely get justice, and they are not afforded an opportunity to appeal adverse decisions to the Board of Veterans Appeals or the US Court of Appeals for Veterans Claims.

The review of any decision under subsection (d) or (e) shall be subject to the Department’s clinical appeals process, and such decisions may not be appealed to the Board of Veterans’ Appeals.”

As for expansion of the Caregiver Program, the program is presently limited to only caregivers of severely disabled veterans who served post-9/11. The bill supports expanding to caregivers of Vietnam era and earlier, too. After four years, veterans of all eras will be added to the program.

The bill also addresses closing down VA facilities that are unneeded similar to BRAC when the Pentagon shut down military facilities. The goal of the bill related to construction is to shed certain facilities from VA’s inventory.

RELATED: RAND Says VA Healthcare Awesome

There are high odds that such facilities will be sold to the highest bidder at severe discounts and then leased back to the federal government following renovations. That seems to be a trend discussed a few years ago.

RELATED: Health Net Slammed For Poor Veterans Choice Performance

In support of VA Mission ACT, VSOs united and provided a letter to Congress, included below in italics for your review.

VSO Letter To Congress

Dear Chairman Roe, Ranking Member Walz, Chairman Isakson and Ranking Member Tester:

On behalf of the millions of veterans, service members and family members we represent and advocate for, we offer our strong support for the “VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018,” also known as the “VA MISSION Act of 2018.”  This historic veterans legislation would consolidate and reform VA’s community care programs; extend funding for the current Veterans Choice Program for one year; strengthen VA’s ability to recruit, hire and retain quality medical personnel; review, realign and modernize VA’s health care infrastructure; and extend eligibility to VA’s comprehensive caregiver assistance program to aging and disabled veterans injured before September 11, 2001.

Our organizations strongly support expanding eligibility for VA’s comprehensive caregiver program to all generations of seriously disabled veterans, while maintaining the caregiver benefits that are currently available.  Today, this program provides full comprehensive caregiver assistance only to veterans injured on or after September 11, 2001, leaving family caregivers and veterans injured during World War II, the Korean, Vietnam and Gulf Wars ineligible for this critical support.  The legislation will help to correct this injustice and we – along with millions of members in our organizations – applaud you for taking this action and look forward to working in the future to ensure that both injured and ill veterans from all eras are eligible for this benefit.

The legislation would consolidate VA’s community care programs and develop integrated networks of VA and community providers to supplement, not supplant VA health care, so that all enrolled veterans have timely access to quality medical care.  The bill includes funding to continue the current Choice Program for an additional year until the new community care program is implemented as well as important workforce improvement provisions to strengthen VA’s internal capacity to delivery care.  This carefully crafted compromise represents a balanced approach to ensuring timely access to care while continuing to strengthen the VA health care system that millions of veterans choose and rely on.

The legislation also includes a new Asset and Infrastructure Review (AIR) process intended to design and implement a comprehensive plan to optimize and modernize VA’s medical care facilities. The AIR process would provide meaningful stakeholder involvement, transparency and other safeguards during the review process to help ensure the final result leads to a stronger and better aligned VA infrastructure able to deliver care to veterans when and where they need it.

Since the access and waiting list crisis exploded in 2014, Congress, VA and veterans leaders have debated how best to strengthen and reform the delivery of veterans health care to ensure timely and seamless access for enrolled veterans.  The legislation before the Committee would take a major step towards that goal by making improvements to and investments in the VA health care system, creating integrated networks so that veterans have access to care when and where they need it, and providing the further recognition and assistance to family caregivers of severely disabled veterans deserve.

As leaders of the nation’s veterans and military service organizations, we thank you for your steadfast leadership in crafting this important bipartisan bill and call on all members of Congress to seize this historic opportunity to improve the lives of veterans, their families and caregivers by swiftly passing the “VA MISSION Act of 2018.”  The men and women who have served, are serving and will serve in the future are counting on Congress’ support.

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  1. 80% of veterans can afford not to use VHA and don’t, 20% use VHA because they have’ no choice’, if they had a choice they would not use VHA. ergo VA can’t administer Choice at face value because most veterans would not use VHA if they didn’t have to. So VA must make rules to limit Choice use. Y’all have a happy Memorial Day sale.

