By Mary Alice Murphy
New Mexico Department of Veterans Services Healthcare Coordinator Program Manager Mitchell Lawrence said he was there to give an overview of the Veterans Choice program, an option of care for veterans who meet certain requirements.
The event took place at the Santa Clara Armory on Friday, Aug. 5, 2016. The room filled with more than 50 people.
"We're here to talk about Veterans Choice," Bradley Brock, NMDVS service officer overseeing the four counties of southwest New Mexico, introduced Lawrence. "If Lawrence doesn't know the answer he'll find it out."
"I work closely with the Veterans Health Care System director in Albuquerque," Lawrence said. "I will give you honest answers. The actual law is being implemented. President Obama in 2014 signed the Veterans Choice Act, which also allocated $10 billion for veterans' care outside of the Veterans Administration facilities. It was passed because of VA access issues. The Choice Program is a complement to the VA and does not replace it."
He explained the act sought to give local access to VA civilian counterparts in medical care. "The $10 billion will last as long as it does or until August 2017, when it expires. I personally think Congress should extend it beyond that date. Contact your congressional representative if you want the program to continue."
Lawrence noted the VA does not implement or control the providers in the Choice Program. The providers must be approved by Tri-West. The requirements for a veteran to be eligible to utilize the program are two-fold:
1) The veteran lives more than 40 miles from any VA medical facility. This includes the Silver City VA clinic; and
2) If a veteran makes an appointment with the VA facility and cannot be seen within 30 days for a medically indicated situation, then the veteran is eligible for the Choice Program.
"The only choice you have is to wait or not wait," Lawrence said. "You can wait for the, say, 45 days, until your appointment or if you do not want to wait, you can call Tri-West for a hopefully local provider. You always have to get authorization from Tri-West and the provider must have a contract with the VA. The Choice program pays Medicare rates."
He said that if the veteran wants to see a specific provider, Tri-West would look on its list to make sure the provider has a signed contract. If not, the veteran will likely have to keep the VA appointment.
"The providers have to be credentialed to the same level as VA providers," Lawrence said. "If you like a particular provider ask them to join the Choice Program."
A caveat is that if the local provider has more patients than he or she can take, the provider may not be able to take the veteran as a patient.
To a question about how many doctors and hospitals in the area have signed up, Lawrence said the VA.gov website has a list of providers in any particular area.
Amanda Holguin of Gila Regional Medical Center said she wished to hear feedback from the veterans, because the hospital is working to get credentialed to provide the Choice Program to veterans.
A veteran's wife said many of those in the room need something to read, because "we don't do computers."
Lawrence said if the veteran had a choice of provider to get it to Angelina Trujillo, who works with Brock, and she can get it to Lawrence, who will try to sign up the provider. "The community will have to be the way it grows. The doctor has to be credentialed and willing to take Medicare rates."
A woman in the audience said she had heard that Tri-West was not paying its bills, which "may be why providers are not wanting to take Choice."
Lawrence concurred that it has been a problem, enough so that some veterans have had collection agencies come looking for the payments. "We have a group working on correcting that. The VA gets the bill from the provider. It has to figure out if the individual is really a veteran. We need the vets to be registering with the VA. If when you left the Department of Defense when your service ended and you did not enroll in the VA, you are not in the system."
"Enroll as soon as you get out of the military, not just when you have the need," Lawrence encouraged all the veterans in the room. "And if you're not in it now, you need to register."
Another veteran said many of the veterans are scared to use Choice because of the threat of collection agents "coming after us, because Choice is so late paying. We don't need that stress."
Lawrence agreed and said the VA has to get better with its payment system.
He also explained that if the VA sends a veteran to a provider and the provider decides on a treatment plan that the VA does not approve of, it will not pay.
"Plus, if the physician does something the VA did not authorize, for instance, the VA authorized the visit for elbow pain, but when you are at the doctor's, you say you have shoulder pain and he examines it, the VA will not pay for the shoulder treatment," Lawrence said. "I tell the VA the referral should be sent to the veteran, so he can say, for instance, this visit is only for my elbow."
A man asked why the VA is signing up more veterans if it can't handle what it has now.
"It puts pressure on Congress to allocate more funds," Lawrence replied. We, at the Department of Veterans Services, will continue to find every veteran we can find to get them enrolled in the VA."
To a question about the $10 billion, Lawrence said it is set aside for care that the VA could not provide. "VA health care used to be only if the need was service connected, but now it is also income level that qualifies."
Lawrence explained that elected officials run the Choice Program. "It is not run by medical providers or veteran-related services. The $10 billion is not in the VA system, it's in Congress. They will either renew the program or absorb any money left over when it ends. At this point, about $5 billion to $6 billion is left. I'm hoping they will change it beyond August 2017."
He also told the veterans that Choice does not pay dental or pharmaceutical claims.
To a question about whether a veteran can go to El Paso to Fort Bliss for VA care or to the Tucson VA hospital, Lawrence said the veteran can ask the local Silver City VA Clinic to put their primary care physician in one of the facilities, because they are closer to Silver City than the VA hospital in Albuquerque.
Questions and discussions continued.
For more information on the New Mexico Department of Veterans Services health care, visit http://nmdvs.org/healthcare/ or for the Veterans Choice Program, visit http://www.va.gov/opa/choiceact/ or for any other questions about other aspects of VA health, visit http://www.va.gov/health or call 1-866-606-8198.