Veteran Access to Substance Use Disorder Treatment:

Community Care Network Providers

Legacy Village, LLC is a Veteran-only, residential treatment program for substance use disorder and dual diagnosis conditions, such as post-traumatic stress disorder, anxiety, depression, and other mental health concerns.  We are a Community Care Network provider contracted with TriWest Healthcare Alliance.  Our company is licensed for addiction treatment by the California Department of Healthcare Services with an ASAM designation of 3.1 and 3.5, and we are accredited by the Joint Commission with the Gold Seal of Approval in Behavioral Healthcare.  Legacy Village accepts admission of Veterans from Region 4 of the Community Care Network. 

Legacy Village respectfully submits the following information for your consideration while debating the Veterans Health Improvement Act 2023 (HR 3520) in the United States House of Representatives and the Veterans’ Health Empowerment, Access, Leadership, and Transparency for our Heros (HEALTH) Act in the United States Senate.  The behavioral and mental health professionals on our team, and dozens of Veterans impacted by the problems outlined below, are available for questions and input on how to improve the current issues related to access to substance use disorder treatment.   Thank you in advance for your review of the following information. 

INTRODUCTION

Over the past decade, the ability for Veterans to seek healthcare outside the U.S. Department of Veterans Affairs (VA) network has been shaped by legislative and regulatory actions. The Veterans Choice Program (VCP) initially enabled Veterans to access care through community providers under specific conditions such as extended wait times or unavailability of VA options. Administered by third-party payers like Optum and TriWest Healthcare Alliances, the system was operated under the Patient-Centered Care Program (PCP).

On June 6, 2018, the Veterans Choice Program was succeeded by the Maintaining Internal Systems and Strengthening Integrated Outside Networks (MISSION) Act. The Community Care Network (CCN), established concurrently, replaced the PCP, under the continued management of OptumServe and TriWest Healthcare Alliance.

Since the MISSION Act’s implementation, Veterans gained access to CCN providers for diverse healthcare needs, including substance use disorder (SUD) treatment. CCN healthcare is initiated through VA healthcare professionals, leading to referrals submitted and authorized for CCN providers. Although challenges exist, the interaction between CCN providers and VA providers, has been largely positive until 2023.

Presently, Veterans facing the need for SUD treatment encounter formidable obstacles hindering their access to care. Active addiction impairs decision-making, these challenges compounded by complexities in accessing the VA system. Co-occurring disorders exacerbate these challenges, often affecting engagement in time-consuming procedures. Homelessness and lack of resources further restrict Veterans’ ability to comply with VA protocols.

In 2023, the Greater Los Angeles VA (GLA) and the VA at large, clarified that the MISSION Act does not cover residential SUD treatment. This interpretation appears contrary to the intention of the lawmakers involved in passing the MISSION Act. By excluding this specialty from the MISSION Act, Veterans’ choice in obtaining essential care was effectively curtailed. The VA’s internal policies restrict CCN provider use to instances when VA wait times exceed 30 days, starting only after previous appointments with the VA are completed.  It also reserves the decision to use a CCN provider for the VA, not the Veteran.

Of note, SUD treatment through VA protocols lacks any immediate access to care within the VA system. A multi-step process involves multiple appointments and wait times. Even Veterans admitted to the Emergency Room for SUD-related issues face similar delays.  Justice-involved Veterans and those self-referred to a CCN provider encounter complications in obtaining timely authorizations, and likely face denials for not following ambiguous protocol. The Greater Los Angeles VA and the VA as a whole, have hindered access to CCN providers, limiting Veterans’ options.

Referrals for CCN providers are denied, ignoring professional judgments and local VA providers’ opinions.

  PROPOSED SOLUTION

• Complying with the MISSION Act or pass legislation to clarify the MISSION Act (HR 3520 Veterans Healthcare Improvement Act 2023, Veterans’ Health Empowerment, Access, Leadership, and Transparency for our Heros (HEALTH) Act).
• Place an emphasis on Veterans’ PCP or VA mental health professional at the local level to make final decisions on placement, such weight removes the Greater Los Angeles VA Healthcare system (or similar large scale VA facilities) from making healthcare decisions for Veterans whom they have not personally treated.
• Prioritize SUD treatment as an urgent healthcare need, allowing self-admission to a facility of their choice and allowing those CCN providers to use professional judgment and submit initial Request for Services.  The allowance for CCN providers to directly submit an initial RFS would significantly reduce Veteran wait time for care.  Additionally, provisions to ensure timely response to an RFS would be necessary.

CONCLUSION

Any efforts must prioritize Veterans’ healthcare choices, considering relevant factors for optimal outcomes. Persistent authorization problems and excessive wait times endanger Veterans’ lives. Swift legislative action is imperative to address these issues and prevent further harm to Veterans in need of timely SUD treatment. Delays and denials in accessing care have dire consequences.  The specific risk to the Veteran of overdoses, legal jeopardy, health consequences, suicide and death increase exponentially while awaiting care.