  2. JS: Do you have a link to the text of the Bill. I haven’t been able to find it. This appears to be an evolution of the CBOC program and solves the problem of grab the contract money and fail to provide in corrupt contract letting by the VA Regional Offices for the contract CBOCs

  3. Ben, please let us know when you learn how we can sign up for this program. It looks like I might be moving from an area where there is a large VA facility within a 20 minute drive, to an area where that drive will be at least an hour (but still somehow under 40 miles). Can’t wait to sign up if I’m allowed.

  4. The VA will be required to network with community providers under the Mission Act so Vets are able to walk into non va facilities and get care on the spot.

    This is something new that I never saw in any legislation before:

    Sec. 105. Access to Walk-In Care.
    Section 105 would authorize access to walk-in care for enrolled veterans who have
    used VA health care services in the 24-month period before seeking walk-in services.
    Community providers that have entered into a contract or agreement to provide services
    under this section and Federally-qualified health centers (FQHC) would provide these
    Veterans who are not required to make a copayment at VA would be entitled to two
    visits without a copayment and then VA would be authorized to charge an adjustable
    copayment determined in regulations by VA. Veterans who are required to make a
    copayment at VA could pay that copayment for the first two visits and then VA would be
    authorized to charge an adjusted copayment after those two visits.
    VA would be required to ensure continuity of care under this section, including through
    the establishment of a mechanism to receive medical records from walk-in care
    providers and to share pertinent patient medical records with walk-in care providers.

  5. My heart sinks even more with this Mission ACT 2018. The CHOICE Program was a-ok for me, until VA Directors pulled the plug on further treatment and further denied my Geographical Excessive Burden, when this was the same criteria that enabled me to access in my Community. It was actually recommended all my care be in my Community, thats when everything went to hell. Providers (1) stated VA would relinquish total control if this was granted. When I requested Appeal Process, pt advocate stated she was not aware of any Appeal Process and the very Director that blocked my care was the final say so. Unbelievable!
    When I requested Congressional intervention, or Disabled American Veterans assistance; neither was any help.
    A letter from Congressman basically stated, an inquiry and been made on my behalf and here was the form letter they received and hoped I would have a nice day.
    VSO, never even gave me a return call.
    Until Congress gives each of us an Insurance Card where we don’t need special permission from the very VAHC that will not benefit from granting any outside Clinical referrals, it isn’t going to happen.
    I’m sad that my Country has let me down and after all we have given.

  6. And you thought you knew everything about this guy, Nothing more then a Commie

    1. @Windguy

      Is it funded? Well, if the definition of “funding” is printing up money so fast they need upgraded vision sensors this year to detect flaws in printing it (the old ones could only quality inspect three million dollars a second off the presses), then yes. This is ALL funded….

      Remember always; if it’s the federal government doing it then it must be legal…

      1. Great – I’ll sleep better knowing that it’s fully funded and the VA will hit the ground running.

  7. As a former VA employee who worked with the Caregiver Support Program (…yes, I’m aware I’ve stated this in a number of my previous post replies, and yes, I’m aware that I’m starting to sound as redundant as some of the Devil Dogs I once served with who rambled on and on about how things were done at their last duty stations [“We get it, everything was better before you arrived to serve with our apparently ineffective unit!”]…), I’m both surprised and pleased to see changes to the Program on the horizon. I can’t count how many times clients were denied access to The Program of Comprehensive Assistance for Family Caregivers (the portion of the program that comes with a stipend, training, psychoeducation, counseling, and health insurance) and instead were offered only The Program of General Caregiver Support Services (essentially, only training and limited psychoeducation) based only on their periods of service. I think this systemic change is long overdue.

  8. “On behalf of the millions of veterans…we represent” That is a big VSO lie, they represent the VA and don’t care about veterans, except there REMF, window dressing members the VA takes real good care of. Never been helped by any VSO’s. Been on my own since “68.

    1. Most VSO’s aren’t worth the skin their stuffed into nor the air they suck down. If I had to make the decision to save the life of a VSO or a rabid animal, the rabid animal wins out every day of the week and twice on sundays. VSO’s have no national standard of certification. In some states becoming a VSO is as simple as tearing open a box of Cracker Jacks. Of course you’ve never been helped by a VSO. That would just get in the way of them helping themselves.

  9. Rise and Shine Veterans the Mission Act we don’t need we need Veteran Quality Care plus called Representative and Senators contract the Veteran Affairs Committee passed a New Veteran Benefits Law can go to go any Medical Center they want to according to their income.

