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HR 961119th CongressIn Committee

Veterans Access to Direct Primary Care Act

Introduced: Feb 4, 2025
Standard Summary
Comprehensive overview in 1-2 paragraphs

The Veterans Access to Direct Primary Care Act would create a five-year pilot program in the Department of Veterans Affairs (VA) to let eligible veterans use non-VA direct primary care (DPC) services through Veterans Health Savings Accounts (VHSAs). Starting one year after enactment, the VA would fund VHSAs for participating veterans, who could use the accounts to pay for primary care from non-VA providers under fixed-fee DPC arrangements and for related costs such as periodic physician fees, screenings, diagnostics, and medicines. While participating, veterans would not receive VA medical care that is part of the DPC arrangement. The program is to be run under VA’s Center for Innovation for Care and Payment (CICP) and would be overseen with quarterly implementation reports, followed by annual results reports, with no new appropriations beyond amounts already authorized to VA. The authority to deposit VHSAs would terminate five years after enactment.

Key Points

  • 1Establishes a five-year VA pilot to provide eligible veterans with a veteran health savings account to access non-VA direct primary care arrangements. The program runs beginning one year after enactment and is implemented through the VA Center for Innovation for Care and Payment (CICP) under 38 U.S.C. 1703E.
  • 2Eligible veterans are those enrolled in VA’s patient enrollment system (38 U.S.C. 1705).
  • 3VHSAs may be used to pay for direct primary care services from non-VA providers and related costs, including periodic physician fees, prepaid or periodic service fees, screenings/diagnostics, and prescription medicines.
  • 4Veterans who participate in the VHSA program may not receive VA medical care that is included in the non-VA DPC arrangement during the pilot period.
  • 5The Secretary must prevent fraud and ensure funds are used as authorized, determine annual deposit amounts using actuarial input, and provide yearly deposits to participants during the pilot. Funding comes from VA appropriations already authorized for the Veterans Health Administration (no new appropriations).
  • 6Reporting and oversight include: quarterly implementation reports for the first two years, then annual reports on pilot results; final design details in implementation report; termination of the VHSA deposit authority five years after enactment.

Impact Areas

Primary group/area affected: Eligible veterans enrolled in VA’s patient enrollment system who opt into the VHSA/DPC model and non-VA primary care providers.Secondary group/area affected: Non-VA primary care physicians who participate in DPC arrangements, VA’s Innovation Center (CICP), and VA’s budgeting and oversight processes.Additional impacts: Potential changes to care access and scheduling for primary care, shifts in how care is paid for (from VA-furnished care to VHSA-supported private DPC), data collection and governance for pilot evaluation, and safeguards against fraud. The program operates within existing VA funding and does not authorize new appropriations beyond current VA health care appropriations.
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