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Urgent Care – Where and When You Need It

 

You’ve probably seen news about the MISSION Act, which expands same-day services in primary care and mental health, as well as expanded telehealth to Veterans in their homes. Under the MISSION Act, urgent care is now a supplemental benefit for eligible Veterans. Urgent care in VA or the community (i.e., non-VA) is for those minor injuries and illnesses that do not require emergency room care. This support for urgent care does not replace the important relationship that you have with your VA health care team.

If you need to use the new urgent care benefit, it is important that you go to an urgent care location in your community that is within the newly established VA contracted network. It is also important to know the following details about the prescription component of the benefit: 

  • If the urgent care provider gives you a prescription, you can fill a 14-day supply of that medication at the VA or in a pharmacy within the VA contracted network.
  • If you choose to fill an urgent care prescription at a pharmacy outside of the VA network, you will be required to pay for the prescription at the time of pick up and then file a claim for reimbursement at your local VA medical facility.

This special publication about urgent care and the MISSION Act provides all the details for you.

If you arrive at an urgent care network location and have any difficulty receiving care, you can call 866-620-2071 to receive assistance.

You can also call your local VA facility 24/7 for advice, or logon to My HealtheVet and send a Secure Message (login required) to your health care team. Any Secure Message should get a response within 3 business days (usually fewer).

Read More

Urgent Care  (VA)

VA Launches New Health Care Options under MISSION Act (VA)

Veteran Community Care: Eligibility (YouTube)

MISSION Act (VA)


 

Emergency Medical Care for Veterans  

The VHA Office of Community Care (OCC) is pleased to provide updated communications products that explain when a Veteran should seek emergency medical care, and how VA can pay for a Veteran's service-connected and non-service connected emergency care from a community provider.

The following resources are now available on this topic:

• Video - Emergency Medical Care<https://youtu.be/2gkfgd31Ifk>
• Fact Sheet - Emergency Medical Care<https://www.va.gov/COMMUNITYCARE/docs/pubfiles/factsheets/FactSheet_20-02.pdf>
• Fact Sheet - Emergency Transportation (Ambulance)<https://www.va.gov/COMMUNITYCARE/docs/pubfiles/factsheets/FactSheet_20-05.pdf>
• Website - Emergency Care<https://www.va.gov/COMMUNITYCARE/programs/veterans/Emergency_Care.asp>

Please help us raise awareness and understanding of when Veterans should seek emergency medical care, including the associated eligibility requirements and payment aspects. This will support greater consistency and better outcomes for Veterans.

Thank you for your help!


From VVA Chapter 1043

Subject: VA Expands Eligibility for Emergency Treatment_Fact Sheet_JAN18-508c.pdf

Remember VA Information MAY Change. Be sure you see your Service Officer if you have any questions about death and burial planning.

VA FAct Sheet January 2018

VA Expands Eligibility for Emergency Treatment

Overview

The U.S. Department of Veterans Affairs (VA) announced through a Federal Register notice

that it

was revising regulation Title 38 CFR §17.1005 concerning payment or reimbursement for emergency

treatment for non-service connected conditions at non-VA facilities. VA will begin processing claims

for reimbursement for reasonable costs that were only partially paid by the Veteran’s other health

insurance (OHI). Those costs may include hospital charges, professional fees and emergency

transportation such as ambulances.

New Regulation

Beginning January 9, 2018, VA will begin to process claims and make payments in accordance with

the Federal regulation (Title 38 CFR §17.1005

) for emergency treatment claims, or travel, pending

with VA on or after April 8, 2016.

Claims and Payments

VA payment will be the lesser of the amount for which the Veteran is personally liable or 70 percent of

the applicable Medicare fee schedule amount, excluding copayment, cost share or deductible

associated with their OHI. VA is prohibited from reimbursing Veteran OHI member liabilities such as

copayments, cost shares and deductibles.

Effective immediately, VA will reject claims pending with VA on or after April 8, 2016, and will contact

community providers to obtain any additional information needed to review and process the claim.

There will be no need to resubmit claims unless a specific request is received from VA.

Claims for emergency treatment, or travel, related to a non-service connected condition provided on

or after January 9, 2018, must be submitted within 90 days of the latest: date of discharge; the date of

death (if death occurred during treatment or transportation); or the date that all efforts to obtain

payment or reimbursement from a third party have been exhausted. The results do not fully eliminate

the Veteran’s liability for the emergency treatment or transportation.

Customer Service

Providers may call a dedicated hotline at 1-877-466-7124 to speak to customer service

representatives specifically about this issue, Monday through Friday, between the hours of 8:00 a.m.

to 5:00 p.m. Eastern Standard Time (EST). Providers can find more information on how the amended

regulation affects them at https://www.va.gov/communitycare/providers/info_payments.asp.


 

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