Rural Vets Get Direct Access to Critical Care: New Bill Drops Pre-Approval for Hospitals Within 35 Miles

The Critical Access for Veterans Care Act is a straightforward piece of legislation designed to cut through red tape for veterans living in rural areas. Essentially, it expands the Veterans Community Care Program by creating a new, faster lane for care. Specifically, any veteran who lives within 35 miles of a Critical Access Hospital (CAH) or its affiliated rural health clinic can now get care there under the Community Care Program without needing to jump through the usual hoops.

The 35-Mile Rule: Care Without the Wait

This bill’s biggest move is eliminating the requirement for pre-authorization or a referral for care sought at these specific rural facilities. Think of it this way: usually, getting specialty care or even primary care outside the VA system requires a referral and approval process that can take weeks, adding painful delays for people who need medical attention now. Under this new rule, if you’re a veteran living 30 miles from your nearest CAH—a facility often serving as the only hospital in a wide geographic area—you can walk in and get covered care without that bureaucratic wait. This is a massive win for convenience and speed, especially for vets dealing with chronic issues or needing quick follow-up.

Stabilizing Rural Hospitals with Better Payments

It’s not just about the vets; it’s also about the hospitals serving them. Critical Access Hospitals are small, rural facilities that often operate on tight margins. This bill addresses that financial instability by changing how the VA pays them. Instead of getting paid based on the VA’s standard service rate, the CAHs will now be paid using the established Medicare rate for CAHs (Title XVIII of the Social Security Act). Affiliated rural clinics will also get paid using their specific Medicare rate. This is a crucial detail because it provides these small hospitals with a predictable, established payment structure that is often more favorable and reliable, helping keep these essential facilities solvent and open for everyone in the community.

The Clock is Ticking for the VA

To ensure this new system actually works, the bill includes some serious operational deadlines. First, any claim submitted by these CAHs under the new provision must include a special identifier, and the VA must issue payment within 60 days of submission. If you’ve ever dealt with insurance claims, you know that 60 days is a hard deadline that forces efficiency. Furthermore, the VA Secretary must work with the Centers for Medicare & Medicaid Services (CMS) to issue guidance on this claims process, using best practices from Medicare contractors. This collaboration is key to making sure the payments flow smoothly from day one.

Congressional Check-In

Accountability is baked into the legislation. No later than one year after enactment, the VA Secretary is required to send a report to Congress detailing how the whole system is rolling out. This report must specifically look at how fast claims are being processed and paid, and what the overall experience has been for veterans using these expanded services. This mandated check-in ensures that the VA can’t just pass the bill and forget about it; they have to actively monitor and report on whether this new access is actually helping the intended beneficiaries.