Critical Access for Veterans Care Act
The Critical Access for Veterans Care Act would broaden veterans’ access to care at critical access hospitals (CAHs) and provider-based rural health clinics affiliated with CAHs through the Veterans Community Care Program. It adds CAHs and related clinics as eligible providers for covered veterans who live within 35 miles of the hospital or clinic, and it removes the requirement that veterans obtain prior authorization or referrals before receiving such care. The bill also changes how these services are paid, shifting to Medicare-based payment rates (CAH rates for CAHs and Rural Health Clinic rates for affiliated clinics) and requiring cost-based reimbursement with a quick 60-day review and payment timeline. A formal definition of CAH is aligned with the Social Security Act, and the bill requires a Congress-wide report within one year on how the changes are working, including claims processing and user experience.
Key Points
- 1Expansion of access: Adds care at a critical access hospital or its affiliated provider-based rural health clinic to the Veterans Community Care Program for veterans who live within 35 miles, including care from nearby providers referred by the hospital/clinic.
- 2No prior authorization/referral required: The Secretary may not require a veteran to obtain authorization or a referral before receiving care under the new expanded access (subsection (d)(5)).
- 3Payment and claims: For CAH-based care, Medicare CAH payment rates apply; for provider-based rural health clinics, Medicare RHC rates apply. Claims must include an identifier for this care and be reimbursed at a cost-based level, with a defined 60-day timeline for review and payment after submission.
- 4Definitions: Clarifies that “critical access hospital” follows the definition in the Social Security Act (42 U.S.C. 1395x(mm)).
- 5Accountability and reporting: Requires a report to Congress within one year outlining implementation progress, timely claim approvals/payments, and user experience, plus defined terms for “community care provider” and “third party administrator.”