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"As we express our gratitude, we must never forget that the highest appreciation is not to utter words, but to live by them." -- John F. Kennedy
VA CARE IN THE COMMUNITY (CCN)
Your partner in health today, tomorrow, and for life.
VA Care in the Community Network Eligibility
A Veteran's eligibility for community care depends on his/her individual health care needs or circumstances.
ELIGIBILITY CRITERIA
- Required Care or Medical Service not available at VA or within Access Standards.
- Best Medical interest-to be determined by your VA provider.
- Veteran Lives in a US state or Territory without a full-service VA medical facility.
CHAMP VA IS NOT ELIGIBLE FOR VA COMMUNITY CARE.
TRICARE AND COMMUNITY CARE ARE NOT THE SAME PROGRAMS.
ACTIVE-DUTY VETERANS ARE NOT ELIGIBLE FOR COMMUNITY CARE
GRANDFATHERED: EXPIRED ON 6/6/2020. NO LONGER VALID IN WV.
ACCESS STANDARDS
- Primary Care and Mental Health Care-
- Drive Time: must live over 30 minutes from a VA facility that offers Primary or Mental Health Care
- Wait Time- 20 days from the Clinically Indicated date (date chosen by provider)
- Drive Time: must live over 30 minutes from a VA facility that offers Primary or Mental Health Care
- Specialty Care
- Drive Time: must live over 60 minutes from a VA facility that offers that type of care. Example of type of care –orthopedics.
- Wait Time- 28 days from the Clinically Indicated date(date chosen by provider)
PLEASE NOTE
- Veteran must be enrolled in VA healthcare to be eligible for Care in the Community benefit. Exception to this rule is the Compact Act.
- Veteran must meet the eligibility criteria, regardless of service connection to qualify for care in the community.
- Wait time to be seen in the community may be greater than wait time to see a VA provider. Community providers do not have to adhere to VA Access standards
- Not all services are available in the community where the veteran lives, you may have to drive to be seen. Not all community providers are enrolled with the VA. Care in the Community can only schedule within network providers
- VA staff members generally make all eligibility determinations based on Mission Act eligibility criteria.
WHAT YOU SHOULD KNOW BEFORE YOU GO!
ENROLLMENT AND APPROVAL
1.Prior approval from VA before obtaining care from an approved community provider, except for ER and Urgent Care Visits. Payment may be denied for unauthorized care.
2. Veterans must be enrolled for VA care to be eligible for community care.
3. Veterans may request Community Care, but VA staff members generally make all eligibility determinations based on the eligibility criteria of the Mission Act.
4. Veterans choosing to use their community care eligibility will be contacted by a VA CITC staff member to set up their appointment with veterans preferred in network provider.
5. The community provider must be part of the VA community care network. Requests for Payment for care for an out of network provider services will be denied for payment.
6. The VA does not pay copayments for Medicare or other Health Insurance. The VA will not reimburse copayments if paid out of pocket. If care was preapproved by the VA and the veteran is incorrectly charged the VA will contact the providers office to correct the error,
7. Community Providers do not follow VA scheduling guideline. They review your referral packet, determine the level of urgency based on their criteria, and then schedule you in the first available appointment
APPOINTMENT INFORMATION AND WHAT COMES NEXT
1.Your VA provider must enter a Care in the Community Consult. They will discuss your care options with you and then place the appropriate consult for that episode of care.
2. Routine care by a community provider must be authorized by the VA prior to the veteran being seen.
Emergency or urgent care medical situations do not require pre-authorization.
3. VA CITC staff will contact the veteran for scheduling preferences, ensure preferred provider is in network (Community provider must be enrolled in the VA preferred network), and explain the scheduling process.
4. The veteran and community provider will both get a copy of the authorization. Authorizations are time limited and requests for continuation of care will be necessary periodically.
5.When you arrive to your appointment verify the provider has the authorization on file. Take your copy with you just in case. If you cancel or reschedule your appointment, please let the care in the community staff know so they can update the authorizations.
6.If additional care is needed OR you are being referred to a new provider, the provider must submit a request to the VA for the care to be authorized. Contact the VA to ensure the referral was received.
7. The community provider must fax the need for bracing or equipment to the VA for an order to be placed. CITC does not cover issued in a provider's office or at medical equipment company unless it is an urgent/emergent or the veteran is set up for an appointment by the VA Prosthetics department.
8. TESTING: If a community provider orders Diagnostic or pre-op testing, the veteran can choose to have it completed at the VA or the community facility. Notify Care in the Community staff or Release of Information staff if the reports need sent to provider.
Who can I talk to if I am in crisis?
To connect with the Veteran Crisis Line anytime day or night:•Dial 988 then press 1
•Start a confidential chat by visiting https://www.veteranscrisisline.net/get-help-now/chat
•Text 838255
•If you have hearing loss call TTY: 800-799-4889
EMERGENCY CARE
CALL 911 IF YOU ARE HAVING A MEDICAL EMERGENCY
THEN NOTIFY THE VA AS SOON AS POSSIBLE
INFORM THE EMERGENCY CARE PROVIDER TO REPORT YOUR TREATMENT TO THE VA EMERGENCY CALL CENTER.
1-844-724-7842 72 HOUR NOTIFICATION NUMBER
or https://emergencycarereporting.communitycare.va.gov/
Notification needs to be completed within 72 hours of admission to the ER in order to make sure that payment for services will be approved. The veteran or family member can also report the ER visit to the hotline.
URGENT CARE
The VA offers urgent care services to eligible veterans at VA medical care facilities or IN NETWORK Urgent Care clinics closer to home.
To be eligible for VA urgent care benefit you must:
- Be enrolled in the VA health system
- received care of the VA in the last 24 months