VA Community Care Referrals, Authorizations, and Continued Care

The direct answer

VA Community Care has several separate moving parts: eligibility, referral, authorization, scheduling, and continued-care approval. A problem at one step does not automatically mean the others are complete.

Community Care generally must be authorized by VA before a Veteran receives non-emergency care from a community provider. The referral or authorization defines the approved episode of care. A provider being available in the community does not, by itself, mean VA has authorized that provider or service.

Eligibility is not the same as authorization

A Veteran may qualify for Community Care under one or more eligibility pathways, including applicable access standards or other statutory and clinical criteria. For mental health care, VA currently lists a 20-day appointment wait-time standard and a 30-minute average drive-time standard, along with other possible eligibility pathways.

But being eligible for Community Care and having an active authorization are different things.

• Eligibility means the Veteran meets a criterion for community care.
• A referral starts the process of arranging that care.
• An authorization defines what VA has approved.
• A scheduled appointment means the community provider has actually agreed to see the Veteran.

A Veteran can therefore be told that care was “approved” while the outside provider still lacks the usable authorization needed for the next visit.

What an authorization controls

The authorization and Standardized Episode of Care (SEOC) matter because VA reimburses only care that falls within the approved scope. Before relying on an authorization, confirm:

• the provider;
• the authorized service or specialty;
• the effective dates;
• the number of visits or episode limits when applicable; and
• whether the provider has actually received the referral information.

VA's provider guidance says services outside the authorized SEOC require the appropriate additional authorization process.

When continued care is needed

When care is needed beyond what is already authorized, the community provider uses VA's Request for Service (RFS) process.

An RFS may be needed for:

• additional visits or time beyond the active authorization;
• an expiring authorization;
• a new specialty service; or
• another procedure or service outside the existing SEOC.

The provider, not the Veteran, submits the RFS to the local VA Community Care office with the required supporting documentation.

Useful questions when therapy or another service is about to stop include:

1. Did the provider submit an RFS?
2. On what date?
3. Was the request complete and signed?
4. Has VA issued a new or extended authorization?
5. What are the new dates and approved services?
6. Has the provider received the updated authorization?
7. If the request was returned or denied, what specifically happened?

Precertification changed in September 2026

VA states that effective September 8, 2026, precertification is no longer required for care that is already authorized under the Veteran's referral and SEOC.

That does not mean authorization disappeared. Providers still must follow the RFS process when care falls outside the existing authorization or SEOC.

So “precertification is gone” should not be interpreted as “the provider can continue indefinitely without authorization.”

What if VA says a provider exists but the appointment still cannot happen?

An operational barrier can be real even when VA technically has a clinician or service available. Staffing, room availability, scheduling capacity, technology, or other issues may prevent an actual appointment.

Ask for the earliest date VA can actually furnish the needed care and whether the delay qualifies under the applicable Community Care eligibility pathway. Do not assume that any single operational problem automatically creates Community Care eligibility.

When the process stalls

A practical escalation sequence is:

1. Identify the exact stalled step: eligibility, referral, authorization, provider receipt, RFS, or scheduling.
2. Contact the relevant VA care team or Community Care office and ask for dates and identifiers.
3. Ask the community provider what referral or authorization it actually has.
4. Use secure messaging when available so the timeline is documented.
5. Contact the VA Patient Advocate when the care-access problem remains unresolved through the treatment team.
6. If VA denies a Community Care eligibility decision, review the applicable VA decision-review process.

Common misconceptions

“If VA cannot see me for any reason, I automatically get Community Care.”

No. Community Care requires an applicable eligibility pathway and VA authorization.

“My VA clinician said it was approved, so the community provider can bill the next visit.”

Not necessarily. Confirm that an active authorization covers the service, dates, and provider and that the provider has received it.

“I submit my own RFS for continued care.”

VA's current provider guidance places RFS submission on the community provider.

“Precertification ended, so authorization no longer matters.”

No. The September 2026 precertification change applies to care already authorized under the referral and SEOC. Care beyond that scope still requires the appropriate authorization process.

When to verify with VA

Referral status, authorization dates, network participation, and local workflows can change. For a specific episode of care, verify the current status with the VA Community Care office and the community provider rather than relying only on general guidance.