A Case of Statin-Induced Myopathy
The MISSION Act: Understanding The VA's Community Care Program
The U.S. Department of Veterans Affairs launched the Community Care Program after the VA Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act was signed into law in 2018. This was done to improve veterans' timely access to healthcare nationwide.
It's like an extension of the VA's primary healthcare system, which provides long-term care for veterans. This includes annual checkups and physicals, among other things. But when the VA becomes backed up with millions of appointments, wait times can become frustrating if not dangerous.
With budget cuts and potential workforce reductions, the future of the Community Care Program is unclear. At the time of this story, the VA Office of Public Affairs has not responded to questions about how budget cuts will impact the program.
VA Primary CareVeterans who receive their healthcare through the VA are assigned a primary care physician (PCP). They can be a Doctor of Medicine (MD), Doctor of Osteopathic Medicine (DO), nurse practitioner, or physician's assistant. They are the first point of contact when veterans are enrolled in the Veterans Health Administration (VHA).
Regardless of their title, the person handling your primary care establishes a long-standing relationship with you to track everything from your blood pressure to weight gain to your behaviors.
It's a form of surveillance on your health, so if things start to change for the worse, like heart failure or dementia, they can address them early on — including early detection of cancer.
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Primary Care oversees the introduction of a veteran to the VHA's "patient-centered medical home model," the Patient Aligned Care Team (PACT). Your team includes family members, caregivers, a primary care provider, a registered nurse care manager, a licensed practical nurse or medical assistant, and a clerk.
This care team is set up to put the veteran at the center and address their needs. Should a specialty care team be needed, like oncology or orthopedics, your PACT will coordinate those appointments for you wherever the specialists are, sometimes requiring a veteran to be treated outside of the VHA.
The MISSION ActThe MISSION Act became law in 2018, bringing the VA's previous Veterans Choice Program to an end and establishing the Community Care Program. The new eligibility created better access for veterans who face lengthy delays in care or are hindered by state-line prohibited telehealth appointments.
The MISSION Act criteria grants a veteran access to community care if:
The VA calculates the drive times via "geomapping software." If you encounter an issue with your route, bring it to your care team immediately. An important note for all the stubborn veterans out there: you must communicate with your VA team to enter the community care program.
Another thing veterans should know is that they may qualify under the "grandfather provision" related to 40-mile distance eligibility under the Veterans Choice Program. The new criteria under the MISSION Act make healthcare access better for veterans.
But, with the Promise to Address Comprehensive Toxics Act, or PACT Act, signed into law, veterans have better healthcare access and treatment than ever before.
The Community Care Program covers primary, urgent, emergency, and specialty care for veterans. Some things covered through community care may surprise you, such as foreign medical care and in vitro fertilization.
A veteran must have enrolled in or be eligible for VA healthcare to receive authorization for community care. The exception is if a veteran needs urgent or emergency care. You'll need to notify the VA of emergency care in the community within 72 hours, though there is built-in leniency on a case-by-case basis.
A veteran must go to an in-network urgent care clinic; otherwise, he or she may be fully liable for the medical bills that result from the visit. Regardless of the level of care, veterans need to meet the basic criteria of being registered or eligible for VA healthcare.
For a veteran to gain access to the community care program, further eligibility criteria must be met:
When the VA cannot provide the services a veteran needs or the wait times are too long, the community care network takes over, and the VA healthcare system stops. The CCN covers five regions.
New England to North Carolina is region one, the Midwest is region two, the Southeast and Puerto Rico are region three, the West, Southwest, Hawaii, and Western U.S. Territories are region four, and Alaska is region five.
Two private companies act as third-party administrators for the VA through processing healthcare claims and signing up community providers for the CCN. Optum Serve covers regions one, two, and three, while TriWest Healthcare Alliance covers regions four and five.
The services provided by the CCN, after your VA healthcare team approves it, can range from routine medical care and surgeries to rehabilitation and nursing homes. Other services that may surprise veterans include hypnotherapy, massage therapy, and "Native American healing practices."
Dental care can be covered through the CCN, but the criteria that qualify veterans for free dental care or a partially covered area are grey areas in the VA's policies.
If you are wondering what you qualify for, it's always best to contact your VA healthcare team to make sure you qualify for community care, what services are in-network, and what services are covered.
If you're thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States. Reach the National Suicide Prevention Lifeline by calling or texting 988, and you'll be connected to trained counselors.
The latest on Task & PurposeVA Urgent Care Coverage Explained
The difference between urgent care and emergency care is a chin-scratcher for many, especially for veterans who rely on the Veterans Affairs (VA) healthcare system.
There are countless stories of veterans footing the bill for a visit to urgent care because of confusing rules and their own missteps in the process. Arming yourself with knowledge of the process is a surefire way to avoid the headaches that can come with being bounced back and forth like a ping-pong ball between an urgent care clinic, the VA, and the billing processor.
