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Veterans' Affairs Committee senators are wrestling with legislation to reform the Veterans Choice program with the hope of unveiling an agreement in the coming days to fix the troubled health benefit.

Senate Democrats led by Jon Tester of Montana introduced a bill, S 2633, on March 3 to consolidate a number of VA community care health programs under a single Veterans Choice umbrella and change the contracting process that uses third-party administrators to manage the program's scheduling and billing processes.

North Carolina Sen. Richard Burr and fellow Republicans have sponsored the Veterans Choice Improvement Act, S 2646, which also would consolidate veterans community care programs and reform the payment processes but includes other provisions, such as stringent requirements on reimbursement rates and a mandate that VA provide compensation to veterans within 90 days of determining that the former service member has a presumptive health condition.

Burr said Tuesday his legislation would make it easier for veterans to understand their health care options and receive treatment.

Citing a North Carolina veteran who waited more than a year to see a spine specialist and was told after the first appointment that he couldn't make a second appointment because the physician had stopped accepting Choice for nonpayment, Burr said VA, Congress and the White House must "fix this."

"We must get it right for our veterans. … In North Carolina, we have seen hospitals stop taking veterans under the Choice program because VA has consistently failed to pay veterans,” Burr said.

The $10 billion Veterans Choice program was created by Congress in 2014 in response to a scandal over long wait times for appointments at VA health facilities. It allows veterans to see private health care providers if they cannot get an appointment at a VA hospital or clinic within 30 days or live more than 40 miles from a VA facility.

But nearly from its inception, veterans across the country reported problems with Veterans Choice, to include not having access to it even though they qualified for the program, challenges finding providers who understood the program, difficulties making appointments for follow-up care or being dropped by doctors, and most recently, credit problems tied to the delays in payments to providers.

VA in November asked Congress for legislative changes that would let it consolidate at least eight of VA's community care programs into a single Veterans Choice program.

Lawmakers have since been working with VA to draft legislation and with the White House to fast-track the final bill through the legislative process.

Senate Veterans' Affairs Chairman Johnny Isakson said Tuesday he hopes an omnibus bill, which will include Choice reform, will be signed by Memorial Day.

"Our goal is to have an omnibus bill …  to let our veterans know we do want accountability at the VA, we do want Choice to work, we do want caregivers providing care to those injured before 9/11, 2001, to have the same benefits as those afterward, and we are close to getting there," Isakson said.

VA Secretary Bob McDonald said Tuesday that fixing Veterans Choice is a main priority for the department this year.

"We're as committed to giving veterans a high-performing organization as we are convinced we can get there, with your help," McDonald said. "But as I’ve testified, important priorities for transformational change require congressional action."

The bills aim to fix payment issues by allowing VA to contract with community providers on an individual basis rather than go through a third-party contract manager. Currently, VA contracts with TriWest and Health Net Federal Services to manage the program.

The legislation also would give VA greater flexibility in managing its community care dollars and make VA the primary payer for bills, ensuring "faster and more accurate payments" to providers, according to McDonald.

Some veterans organizations said they support the legislative proposals but a spokesman for the Independent Budget — a group of veterans organizations that craft policy and spending recommendations on veterans issues — raised concerns that expansion of Veterans Choice could hurt funding of VA medical centers and clinics.

"Just outsourcing the care into the community, while it might seemingly improve access, runs the risk of undermining the larger health care system which many veterans, particularly those with catastrophic disabilities, rely upon,” said Carl Blake, associate executive director of government relations for Paralyzed Veterans of America.

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