  10. Oh hey… got a PBS channel back on the TV programming. Imagine that.


    All these butt wipes keep harping on pain meds and how to further restrict us getting access to any at all. It’s already impossible to find care locally if you’re a chronic pain patient. Who the hell are LEOs to college Profs to get involved or have rule over our health care or tell us what we need for quality of life? While supporting, protecting, side-stepping every other damned serious issue out here. Like censoring, phony investigations, phony drug war to oppress people, to lawyers not wanting to get involved in local corrupt politics, health care phonies, and all the rest. Too damn many issues out here to deal with in reality.

    VSOs: Piss on all of them and who cares what they think or write? As far as this dude is concerned they can all go to hell and burn. They or their highly esteemed leaders and cliques must read this blog. Virtually or physically, real life, where is all the help and support in the many serious issues they all side-step or refuse to report on or get involved with?? The local filth who claim to do so much won’t do anything to help with VA retaliation, any level of corruption, or get involved with Draconian politics or the same in our health care.

    “Community Care?” Where, how, when, from who? Go out only to find the same kind of treatment, abuse, lies, games, attitudes… or more attacks and retaliation? Unable to find out why or if it is from the VA making their threats good. Community my ass, nothing but facade and circus in Indiana especially in Terre Haute where there is simply no real media or representation of any kind. VSOs say, oh “we can’t involved our hands are tied due to politics,” WTF. Then put on shows in MSM and over issues like this? Barf-ola.

    Community care refused to X-ray a broken jaw the VA gave me. Total cover-up and dismissed by the state’s Attorney General, local dentistry, state boards, etc. Care? Or the scum attorney general claimed investigated and found no wrongs? What F-ing investigation? No-one wanted to see my proof or dared to call me or contact me in any way but now it’s a done deal with the state and others? BS

    Things designed to put more money in the pockets of those medical care providers? More trips to make, more push for anti-depressants, more info spreading to God only knows who and by what kind of staff.

    Civilian care, or community care? Go have surgeries only to encounter rip-offs, scams, or fraud? Right off the bat. Having to stay silent because of having enough on my plate to deal with. Get ordered to prepare for surgeries and have 7, seven, different prescriptions filled for antibiotics, steroids, told to take them with you during surgery and for visits only to walk away with half of them taken or confiscated and not all can be used at one time during the surgery? Why. Then to see huge bags full of them and unopened in cracked doors at the MDs office? Large bags of them. Foreign MDs collecting them to be sent over-seas or for the black market? Same thing happening to other patients but don’t care to discuss the matter. Or told nobody knows anything about it? C-mon. Or told to talk to a MD that can’t seemingly understand English well?

    Community care when MDs refuse to see chronic pain patients. Geriatric MDs are no-where to be found locally. Most are not taking new patients? Spend entire days on the phone trying to contact MD only to end up with nothing, or no returned phone calls or given old names on lists that are no longer in practice. The whole sheebang is phony and corrupt as hell. Well here it is and must be state wide.

    Been three years since leaving the VA and still can’t find a decent MD to see. But sure can find a bunch of activist and all the retaliation to deal with. VSOs, medical boards, VSOs (all), media, politicians locally on up don’t give a damn but sure can make matters worse or wanting more of our info to be used maliciously. Why don’t these bastards contact me?

    HIPPA and Disability Act violations out the ass and can’t get attention or help from anywhere. Or just told to hire an attorney when we are supposed to have the means not to have to hire an attorney for everything. Like one would do such a thing locally or to harm the state’s image. Immigrants, illegals, animals must come first. Not a Democrat… go die…. identity politics run rampant in health care too. VA staff say..’vote Democrat for better care.” Oh who cares they all can get by with murder and gross professional misconduct.

    Local attorneys don’t want involved in local politics either or the corruption. Some are wealthy beyond measure just doing bankruptcies while telling vets their VA disability is not exempt from bankruptcies. The total opposite of laws I’ve read or been told by every VSO head out there or VA in DC. Investigations? Not in this state or town, why?

    Why so much fear among the veteran community or in the publc sector and not wanting involved or to help? Should tell the whole story while the majority are distracted with BS like Hollywood or DC games. Where are all these investigative reporters? None I have contacted seem concerned or care. Faux news, locals to Project Veritas.. et al. As more censoring and post on FB disappears. And politicians contacted failing to respond, or just wanting our VA files and such.

