Administrative and reimbursement hurdles hamper VA initiative on private-care access

Administrative and reimbursement issues are hindering the Veterans Affairs Department’s new initiative aimed at granting wider access to private care for veterans unable to get treatment within the system, according to some providers around the country who have tried working with the new program.

The opportunity for more veterans to seek private-sector care was made possible by a $16 billion veterans-related measure signed by President Barack Obama in August. But as vets have begun to receive information on how to access care outside VA facilities, providers in some of the most rural regions of the U.S. say they’ve either declined to contract with the managed-care companies involved in the program or haven’t been approached.

The VA emergency funding law states that “rates negotiated shall not be more than the rates paid … under the Medicare program.” As a result, the VA pays Medicare rates to TriWest Healthcare Alliance or HealthNet Federal Services, the managed-care companies the department has contracted with to oversee the choice program. But those companies reimburse at less than Medicare rates, prompting some providers to not join the program.

“We are not connected to the negotiations they have with local providers, so we don’t know what they are actually reimbursing,” a VA spokeswoman said.