§ 17.1510 Eligible veterans. A veteran must meet the eligibility criteria under both paragraphs (a) and (b) of this section to be eligible for care through the Veterans Choice Program. A veteran must also provide the information required by paragraphs (c) and (d) of this section. ( a ) A veteran must be enrolled in the VA health care system under § 17.36.
( b ) A veteran must also meet at least one of the following criteria: ( 1 ) The veteran attempts, or has attempted, to schedule an appointment with a VA health care provider, but VA is unable to schedule an appointment for the veteran within: ( i ) The wait-time goals of the Veterans Health Administration; or
( ii ) With respect to such care or services that are clinically necessary, the period VA determines necessary for such care or services if such period is shorter than the wait-time goals of the Veterans Health Administration.
( 2 ) The veteran's residence is more than 40 miles from the VA medical facility that is closest to the veteran's residence.
( 3 ) The veteran's residence is both: ( i ) In a state without a VA medical facility that provides hospital care, emergency medical services, and surgical care having a surgical complexity of standard (VA maintains a Web site with a list of the facilities that have been designated with at least a surgical complexity of standard. That Web site can be accessed here: *www.va.gov/health/surgery*); and
( ii ) More than 20 miles from a medical facility described in paragraph (b)(3)(i) of this section.
( 4 ) The veteran's residence is in a location, other than one in Guam, American Samoa, or the Republic of the Philippines, which is 40 miles or less from a VA medical facility and the veteran: ( i ) Must travel by air, boat, or ferry to reach such a VA medical facility; or
( ii ) Faces an unusual or excessive burden in traveling to such a VA medical facility based on geographical challenges, such as the presence of a body of water (including moving water and still water) or a geologic formation that cannot be crossed by road; environmental factors, such as roads that are not accessible to the general public, traffic, or hazardous weather; a medical condition that affects the ability to travel; or other factors, as determined by VA, including but not limited to: ( A ) The nature or simplicity of the hospital care or medical services the veteran requires;
( B ) The frequency that such hospital care or medical services need to be furnished to the veteran; and
( C ) The need for an attendant, which is defined as a person who provides required aid and/or physical assistance to the veteran, for a veteran to travel to a VA medical facility for hospital care or medical services.
( c ) If the veteran changes his or her residence, the veteran must update VA about the change within 60 days.
( d ) A veteran must provide to VA information on any health-care plan under which the veteran is covered prior to obtaining authorization for care under the Veterans Choice Program. If the veteran changes health-care plans, the veteran must update VA about the change within 60 days.
( e ) For purposes of calculating the distance between a veteran's residence and the nearest VA medical facility under this section, VA will use the driving distance between the nearest VA medical facility and a veteran's residence. VA will calculate a veteran's driving distance using geographic information system software.
(Authority: Sec. 101, Pub. L. 113-146, 128 Stat. 1754; Section 3(a)(2) of Pub. L. 114-19, 129 Stat. 215)
(The information collection requirements have been submitted to the Office of Management and Budget and are pending OMB approval.)
[79 FR 65585, Nov. 5, 2014, as amended at 80 FR 22909, Apr. 24, 2015; 80 FR 74996, Dec. 1, 2015]