The Veterans Access to Direct Primary Care Act directs the Department of Veterans Affairs to establish a five-year pilot program that provides eligible veterans with a health savings account to pay for primary care furnished by non-VA direct primary care providers. The program will be conducted under the Center for Innovation for Care and Payment and is funded from existing VA appropriations.
Veterans enrolled in VA’s patient enrollment system can participate, receiving an annual HSA deposit to cover defined medical services, with strict rules to prevent misuse and to report outcomes to Congress. The bill does not create new appropriations and terminates five years after enactment.
At a Glance
What It Does
Establishes a five-year pilot program beginning one year after enactment to provide eligible veterans with HSAs used for primary care delivered by non-VA direct primary care providers, funded from VA sources and overseen by the VA Center for Innovation for Care and Payment. It also defines eligible veterans and sets fraud controls and reporting requirements.
Who It Affects
Veterans enrolled in VA’s patient enrollment system who opt into non-VA direct primary care, plus private providers who participate in non-VA DPC arrangements and VA program administrators implementing the pilot.
Why It Matters
Tests whether shifting a portion of primary care to direct primary care with HSAs can improve access and control costs within a VA pilot framework, while clarifying governance and accountability for non-VA care within veteran health benefits.
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What This Bill Actually Does
The bill creates a test program for five years that lets certain veterans use a Veterans Health Savings Account to pay for primary care provided by non-VA physicians under direct primary care arrangements. The program runs for five years, with the VA funding the accounts from existing appropriations and overseeing the design and implementation through the VA Center for Innovation for Care and Payment.
To participate, veterans must be enrolled in VA’s patient enrollment system, and during the pilot they may not receive VA medical care that falls under the non-VA direct primary care arrangement. The VA will implement safeguards to prevent fraud and will deposit a set annual amount into each participating veteran’s HSA, calculated with actuarial input and reviewed by VA.
The act requires quarterly implementation reports for two years and annual results reports thereafter, but it does not authorize new spending beyond current VA appropriations and terminates after five years.
The Five Things You Need to Know
The bill creates a five-year pilot program to allow eligible veterans to use HSAs for non-VA direct primary care services.
An eligible veteran must be enrolled in VA’s patient enrollment system to participate in the pilot.
Funds deposited into veteran HSAs are determined annually by the VA and an actuarial service, and paid each year for the pilot period.
During the pilot, veterans may not receive VA medical care that is included in the non-VA direct primary care arrangement.
The VA must produce quarterly implementation reports for two years and annual results reports after that, using VA appropriations already authorized.
Section-by-Section Breakdown
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Establishment of the pilot program
The Secretary of Veterans Affairs must start a five-year pilot one year after enactment to offer eligible veterans the option of primary care from non-VA providers under a direct primary care arrangement, funded through a veteran health savings account. The pilot will be designed and operated under the Center for Innovation for Care and Payment, as specified in section 1703E of title 38 U.S. Code. This section sets the framework for who can participate, how services are arranged, and how oversight will occur.
Eligible veteran
An eligible veteran is someone enrolled in the VA patient enrollment system under section 1705 of title 38. This creates a defined pool of participants with access to the new HSA-supported DPC option, establishing a threshold for eligibility that ties the pilot to VA’s existing enrollment infrastructure.
Veteran Health Savings Accounts
The Secretary must provide HSAs to participating veterans that may be used to pay for primary care services through non-VA DPC arrangements and to cover related costs such as periodic physician fees, wellness screenings, and medicines. This section sets the scope of permissible expenditures and clarifies that HSAs cover both defined services and access-related costs.
Limitation on Department medical care during pilot
Veterans who participate in the HSA-based pilot may not receive medical care from VA that falls under the non-VA DPC arrangement during the pilot period. This creates a clear boundary between VA care and non-VA care within the pilot to prevent overlap and ensure the integrity of the test.
Fraud prevention and monitoring
The Secretary must implement a mechanism to prevent fraudulent activity in connection with payments under this section and to ensure veterans use HSAs only as authorized. This includes controls on claims, eligibility, and the use of funds to guard against misuse and waste.
Amounts deposited in accounts
The Secretary, using actuarial input, will determine the annual deposit amount for each participating veteran’s HSA and ensure that amount is available on an annual basis for the duration of the pilot. This creates a predictable funding stream for participants and a budgetary anchor for the program.
Direct primary care service arrangement
The act defines a direct primary care service arrangement as an agreement where a physician provides a defined set of medical services for fixed periodic fees. This operational definition anchors what constitutes DPC within the pilot and clarifies the contracting model for participating providers.
Reports
The Secretary must submit implementation reports quarterly for the first two years and annual outcome reports thereafter to the Senate and House Committees on Veterans’ Affairs. One report will describe the final design, and subsequent reports will summarize results and lessons learned to inform future policy.
No additional appropriations
The funds required to run the pilot come from amounts already authorized for the Veterans Health Administration. No new appropriations are required, signaling a test-and-learn approach within existing VA budgets.
Termination
The authority to deposit funds into veterans’ HSAs ends five years after enactment. This creates a hard sunset for the pilot and concentrates attention on the evaluation results to determine any longer-term policy implications.
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Who Benefits
- Participating veterans enrolled in VA's patient enrollment system gain access to an additional primary care option with funds earmarked in a personal HSA to cover services and related costs.
- Non-VA direct primary care providers gain a government-backed patient base and new revenue streams from VA participant HSAs under structured pilot arrangements.
- The VA Center for Innovation for Care and Payment gains data, experience, and governance insights to inform potential future policy on veteran primary care delivery.
Who Bears the Cost
- VA health administration resources are allocated to design, monitor, and report on the pilot, potentially diverting attention from other programs within the existing budget.
- If participation scales, there could be opportunity costs within VA that must be managed within current appropriations, given there are no new funds provided for the pilot.
- Non-VA DPC providers may incur administrative costs to establish arrangements and ensure compliance with pilot requirements, including fraud prevention and reporting obligations.
Key Issues
The Core Tension
The central tension is balancing expanded, flexible access to primary care through non-VA providers against the risk of fragmented care, potential gaps in care coordination, and budgetary constraints within a five-year window and a non-appropriated pilot.
The bill creates a novel mechanism to fund veteran primary care through HSAs tied to non-VA direct primary care arrangements, which raises questions about continuity of care, care coordination, and the potential fragmentation between VA and non-VA services. While the pilot aims to test access and cost effects, it relies on existing VA funding without additional appropriations and requires robust data collection to evaluate outcomes.
The fraud-prevention and accountability provisions must be strong enough to prevent misuse of funds while not stifling provider participation. The design of deposits, eligibility, and the final evaluation will shape whether a broader policy is warranted after the sunset.
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