Starting today, U.S. military veterans in suicidal crisis will be able to visit any Veterans Affairs or non-VA facility to get help at no cost.
That help includes inpatient care for up to 30 days and outpatient care for up to 90 days, according to a VA press release.
VA officials’ concern about suicide among the more than 9 million veterans that it serves made them decide to reverse the usual procedure to implement the changes. The interim final rule (PDF) establishing enhanced suicide prevention care would usually be followed by a 60-day public comment period.
This time, the VA placed the new rule in the Federal Register, and the clock for public comments starts today and lasts through March 20, 2023.
Secretary for Veterans Affairs Denis McDonough “has concluded that ordinary notice and comment procedures would be impracticable and contrary to the public interest,” according to the interim final rule. The VA “will consider comments that are received within 60 days after the date that this interim final rule is published in the Federal Register and address them in a subsequent Federal Register document announcing a final rule incorporating any changes made in response to the public comments.”
Under the rule, the VA will provide 24-hour medical supervision in “a residential facility setting that can adequately monitor the safety and medical condition of an individual that has been determined to be in acute suicidal crisis. Such crisis residential settings could include but not be limited to crisis residential programs, such as residential treatment centers, administered by either a state or private business but would not include any care that could be received in a personal residence” because the rule requires that such care be provided in a healthcare facility.
McDonough says “this expansion of care will save veterans’ lives, and there’s nothing more important than that.”
In addition to the inpatient and outpatient services, the rule allows the VA to:
- Pay for treatment for emergency suicide care, including transportation costs.
- Pay for follow-up care—including referrals to specialists—after the emergency subsides.
- Ascertain whether the patient is eligible for other VA benefits and services.
Individuals who are eligible for the extended benefits include:
- Veterans who were discharged after 24 months of active duty so long as they hadn’t been dishonorably discharged.
- Veterans who served more than 100 days under a combat exclusion “or in support of a contingency operation either directly or by operating an unmanned aerial vehicle from another location who were discharged under conditions other than dishonorable.”
- Veterans who’d been victims of a physical or sexual assault or sexual harassment while serving.
The interim rule states that “the expanded eligibility for this care, the associated transportation to receive such care, and the prohibition on charge for the care are all unique factors that we believe will encourage individuals to seek care where they may not have previously.”
COVID-19 exacerbated behavioral health problems in the U.S. while underscoring the issues that plagued the mental health care system even before the pandemic. In the interim final rule, the VA cites an analysis of data from the National Health and Resilience in Veterans Study that found 19.2% of veterans experienced suicidal ideation during the pandemic.
Those veterans were more likely to have low income and were more likely to be infected by COVID-19. They also “reported greater COVID-19-related financial and social restriction stress and increases in psychiatric symptoms and loneliness during the pandemic when compared to veterans without suicidal ideation.”
As Fierce Healthcare reported in 2018, while the VA offers high-quality mental health services, veterans often encounter problems gaining access to those services, noting that as a result “about half of veterans who need mental health services do not visit a VA or non-VA site for treatment, leaving post-traumatic stress, depression, addiction and other behavioral health concerns untreated.”
Installing the rule change first and then taking public comment allows the VA to avoid implementing the suicide prevention program piecemeal and enables the VA to furnish the care directly and establish a system that would allow payment for care at non-VA facilities.
“For instance, VA has had to plan and initiate multiple systems changes to ensure that copayments or other potential costs are not charged to individuals who would be eligible for this care,” the interim rule states. “Systems changes were also needed to recognize expanded eligibility for this care, particularly because such eligibility changes [depend] on whether an acute suicidal crisis is present or whether symptoms related to such crisis continue to require care under this program.”