    Talking heads report bullying in schools to child suicides way up. Dismissing and refuse to report on vet suicides or the numbers or who dunnit and why. I wonder why.

    Body count this week is, as the DC cliques to the locals play activist and circus maximus? “Community Care?” What a joke.

    1. Here are some other complaints or thoughts about “community care.”

      How about the hate and disgust civilian health care workers have for getting files from the VA? Getting fifty pounds or more interspersed BS from every clinic seen for years? Or some facts or info totally ignored. Or be told it may take multiple visits to get though it all due to the various health issues only to be forgotten by the time the next visit comes up. Then to hear flies or notes from that first visit were lost or not put into the computer, etc. Again? More VA like BS to endure.

      What about that for inner office use or comments about us in our files that may not be available or for our use. Or included in copies of our request for copies in a med file? Got that in black and white too. MD to MD or clinic communications MAY NOT be for our consumption. Gotcha. Thanks.

      Waiting room times up to and over six hours. Seen as totally acceptable by the sheep and ethical by those in the medical field. Oh, yeah, no food or water allowed in waiting rooms. No water fountains present either. Food baskets and drinks must be kept in the parking lot for us to trudge and gimp back to for a drink or a munchie out of the carried picnic basket for health care. Thanks for being so thoughtful, scum bags. When every move hurts or can easily make things pop out of place. What Disability Act? HIPPA?

      No big deal when you inform them long waits you can’t do like inability to sit in those regular small chairs found in them. No, gotta stand and sachet around for hours until so sick gotta leave.

      Procedures or test required that is not covered by insurance, Medicare, supplemental, etc. But MUST be paid on demand, the spot, for further treatment.

      Not caring about patient reports or what has worked. No. They want to send you to all their MD specialist after yeas of seeing such kinds and told nothing more to do but pain management. Yet they want you to run and play games to spread the money around totally disregarding what we have already done for years and been told. More testing, more games when all this info should be in our files. Oh no, gotta play the money game and see their chain of buddies in the health care field or told to do physical therapy and such that you can’t do, hasn’t worked in previous years, but told YOU MUST do it or try it again. Kinda like the old bitch told me in the new Purple Team that ‘didn’t have time to read your file,” but started changing everything and meds, then told the new VA way is to have me do approx 20 years of testing and running though the clinics all over again. And forgetting whatever we have been told, needs, treatments to-date, and disregard what any civilian care or specialist has told us/me.

      Won’t accept or see X-rays or test already taken, VA or not. No, gotta do their own in every office even in the same hospital but different clinics under them. PCP to the bone MD just across the street. Why. Obvious.

      MD and staff laughing thinking it funny when you inform them you are not there to run the gamut or go bankrupt for medical care again. Big joke them apparently and most obviously. Or them not shutting up acting like speed freaks not allowing a patient to get a full sentence in, maybe a word, breaking in like they can read minds or something. Med care is not what it once was for sure. Long gone.

      Now what can the VSO scum or those in DC tell me about “community care” or how great that will be and is for all vets or people? Total hogwash.

      1. Another thought since I am too damn worn out and sore to do anything else.

        “Now, certain veterans can use community care if approved.

        Of course, the Department of Veterans Affairs has sole purview over who does and does not get community care. ”

        Certain vets, if approved, sole purview, etc. The hatchet still seems to be in place. Both ways.

        How about all those health care workers and MDs out there that refused the pay range on the Choice Card, or what the VA will pay for some office visit, treatment or MD costs? More than once I was told MDs do not have to lower their charges, will not, to appease the VA or what is allowable by the gov or supplementals. They will accept what the VA is willing to pay or allows but the rest the vet has to sign payment responsibility contracts with them to cover all costs the VA or insurance will not. Or possibly have to pay out of pocket ‘at the time/same day of service.’

        Question being, no bill, no law, will force MDs or specialty care people, in house or not, from accepting the patients or their their charges, inflated or not. Will the vets, their care givers, still be responsible for any over-charging or inflated cost by medical ‘professionals?’ Since the VA may, or will not accept certain charges demanded by MDs, added service for in home care/visits or clinics? From what I have experienced there are no laws or acts that can be enforced easily by us serfs or vets. Some may say something is written in stone… and easily enforced….agreed on across the board, oh no they are not. Just according to ones location or connections.

