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).
Urgent Care (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/2gkfgd31
• Fact Sheet - Emergency Medical Care<https://www.va.gov/COMMUN
• Fact Sheet - Emergency Transportation (Ambulance)<https://www.va.gov
• Website - Emergency Care<https://www.va.gov/COMMUN
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
The U.S. Department of Veterans Affairs (VA) announced through a Federal Register notice
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.
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.
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.