VA-paid care from a community provider when VA cannot see an enrolled veteran within 30 minutes’ drive and 20 days for primary or mental health care, or 60 minutes and 28 days for specialty care.
Also called: community care, MISSION Act, Choice, outside provider, VCCP, care in the community.
The Veterans Community Care Program, created by the MISSION Act of 2018, lets an enrolled veteran see a community provider at VA's expense. The care has to be authorized by VA first; VA then pays the provider, and the veteran owes only the VA copay that would have applied.
A veteran is eligible when any one of these is true: VA does not offer the care needed; VA has no full-service medical facility in the veteran's state; the veteran was eligible under the old 40-mile rule and still qualifies under grandfathering; the veteran and the VA provider agree it is in the veteran's best medical interest; a VA service line does not meet VA's quality standards; or VA cannot meet the access standards.
The access standards in 38 C.F.R. 17.4040 are an appointment within 30 minutes' average driving time and 20 days of the request for primary care, mental health care and non-institutional extended care, and within 60 minutes' driving time and 28 days for specialty care. The driving time is measured by VA's mapping software from the veteran's home.
Ask the VA care team for a community care referral. Urgent care at a network urgent care clinic does not need a referral, and an emergency at a community hospital should be reported to VA within 72 hours.
Thresholds
Thresholds for VA Community Care
Gate
Rule
Enrolled in VA health care
The veteran must be enrolled in VA health care or otherwise eligible for VA care, and meet one of the six community care criteria.
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Disclaimer
VetTOC is not affiliated with the U.S. Department of Veterans Affairs or the Department of Defense. Information is for reference only and is not an eligibility determination. Verify with VA, the relevant state or territory, or an accredited VSO.