  11. “”

    “(Sec. 2) This bill amends the Internal Revenue Code to specify that, for the purpose of determining eligibility for the premium assistance tax credit, an individual may not be treated as eligible for coverage under certain Department of Veterans Affairs health insurance programs unless the individual is enrolled in the program.
    The bill applies to the premium assistance credit under current law for tax years ending after 2013 and, if the American Health Care Act of 2017 is enacted, the modified premium assistance credit that would take effect under that bill after 2019.
    (Under current law, the premium assistance tax credit is a refundable tax credit provided to eligible individuals and families to subsidize the purchase of health insurance plans through an exchange established under the Patient Protection and Affordable Care Act. Individuals eligible for minimum essential health coverage from certain sources other than the individual insurance market are not eligible for the credit.)”

    So what veterans are getting is “premium assistance” to buy health insurance of your choice. It won’t come cheap but should satisfy those who complain of service at VA facilities. Question is “How much assistance?” Which Policies will be approved? etc.

  12. Community Care = CBOC? Scottsbluff, NE has a CBOC under contract with SPRINGER. Former contract cancelled within the last 2 years. This CBOC looks good but PTSD treatment unsat A one size fits all approach with Cognitive Therapy that puts you back in the military study guides and authoritative leader that will kick you out of the study group on a dime.

    So is the VA becoming an “insurer” under this new bill? What is changing?

    1. Received a quick consult to a local rehab specialist. Working on a consult with a neurologist. Time lapse for these types of appointments not as good as Japan but as good as any from any other source in this area.


      1. More of the same. Big wheel keeps on turning. Sheep don’t care. Like it takes ‘scholars’ to see all this going on plus the reports about skids of federal dollars just …. missing or lost? This country is laying at the bottom of the cesspool. There again, most don’t know what a cesspool even is or for.

      2. Ain’t that some shit. Remember Pepsodent?

        Oh, you’ll wonder where the money went,
        When you put your faith in Government, Government, Government

        Always had a nice little ring to it

      3. HUD and the DOD. Huh – Trillions for the Democrats and Trillions for the Republicans. Fair and fucking balanced thievery.

  13. Call me cynical but mark my words, $55 Billion or $200 Billion matters not because…mark my words, it will not be more than 6 months or sooner before the VA goes with empty funny hats to congress critters demanding even *more* $$$$$ because they will do as they did with CHOICE ACT, squander the $$$, deny service, but yet will probably by say…November this year, election time, say that The VA MISSION ACT $$$$ Funds are ALMOST GONE….we better filler-up again….

    Larger Question???? CHOICE and the VA utilized ‘As a crow flies” territorial boundaries to access; will The VA MISSION ACT utilize Dodo Birds or Duck-Billed-Platypuses?

    1. namnibor,
      November is too far off. In my opinion, July, or possibly August, IS when VA and those reprobates in “funny little hats”, WILL BE asking….er – begging for more taxpayers dollars!

  14. I appealed multiple times with the VA clinical decision making process and not one single time did they even bother to answer. I appealed my DBC flags every time and they refused to answer those as well until the third one when the press started getting involved and even then it was a bizarre response to the appeal; “I am afraid that even casual comments like th done you made are taken very seriously… appeal denied.” In response to an appeal of a claim that I had threatened to murder the entire CBOC staff which even VA police could not confirm???

    Appeals mean zilch at VHA. Not worth toilet paper on the printed appeal. One chief of staff even argued with me in person in front of his chief of VA police that he was not required to forward my appeals of those DBC flags. Even the chief of police informed him that the flag letter itself says that is exactly what the chief of staff is supposed to do. He said he was chief of staff and his decision not to forward appeals to the VISN stood and that further discussion about it was over.

    Then he ordered the VA police to escort me everywhere on the basis of a flag that he refused to allow appeal on. Even the chief of VA police said he had no idea why he was ordered to do this.

    Tell me, where in this brand new law sitting now atop a Mount Everest stack of decades upon decades of laws to “fix” VA is it that can now magically force ANY of these assholes to do ANYTHING different than they have done for generations???

  15. All I can say is that you should get ready to been over and spread them for a bad ass fucking by the same people who made so many of us die and just because of money and the system allow It to happen again and again. Just give it more and more money and no one will ever be heald accountable for their bad and deadly service to us the ones who made the jobs they have and getting paid more than any vet. So they can say many things but you as well as I know they will never be happy until they can kill all of us who they were working for but never do anything for but same too think we are only a pain in their day.
    James M. Hanrahan 100DAV

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