The short answer
A Veterans Care Agreement (VCA) is a direct agreement between a VA medical center and a community provider. VA uses one in limited situations, when care isn't feasibly available through VA, the Community Care Network, or a sharing agreement. VCA providers are certified and paid directly by VA.
What is a Veterans Care Agreement?
A direct agreement between VA and a community provider to treat Veterans. It comes from 38 U.S.C. 1703A and 38 CFR 17.4100 through 17.4135. VA's VCA page says providers who sign one give care at VA's request and are paid directly by VA.
How is a VCA different from CCN?
| Community Care Network (CCN) | Veterans Care Agreement (VCA) | |
|---|---|---|
| Who the provider contracts with | Optum or TriWest, for VA | VA directly, through a VA medical center |
| When it's used | Most Community Care | Limited situations when CCN can't meet the need |
| Who pays the provider | The network administrator | VA |
| Provider setup | Network credentialing | VA certification, VA Form 10-10171 |
| Veteran needs VA approval first | Yes | Yes |
When does VA use a VCA?
Under 38 CFR 17.4115, when the care isn't feasibly available through a VA facility, a contract, or a sharing agreement. VA can base that on the Veteran's medical condition, the travel involved, the nature of the care, or a combination. VA's page says VCAs are for limited situations when CCN services are unavailable or inadequate.
That's why a Veteran might be sent to a VCA provider: no network provider nearby offers the care, or the only network options can't see the Veteran in time.
How do providers get a VCA?
They contact the Community Care office at the nearest VA medical center, which decides whether a VCA is needed.
Certification, under 38 CFR 17.4110:
- Providers send proof of licensure and other information VA asks for, which can include NPI, tax ID, specialty taxonomy, and practice addresses.
- VA must deny certification to providers excluded from federal health care programs or listed as excluded in the federal System for Award Management.
- VA aims to decide within 120 days.
- Certification lasts three years. Recertification applications are due at least 60 days before it expires.
- Certified providers must report relevant changes to VA within 30 days.
The agreement itself uses VA Form 10-10171. A group practice can use one agreement that lists all its providers' NPIs.
How are VCA providers paid?
VA's page says Medicare-covered services are paid at Medicare rates, and other services at VA's fee schedule or billed charges. 38 CFR 17.4035 allows exceptions for highly rural areas and Alaska. VCA providers may not bill the Veteran or the Veteran's other insurance for authorized care, and VA doesn't pay for care given before the agreement is signed.
Payment disputes have their own process under 38 CFR 17.4135. Providers must file within 90 days after the dispute arises. See Provider Claim Disputes vs. Veteran Appeals.
What happens when a VCA ends?
Under 38 CFR 17.4130:
- Either side generally gives 45 days' written notice.
- VA can end an agreement faster, even immediately, to protect Veterans' health or when the agreement allows it.
- VA can end it for things like failing to follow the rules or the agreement, exclusion from federal health programs, or a serious criminal conviction, or when it's reasonable based on Veterans' health care needs.
If your VCA provider's agreement ends, call your VA Community Care office right away to set up care with another provider so treatment doesn't stop.