It's no secret that veterans can be stubborn. I know this because I have worked as a paramedic for 10 years, both for private hospitals and now as with a fire station, and convincing a veteran to get care is one of the hardest parts of my job. I've had veterans in the midst of a heart attack insist they don't need to go to the Emergency Room. I've also explained to other vets with minor aches and pains that they could face a major bill if the VA determines they did not need a trip to the ER for complaints that an urgent care is well-equipped to handle.
Some have thanked me. Others have told me to shut up and drive the ambulance. Like I said, we're a stubborn group.
This story is not medical, legal advice, or official VA policy. Instead, it's to help explain the convoluted process for rapid, emergency- and urgent-level care that many veterans seek out only to find themselves in an expensive billing headache. If you ever have questions about your eligibility, coverage, or anything else that pertains to your healthcare through the VA, please reach out to your local VA or Veterans Service Officer.
Emergency care vs. Urgent careUnder VA health insurance, billing and coverage differ depending on whether you need emergency or urgent care. Emergency care is for people under threat of dying or losing limbs or senses. Serious trauma from a car crash or an accident that threatens eyesight or amputations falls under emergency care, as do immediately life-threatening health conditions like cardiac arrhythmias or strokes.
Urgent care is for health issues that require immediate treatment, from physical accidents to contagious sicknesses, but that are not life-threatening and unlikely to require specialized treatment like surgery, blood transfusions, or intubation. Ailments like the flu, a sprained ankle from basketball, or a urinary tract infection are all examples the VA gives as reasons to visit an urgent care clinic.
The problem veterans face is that the VA covers visits to an emergency room very differently than visits to an urgent care.
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ER visitsFor emergency room visits, the VA will cover nearly all care that is immediately needed to save a patient's life, regardless of where they get it, but there are still rules you'll need to follow.
First, if you find yourself at a non-VA emergency room, you need to inform the VA within 72 hours. You can still get covered if you miss this deadline, but you'll have to go through a reimbursement process that will likely take longer.
Second, you'll only be covered for an extended ER stay until you're healthy enough to be transferred from the non-VA facility to one in the VA's network. According to the VA's website, the VA will "only cover non-VA emergency care until we can safely transfer you to a VA or other federal facility."
But an urgent care facility can make more sense if you don't need a full emergency room but can't wait to see your primary care doctor. Just make sure you understand the VA's rules.
Veteran eligibility for urgent care treatmentThe list of conditions that qualify for coverage at in-network urgent care clinics can be a grey area, as the VA lists these conditions:
Another pitfall for veterans can be in the types of care available at an urgent care facility, even ones in-network for the VA. Though some care is obviously urgent like those listed above, many urgent care facilities have begun to offer more routine care, like employment physicals or "wellness" visits. But without the correct prior approvals, VA healthcare is likely to rule that you should see your VA primary doctor for routine care and not cover the cost of that urgent care visit.
The easiest way to make sure your treatment is covered, regardless of its severity, is to visit a VA facility. Veterans can go to any VA Urgent Care clinic, which can be a stand alone clinic or under the same roof as their ERs. Veterans with a 50% disability rating or higher have full healthcare coverage through the VA and its local, VA-approved urgent care clinics.
Gulf War veterans have benefits specific to them and with their own criteria. As of March 5, several more veterans can sign up for VA-sponsored healthcare without first applying for VA benefits. Your priority group will determine your coverage, but whether you can receive community care depends on different criteria.
To be eligible to receive treatment at VA hospitals, in-network urgent care clinics, and same-day service clinics, you must be enrolled in VA health care and have received care at a VA or in-network provider in the past two years. If you have any questions about your eligibility, this is straight from the VA's website:
You can check your eligibility by calling the VA at 800-698-2411 (TTY: 711).
Flu shots are free for eligible veterans. Clinics cannot charge veterans copays for the shot. If you mistakenly pay a fee for that service, contact the VA for reimbursement. It's on a case-by-case basis, so be ready for a yes or no response.
Urgent care under VA rules also has a specific set of copays, which depend on a veteran's priority group, which is based on their service-connected disabilities and service record. For 2024, priority groups 1 to 5 do not have a copay for the first three visits to urgent care within a year, and each subsequent visit will be a $30 copay. Group 6 has the same setup for any condition covered by special authority, like toxic exposures and military sexual trauma.
All other priority groups will pay a $30 copay. If the clinic tries to charge you at copay at the visit, be wary. Your copay should go through the VA, not the clinic. All copays due will come via a mailed bill from the VA. The VA says, "Don't pay a copay" if the urgent care tries to charge you at admission.
If the clinic staff insists you have to pay before receiving assessment and treatment, call your VA.
