VA’s Revamped Community Care Program Aims to Improve the Veteran Health Experience

VA’s Revamped Community Care Program Aims To Improve The Veteran Health Experience

VA encourages Veterans to get their medical care at VA facilities – but VA can’t always deliver the care and services Veterans need, where and when they need it. In this case, VA provides care through community providers. Starting this summer, VA’s streamlined community care program will make it easier for Veterans to access the top-notch and timely care they need thanks to the MISSION Act.

What is the MISSION ACT?

This new law gives Veterans more ways to access health care within VA’s network and through VA-approved community providers.

How does VA Community Care work?

  • First, VA confirms that a Veteran is eligible.
  • Next, the Veteran or VA staff member schedules an appointment with a community provider in VA’s network. VA also sends the Veteran’s medical documents to the community provider to make sure care is properly coordinated.
  • The Veteran receives care.
  • Finally, the community provider sends the claim to a third-party administrator (TPA) or VA for payment. Veterans may have to pay a copayment for nonservice-connected care, just as they would at VA medical facilities.

Who is eligible for VA Community Care?

Eligibility depends on a Veteran’s health care needs or circumstances. In most cases, Veterans must receive prior approval from VA. There are six criteria that can qualify a Veteran to receive community care under the new MISSION Act. Veterans need to meet only one of these criteria to be eligible.

  1. The Veteran needs a service that is not available at a VA medical facility.
  2. He/she lives in a U.S. state or territory without a full-service VA medical facility.
  3. The Veteran qualifies under the “grandfather” provision related to distance eligibility for the Veterans Choice Program.
  4. The VA cannot provide care within certain designated access standards. For example, the Veteran meets specific access standards for average drive time or appointment wait-times.
  5. It is in the Veteran’s best medical interest to be referred to a community provider.
  6. The Veteran needs care from a VA medical service line that does not meet certain quality standards.

Even if a Veteran is eligible for community care, he/she generally still has the option to receive care from a VA medical facility.

QuickTip: Veterans should tell their VA and community providers of all medicines they’re taking, including over-the-counter medicines, vitamins, supplements and herbals. They should also tell providers about any changes to their health, or changes in treatment or medicines made by either provider.

For more information on VA health benefits and services, see the QuickSeries® guide: Benefits for Veterans, Dependents and Survivors.