Critical Access for Veterans Care Act

Bill Summary: Critical Access for Veterans Care Act (S. 1868)

Overview

The Critical Access for Veterans Care Act is designed to expand healthcare access for veterans living in rural areas by integrating "Critical Access Hospitals" (CAHs) and their affiliated rural health clinics into the Veterans Community Care Program. The bill aims to remove administrative barriers and financial disincentives that currently prevent rural hospitals from providing care to veterans.

Main Purpose and Intent

The primary intent of this legislation is to ensure that veterans in remote or underserved areas can receive necessary medical services closer to home. By aligning Department of Veterans Affairs (VA) reimbursement rates with Medicare’s cost-based reimbursement model for critical access hospitals, the bill encourages these facilities to participate in the VA network.

Key Provisions

1. Expanded Eligibility for Care

The bill establishes a new criteria for veterans to receive care under the Community Care Program:
* Distance Threshold: Veterans residing within 35 miles of a Critical Access Hospital or an affiliated provider-based rural health clinic are eligible to seek care at these facilities.
* Referral Coverage: This eligibility extends to other healthcare providers in the surrounding community if the veteran was referred to them by the CAH or rural clinic.

2. Removal of Prior Authorization

To streamline access and reduce delays in care, the Act mandates that the Secretary of Veterans Affairs cannot require prior authorization or a referral for veterans seeking services at these specific rural facilities.

3. Revised Reimbursement Rates

The bill changes how these facilities are paid to ensure financial viability:
* Cost-Based Reimbursement: Instead of standard service-based rates, CAHs will be reimbursed at the Medicare critical access hospital rate.
* Rural Health Clinic Rates: Affiliated clinics will be reimbursed according to the rates specified under section 1833 of the Social Security Act.
* Payment Timeline: The VA must review and issue payment for these claims within 60 days of submission.

4. Oversight and Reporting

The Secretary of Veterans Affairs is required to submit a report to Congress within one year of the Act's enactment. This report must evaluate:
* The implementation of these changes.
* The efficiency of third-party administrators in processing claims.
* The overall user experience for veterans accessing these services.

Who is Affected?

• Veterans: Specifically those living in rural areas who currently face long travel distances to reach VA-approved providers.
• Critical Access Hospitals & Rural Health Clinics: These facilities will see a change in how they are reimbursed, potentially making it more financially sustainable to treat VA patients.
• The Department of Veterans Affairs (VA): The agency will need to update its claims processing and oversight mechanisms to accommodate the cost-based reimbursement model.

Procedural Status

The bill was introduced in May 2025 and has progressed through the Committee on Veterans' Affairs, which ordered it to be reported favorably with an amendment in the nature of a substitute as of March 18, 2026.