The VA Maintaining Internal Systems and Strengthening Integrated Outside Networks Act of 2018 (S.2372), also known as the VA MISSION Act, was signed into law by President Trump on June 6 after passing the Senate on May 23 with a vote of 92-5 – a week after the House passed the bill in a 347-70 vote.

Among a whole host of objectives, the bill aims to streamline VA Community Care Programs, improve healthcare delivery and payment, and expand eligibility and support for family caregivers.

The Congressional Budget Office (CBO) estimates the VA MISSION Act will cost $46.5 billion over five years; allocate an additional $5.2 billion for the Veterans Choice Fund and increase direct spending by $4.5 billion.

The VA MISSION Act will fund the Veterans Choice Program, passed in the wake of the VA waitlist scandal in 2014, for one more year. In its place, the bill establishes the Veterans Community Care Program (VCCP) to guarantee veterans care from outside health care providers in the event that VA facilities cannot meet their needs.

Timeliness is a central goal of this program which consolidates seven community care programs into one, eliminates the 30-day/40-mile rule and other red tape, and sets a standard for prompt payment of community care providers. In addition, a VA strategy for monitoring the VCCP’s efficiency and effectiveness is required to be submitted to Congress.

With the creation of the VCCP, the CBO estimates that an additional 640,000 veterans will seek outside care each year at an average cost of $8,600 per patient.

The VA Mission Act also aims to make general improvements in the quality of VA healthcare by lifting several restrictions regarding healthcare practices, including:

  • Regulatory barriers impeding the practice of telemedicine by VA healthcare professionals.
  • Refusal to fund transplant operations on non-veteran live donors.
  • Allowing veterans to be treated in the community by healthcare providers who were previously removed from VA practices have all been ended.

The bill also establishes the VA Center for Innovation for Care and Payment to administer pilot programs to test improved and efficient methods of payment and service delivery. The VA may not carry out more than 10 such pilot programs simultaneously, and each can last no longer than five years.

Among the innovations within the MISSION Act is the VA’s Program of Comprehensive Assistance for Family Caregivers, which supports the caregivers of veterans with serious injuries incurred in the line of duty. This will vastly expand eligibility, taking on approximately 60,000 additional veterans at a cost of $6.7 billion, according to CBO estimates. Whereas only veterans injured in the line of duty on or after September 11, 2001, are currently eligible for the program, the VA MISSION Act will allow all veterans, no matter the date of their injury, to become eligible.

While the bill passed through the House and Senate without much resistance, it’s not without its critics. Rep. Tim Walz (D-MN), Ranking Member of the House Veterans’ Affairs Committee, voted against it, claiming that the program’s funding will be shifted to discretionary funds, forcing the VA to “cannibalize itself” if Congress doesn’t approve higher spending caps.

Senate Veterans’ Affairs Committee member Jon Tester (D-MT), on the other hand, gives little weight to Walz’s concerns, asserting that funding the overhaul will be easier than writing the bill. Other senators, such as Sen. Bernie Sanders (I-VT), have denounced what they perceive as increased privatization.