Legislation would increase accountability for VA facilities, boost access to private-sector providers

Sen. Jerry Moran (R-Kan.) proposed holding VA facilities accountable for meeting the access standards.

Private-sector providers could see an expanded role in caring for veterans under legislation that is entering final negotiations in the Senate.

Currently, veterans can opt into the Veterans Choice program if they face wait times of 30 days or more or a 40mile travel time to a Veterans Affairs clinic. Under the new legislative language, those standards would be jettisoned, forcing the VA secretary to not only develop new access standards, but hold VA facilities accountable for meeting them. Ultimately, this would open up Choice to more veterans and a wider array of community providers.

It’s a significant technical change to bipartisan legislation that passed out of the Senate Veterans’ Affairs Committee in December and originally gave the VA secretary discretion to relax restrictions to community care, but did not require through statute that VA facilities meet so-called designated access standards.

Myriad other issues remain to be worked through, but the tweak is a compromise agreed to by the VA, albeit one that veers from what Veterans Affairs Secretary Dr. David Shulkin publicly endorsed in a recent Senate hearing. It also wakened concerns over accelerating privatization of the VA’s healthcare system, particularly in light of the involvement of the political action committee Concerned Veterans for America, which is funded by conservative mega-donors Charles and

David Koch.

The change came at the urging of the White House, according to documents obtained by Modern Healthcare. A Senate aide confirmed that the provision would be incorporated into the final legislation, which committee leaders hope to complete shortly and bring to the floor.

Even as Senate and House committees with jurisdiction advanced VA Choice reforms late last year, differences were brewing over the technicalities of granting more access to the VA Choice program while not hurting or under-using VA facilities. As a result, VA Choice reforms stalled in January, which President Donald Trump alluded to in his

State of the Union address.

The Trump administration jumpstarted legislative talks with its own list of proposals including an idea from Sen. Jerry Moran (R-Kan.) to hold VA facilities accountable for meeting the access standards. That language also had backing from Concerned Veterans for America, which had been campaigning to expand VA Choice for months.

Dave McIntyre, CEO of TriWest—a third-party contractor with the Defense Department and now with VA Choice— acknowledged that the sticking points over the issue of access are difficult because no one wants the VA facilities to lapse or the government’s investments to go to waste.

TriWest's business is booming with VA Choice. The company just pro- cessed its 10 millionth VA Choice claim and sees thousands of new veterans coming in each day. The western region covers 28 states and TriWest has 200,000 providers under contract within those states.

“This is about resetting the VA for this generation and the next,” McIntyre said. “This is the hardest thing we have ever been involved in.” Tensions over the legislation came to a head in a hearing last month when Moran sharply rebuked Shulkin, who also served in the Obama administration.

“Our inability to reach agreement is due to your double-talk,” Moran said.

Shulkin called the characterization “grossly unfair” and said his stance alongside the committee’s original bill came from trying to do right by veterans as well as the VA while also making sure patients can make their choice of provider “based on their clinical needs.”

Ultimately, the revised provision for eligibility, which Shulkin consulted on, is a win for Moran. It follows reports from the New York Times and Washington Post that detailed the inner-department turmoil at the VA. The politicking has pushed Shulkin into an increasingly difficult position, according to the reports.

The news stories also traced Concerned Veterans for America’s involvement within the VA Choice debate, which drew the ire of Rep. Tim Walz (D-Minn.), a veteran and raking member on the House VA committee. The reports, he said, confirm “that the Koch brothers and corporate interests are at the center of an effort to take over and privatize the VA to make money.”

Concerned Veterans for America did not respond to a request for comment about its lobbying efforts.

Although Senate leaders hope to move their bill soon, House policymakers haven’t worked out how to pay for their

● parallel version, according to an aide.