The short answer
VA Community Care uses a lot of official terms. The ones you'll hear most are referral (VA sending your request to an outside provider), authorization (VA's approval of specific care for a set time), SEOC (the list of services that approval covers), and RFS (the form a provider uses to ask VA for more care). This page explains each one.
Why learn these terms?
Because they're the words on your letters and the words VA staff use on the phone. Knowing them makes it easier to ask the right question and to spot when something is missing. Terms are grouped by where you'll run into them.
The program
- Veterans Community Care Program (VCCP): The official name for VA Community Care, set up by the MISSION Act. The rules are in 38 CFR 17.4000 through 17.4040. See What Is VA Community Care?
- MISSION Act: The 2018 law that created the current Community Care program, replacing the older Veterans Choice Program.
- Covered Veteran: A Veteran enrolled in VA health care, or one of a few unenrolled groups, such as Veterans rated 50% or more. It's the first requirement for Community Care. See Who Is a Covered Veteran?
- Medical benefits package: The list of care VA covers, in 38 CFR 17.38. Community Care can't cover anything outside it.
Qualifying
- Eligibility criteria: The six ways to qualify for Community Care in 38 CFR 17.4010. See Who Qualifies?
- Access standards: VA's wait-time and drive-time limits. For primary care and mental health, VA has 20 days to schedule you within a 30-minute average drive. For specialty care, it's 28 days and 60 minutes. See Wait-Time and Drive-Time Standards.
- Best medical interest: When you and your VA provider agree outside care is better for you, based on factors like distance, how often you need care, and continuity. See Best Medical Interest.
- Full-service VA medical facility: A VA facility with hospital care, emergency care, and surgery. If your state has none, you qualify for Community Care.
- Grandfathered (40-mile) eligibility: A protected rule for certain Veterans who qualified under the old Choice program's 40-mile distance rule.
- Residence: Your legal home for drive-time purposes. It can be seasonal, but you only have one at a time, and a PO box doesn't count. Report a change within 60 days.
Approval
- Referral: VA's request sent to a community provider for your care. VA says preparing one can take up to 14 days.
- Authorization: VA's approval of specific care from a specific provider for a set time. It comes with an authorization number and letter. See Your Authorization Letter.
- Episode of care: A course of treatment, including follow-ups and related services, lasting no more than one calendar year, under 38 CFR 17.4005.
- SEOC (Standardized Episode of Care): The standard package of services VA approves for a type of care, like a set number of visits and the services allowed. Anything outside it needs a new request.
- RFS (Request for Service): VA Form 10-10172, which a community provider sends to ask VA for more visits, more time, or new services. See How Community Providers Request More Care.
- Precertification: An extra provider notification step VA ended on September 8, 2026. See What Changed When VA Ended Precertification.
- Self-scheduling: Booking your own Community Care appointment after the referral. VA asks you to tell your team within 14 days. See Scheduling Your Own Appointment.
The network
- CCN (Community Care Network): VA's main group of contracted outside providers. See Community Care vs. CCN.
- TPA (third-party administrator): The company that runs a CCN region for VA. Today that's Optum (Regions 1 to 3) and TriWest (Regions 4 and 5).
- VCA (Veterans Care Agreement): A direct agreement between VA and a provider, used when no network provider can meet your needs. See Veterans Care Agreements.
- HSRM (HealthShare Referral Manager): The online system VA and community providers use to send referrals, authorizations, and RFS forms. See What Is HSRM?
- Community Care office: The team at your VA medical center that handles referrals, authorizations, and scheduling for outside care.
Costs and problems
- Copay: What you may owe VA for care, based on your priority group. You pay $0 at a Community Care appointment, and VA bills any copay later. See Copays for Community Care.
- Priority group: VA's ranking, from 1 to 8, that sets what copays you owe.
- Balance billing: A provider billing you for the difference between their charge and what VA paid. Providers shouldn't do this for authorized care. See What a Provider Can Bill You For.
- Clinical appeal: The process to challenge a Community Care eligibility decision. It goes through your facility's Patient Advocate, not the Board of Veterans' Appeals. See Appealing a Community Care Denial.
- Patient Advocate: The VA staff member at each medical center who helps resolve care problems and guides clinical appeals.