The short answer
A provider can furnish VA Community Care if they have a contract or agreement with VA, usually through the Community Care Network or a Veterans Care Agreement, aren't acting as VA staff, and are accessible to the Veteran. VA judges accessibility by wait time, ability to provide the care, and distance.
What makes a provider eligible?
Three requirements in 38 CFR 17.4030:
- A contract or agreement with VA to provide Community Care.
- Not part of VA. The provider isn't VA, or is a VA employee who isn't acting in their VA job when providing this care.
- Accessible to the Veteran.
What counts as a contract or agreement?
Most often, one of these:
- Community Care Network (CCN). The provider contracts with the network administrator for their region: Optum for Regions 1 to 3, TriWest for Regions 4 and 5. See CCN Regions.
- Veterans Care Agreement (VCA). A direct agreement between VA and the provider, used when network care isn't available or adequate. See Veterans Care Agreements.
VA also has other arrangements, like sharing agreements with other federal health systems.
A provider without any of these can't be paid by VA for routine Community Care, even if they're licensed and willing.
How does VA decide a provider is accessible?
Under 38 CFR 17.4030(c), VA considers:
- Wait time: how long you'd wait to be seen by that provider;
- Qualifications: whether the provider can actually provide the care you need; and
- Distance: how far the provider is from where you live.
The regulation doesn't set numbers for these. In practice, it means VA shouldn't send you to a network provider who can't see you for months or who's hours away. If that happens, ask VA to find someone else.
Do licensing and scope still matter?
Yes. Being in the network doesn't change what a provider is licensed to do. VA's Veterans Care Agreement rules, for example, require proof of licensure and screening against federal exclusion lists before a provider is certified. Network administrators credential CCN providers.
What should providers know about joining?
- CCN: Contact the administrator for your region about joining the network. Joining doesn't guarantee referrals. VA still decides each Veteran's eligibility and referral.
- VCA: Contact the Community Care office at your nearest VA medical center. VA decides whether a VCA is needed, usually when CCN can't meet a need.
- HSRM: Once you're in, VA sends referrals and authorizations through HealthShare Referral Manager. See What Is HSRM?
- Payment: VA pays at contract or agreement rates, generally capped at Medicare rates under 38 CFR 17.4035, with exceptions for highly rural areas and Alaska.
What should Veterans take from this?
- "We take VA" isn't enough. Ask: "Are you in the VA Community Care Network?"
- If you want a specific provider, VA can only use them if they have a contract or agreement.
- If no eligible provider is accessible, VA should help find one. See When the Provider You Need Isn't in the Network.