Project 2025 Tracker / What’s done, what’s next

20. Department of Veterans Affairs · Notable

Issue new Secretarial directives to implement the VA MISSION Act

Partially done

645 20. Department of Veterans Affairs

“To strengthen Community Care, the next Administration should create new Secretarial directives to implement the VA MISSION Act properly. Sections for consideration and areas for reform include the following: 1. Sections 101 and 103 (Community Care eligibility for access standards and the best medical interest of the veteran). 2. Section 104 (Community Care access standards and standards for quality of care).”

What has happened

  1. Partially done

    VA released a request for proposals for the next generation of community-care third-party administrator contracts, structured as a multi-award IDIQ and requiring health plans to meet “broad industry standards of care used by all other major health care systems” — the closest the record comes to the sec. 104 quality standards half of the Quote. It is an RFP, not an award, and the sec. 104 access standards themselves are unamended, so the ask stays partial: directives have issued on eligibility and best medical interest, nothing has changed the access or quality standards in regulation.

  2. Partially done

    Second departmental instruction on the same sections: community-care authorizations for 30 standardized types of care were extended to twelve months, replacing 90- to 180-day reauthorization cycles for those services. Again an administration of sec. 101/103 eligibility rather than a change to the sec. 104 standards.

  3. Partially done

    VA removed the second-clinician review step from “best medical interest” community-care determinations, effective immediately, so that the referring clinician and the veteran decide together — the VA MISSION Act sec. 101/103 eligibility criterion the Quote names. VA framed the change as implementing language in the Senator Elizabeth Dole 21st Century Veterans Healthcare and Benefits Improvement Act and backed it with VHA employee training. This is a departmental instruction changing how sec. 101 and 103 are administered, not a revision of the sec. 104 access standards, which the same release restates unchanged (20/28 days, 30/60 minutes).

Research log

What was searched, and what didn’t count as evidence

Research notes

Queries and sources, 2026-09-01:

  • Corpus: every Federal Register rule, proposed rule and notice with VA as an agency since 2025-01-20, read by title. The community-care items are the 72-hour emergency-treatment notification pair (proposed 2025-07-22, final 2026-07-10) and the rescission of the obsolete Veterans Choice Program regulations (2026-07-28, https://www.federalregister.gov/documents/2026/07/28/2026-15210/rescission-of-outdated-veterans-choice-program-regulations). Neither amends 38 CFR 17.4000 et seq. access standards; the rescission is housekeeping on a program that ended in 2019, so it is recorded here rather than as Evidence.
  • news.va.gov press-release search: community care, access standards, MISSION Act.
  • The VA MISSION Act table of contents was read at govinfo.gov/content/pkg/PLAW-115publ182 to confirm which section numbers the Quote means: sec. 101 Establishment of Veterans Community Care Program, sec. 103 Conforming amendments for State veterans homes, sec. 104 Access standards and standards for quality. The Quote’s gloss on sec. 103 (“best medical interest”) is really the sec. 101 eligibility criterion; the events above are leveled on the substance, not on the Mandate’s section numbering.
  • Overlaps #1760 (major, p. 645), which asks Congress to codify the same access standards in legislation and stays at not started.
Action
issue
Object
Secretarial directives implementing the VA MISSION Act
ID
1762