Last month, I wrote about the VA Mission Act of 2018, and I will add to it with this month’s column.

The formal name of the legislation passed in 2018 is the VA Maintaining Systems and Strengthening Integrated Outside Networks Act. It has many provisions that change the way the VA administers care through medical providers in the community. Many of the changes are due to start very soon.

It is important to note that this is not the launch of an insurance program such as Medicare, Medicaid or anything covered in the Affordable Care Act of 2010. Veterans utilizing the Mission Act will be given authorization by the VA to see a community care provider. The authorization may include only one visit or may be open ended depending on circumstances.

Some veterans think that the changes will allow them to select a medical provider, identify themselves as a veteran, complete an examination and receive treatment, instruct the provider send the bill to the VA, and the VA will pay the bill. This is not going to happen this easy. 

A veteran will have to be eligible for Mission Act coverage according to one of six criteria developed by the VA. Once eligible and in need of care, the VA will send an authorization letter to a provider who agrees to accept the veteran as a patient. Upon completion of the medical visit, the provider must send documentation of the results of the visit to the VA for review. 

The VA may or may not agree with determinations made by the outside provider and may recommend alternatives to the veteran.

The VA does not want to simply become a bill payer. The VA wants to stay in the decision making process with the veteran to ensure that the veteran receives the best care possible. 

This essentially means that veterans will come under somewhat of a duplicated system. One is the care received by the outside provider and the other is the review of that care by the VA. 

Does this streamline the system or does it make it more of an obstacle course? We shall see.

Issues arise as to who has paramount responsibility for the veteran. Since the VA will authorize the outside provider and pay for the care it has a major interest in what is done.

The VA may also have differing protocols on how to proceed with care. 

For example, if a veteran’s blood test reveals a prostate-specific antigen of 5.2, the VA may advise the veteran to consider a biopsy of the prostate. The outside provider may suggest taking another test in 90 days to see if there is any change. Both protocols may be acceptable, but the VA wants the veteran to know the VA’s position. This can only be accomplished when the outside provider sends the examination results to the VA for their review. 

One of the major hindrances to the Mission Act may be the willingness of community providers to sign up with the program. The VA pays an established rate for services and is known to be slow in making payments to providers. 

The Mission Act has provisions to speed up the payments to providers and to encourage them to accept veterans for care. 

Even though provisions are due to roll out very soon it will probably take time for things to get past the break-in point and allow for a review of the success of the changes.

Veterans may well need to have patience as the new provisions are put into place.

Gary Noller is commander of the Cpl. Jacob C. Leicht AMVETS Post 1000 in Kerrville. He can be reached at


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