Out-of-network providersWhen you are sick and need help to get back on your feet, the last thing you may be worried about is whether a healthcare provider is in-network or not. But, even though it won't cause an initial headache, that bill that comes in the mail will, especially if you thought you were covered.
Sometimes, providers cancel their agreement with the VA as in-network providers but don't advertise that publicly. Other times, coverage is location-specific. But since you shouldn't go to urgent care with true life-threatening emergencies, take the time to check whether the clinic is in-network here.
When you arrive at covered urgent care, you'll need your government-issued ID and urgent care assistance card, which can be a physical copy or an image on your phone. Most clinics will know whether they can treat veterans under the VA's coverage.
So what happens if a clinic mistakenly bills a veteran and they pay it? Veterans should call the VA when they realize their mistake, and the VA may reimburse them. But if you receive care at an out-of-network clinic, it doesn't matter what reason; you will be responsible for the entire bill if you don't have other insurance to cover you.
If you're thinking about suicide, are worried about a friend or loved one, or would like emotional support, the Lifeline network is available 24/7 across the United States. Reach the National Suicide Prevention Lifeline by calling or texting 988, and you'll be connected to trained counselors.
The latest on Task & PurposeResources For Helping Veterans With Their Invisible Wounds; Mental Health
After a veteran who was reported missing was found in Central Texas, 6 News is shining a spotlight on some resources for those who have served.
TEXAS, USA — A Nevada family is thanking the Central Texas community for its help and support in finding their missing loved one.
6 News reported a 35-year-old veteran was missing in Waco, but he has since been found as of March 28. 6 News was told by a family friend that the 35-year-old was an at-risk veteran who had a history of mental health conditions. He had reportedly been sent to Waco from Reno, NV.
The missing person report created chatter amongst the community on what resources are available to help veterans in crisis or who are struggling with their mental health.
6 News reached out to Heart of Texas Behavioral Health Network, which connected us to Veterans One Stop in Waco. Allyson Afinowicz, one of the qualified mental health professionals and case managers at Veterans One Stop, said she sees many veterans locally with different situations and levels of mental health illness.
"It can be on a lower side where a veteran is managing and coping with, whether it's PTSD, anxiety or depression," Afinowicz explained. "Or it can be very severe where a veteran is not handling life whatsoever in our community."
Afinowicz works to learn veterans' needs and provides resources to help them in whatever battle they might be facing. Afinowicz and the team at Veterans One Stop also has counselors available and are able to provide coping skills to veterans, too.
Afinowicz also said the community's support of veterans and knowledge about how to help them can be helpful through a veteran's transition, and when seconds matter the most.
"If you have someone that you care about that is a veteran, do research to support them, make sure that they know their resources because at any point in time, they might need that," Afinowicz added.
6 News also reached out to Combined Arms, a veteran nonprofit that also serves as the state provider of the Texas Veterans Network (TVN). TVN uniquely brings agencies, nonprofit organizations and other resources to provide holistic support to service members, veterans, military family members, gold-star families and caregivers.
John Smith, the Southeast Texas Regional Manager for TVN, said when it comes to veterans and mental health -- there is tons of support and resources for it, but it's hard for many to overcome the stigma.
"When you join the military, they train you to be 10 foot tall and bulletproof, so there is a pride issue there," Smith explained. "It does take some convincing, but typically that convincing comes from fellow veterans to say 'Maybe you need a professional to talk to' or there's peer support. It really comes down to the friends and family and supporters to be that advocate for that individual as they are transitioning into becoming a civilian again, because that's really the hard part."
Working at the TVN, Smith is able to see what the needs of the veteran community are and how many connections are being made because of mental health matters. Something that has recently stuck out to him is that women veteran suicide is reportedly on the rise.
"The VA has released their veterans suicide annual report and women veteran suicide is on the rise," Smith said. "Women veterans aren't immune to the types of issues that male veterans face when exiting the military."
For veterans who are struggling with mental illness, Smith recommended the Veterans Wellness Alliance, which was created in Texas by the George Bush Institute.
"It's a network of the best in class intensive inpatient and outpatient treatment facilities that focus on PTSD, extreme mental health and brain health issues and it's 100 percent free for the veteran to go to these facilities," Smith said.
Smith told 6 News that 80 percent of veteran issues are basic human need issues and sometimes the best solution or aid for a veteran is having someone often checking in on them, not just on designated holidays.
"Our veterans are veterans 365 days of the year," Smith said. "Memorial Day to remember those ones that passed, Veterans Day celebrations for those ones that are still here, but just remember that some of those battles are still happening every day."
Smith said oftentimes, veterans can relate better to other veterans. That's why the Buddy Check Day is in place. It is on the 11th of each month.
If you are a veteran and you or someone you know are struggling, call 9-8-8 to reach the Veteran Crisis Line.
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