Critical Access for Veterans Care Act

This bill makes it easier for veterans who live near small rural hospitals to get care in their own communities. If a veteran lives within 35 miles of a critical access hospital or its affiliated rural health clinic, they can get care there through the Veterans Community Care Program. If that hospital or clinic refers them to another nearby provider, that care is covered too . For this care, the VA cannot require prior authorization or a referral before the veteran is seen .

It also sets clear, faster payment rules for community providers. These rural hospitals and clinics will be paid using Medicare’s cost-based rates, and claims must be reviewed and paid within 60 days of submission. The VA may issue guidance to help with the claims process. Claims should include a special identifier showing they are under this new option . The VA must report to Congress within one year on how well this is working, including whether claims are approved and paid on time and how the user experience is going for veterans and community providers .

• Who is affected: Veterans living within 35 miles of a critical access hospital or its affiliated rural health clinic; local community providers who treat them .
• What changes: No prior authorization needed for this local care; Medicare-style, cost-based payments; faster claim reviews and payments; VA guidance for claims; required progress report .
• When: Applies once enacted; claims must be paid within 60 days; VA report due within one year .