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VA to Lower Copayments for Outpatient Care

WASHINGTON, PRNewswire/ -- Veterans who currently make copayments for outpatient health care provided by the Department of Veterans Affairs (VA) will have lower bills, and in some cases, no bills at all, under rules published today in the Federal Register.

Secretary of Veterans Affairs Anthony J. Principi is lowering the $50.80 copayment some veterans now pay for outpatient care. This decrease is part of an evaluation of copayments -- outpatient, medication and long-term care -- by VA.

The new regulation sets up a three-tier copayment system for outpatient care. The first tier will be for preventive care visits and will cost veterans nothing. This care includes flu shots, laboratory tests, certain radiology services, hepatitis C screenings and numerous other preventive services. Primary care outpatient visits comprise the second tier and will require a copayment of $15. The last tier includes specialty outpatient care, like outpatient surgery, audiology and optometry and will cost $50.

The copayments do not apply for the treatment of medical problems that are officially recognized as "service connected." For nonservice-connected conditions, the outpatient copayments apply primarily to veterans enrolled in Priority Group 7.

"This is great news for veterans," said Principi. "It eliminates barriers for veterans to get the preventive care they need and will lower the cost of health care for many. Although VA recently announced increases in medication copayments, the decrease in outpatient copayments often will offset the pharmacy increases."

Another VA regulation will increase the copayment some veterans make for outpatient medications from $2 to $7 for each 30-day supply, with maximum annual out-of-pocket payment of $840 for veterans in certain enrollment priorities.

The $7 medication copayment would be lower than -- or equal to -- most medication copayments charged by the private health care industry. On the other hand, the existing outpatient visit copayment was too high compared to private health care, Principi said. Consequently, VA is readjusting both to provide fair and equitable costs for veterans who must make copayments.

Every dollar collected from outpatient and medication copayments is returned to the VA facility where the veteran received medical care. The copayment collections are used to improve medical care for veterans.

During fiscal year 2001, VA collected $95 million in outpatient copayments. Under the three-tier system, it is estimated that VA will collect $30 million. This decrease will be made up by the increase in medication copayments.

"Many veterans still come out ahead," said Principi. "Today, for example, a veteran who sees his primary care doctor for an illness and receives two prescriptions pays $54. Under the new regulations, he will pay $29 -- $15 for the visit and $14 for the medications."

VA is proposing no changes to the hospital care copayments. Currently, some veterans pay $792 for each 90 days of hospital care. In addition to this, there is a $10 per diem charge. For each subsequent 90 days of care in the same fiscal year, the charge is $396, or half the cost of the first 90 days.

Congress gave the VA Secretary the authority to change outpatient and medication copayments in Public Law 106-117 (November 1999). The new regulations changing outpatient care copayments became effective today, Dec. 6. The medication copayment regulation will be effective Feb. 4, 2002.

"VA was long overdue in looking at what we charged for copayments," said Principi. "Since 1990, veterans had been paying $2 for medication copayments, even though our costs for pharmaceuticals rose from $715 million to $2.1 billion during the same period. We have aligned our copayments with those in the private sector, with emphasis on fair and equitable charges and providing the best health care possible."

SOURCE U.S. Department of Veterans Affairs

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