The Department of Veterans Affairs, under pressure to expand veterans’ access to private doctors outside its understaffed medical system, announced new rules Tuesday to expand the number of patients who are eligible under the Veterans Choice Program.

The agency said its staff has now been given broader flexibility to determine if a veteran can be referred to a private clinic or doctor’s office. For example, if a patient faces an “undue burden” getting to treatment at a VA medical center, he or she can be referred outside the system. These burdens include geographic barriers, environmental factors, severe medical conditions or a need for frequent care, such as chemotherapy or tests that can be done quickly closer to home, officials said.

The changes, which are effective immediately, also include a tweak to the requirement that a veteran must live more than 40 miles from a VA medical center to be eligible for private care. If VA has no primary-care doctor on staff, a referral for private care is required. That change alone should open the program to about 160,000 more veterans, officials said. The new rules also allow referrals to private doctors for any veteran who must travel by air, boat or ferry to a VA facility.

Before the “Choice” card rolled out last year, veterans could only receive outside care for emergencies — wherever the closest hospital is, for instance — or for procedures VA didn’t offer. The program was supposed to bring thousands of veterans into the private-care system, giving those waiting more than 30 days for appointments or who live more than 40 miles from a VA center the chance to see a private doctor.

But the system, funded with $10 billion from Congress to help former troops struggling to obtain care at overwhelmed VA clinics, has been slow to enroll patients, beset by resistance from employees to make referrals and restrictive rules, officials have acknowledged. The rules have hampered veterans in states with no full-service VA medical centers from getting to private doctors, for example. Members of Congress have pressed for more relaxed rules.

“As we implement the Veterans Choice Program, we are learning from our stakeholders what works and what needs to be refined,” VA Secretary Bob McDonald said in a statement. “It is our goal to do all that we can to remove barriers that separate veterans from the care they deserve.”

This the second change to eligibility VA has made to the program. In April, the agency redefined the 40-mile distance standard it had established as a requirement for care from a straight-line, “as the crow flies” measure to the actual distance a veteran had to drive from home to a VA medical facility.

The original rule, by sticking to a strict 40-mile measure, was quickly criticized by lawmakers and veterans service organizations, who said many veterans in rural areas may technically live closer than 40 miles to a VA medical center but must drive circuitous routes to get there.

The idea, again, was to expand patients’ access to doctors. But the change still fell short of  addressing the needs of veterans who live within 40 miles of a VA medical center but need care that goes beyond the scope of the basic service that facility offers.

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