Veterans Community Care (VCC) Program

What is the Veterans Community Care Program? Veterans have access to general healthcare needs at a Veterans Medical Center (VAMC) but sometimes may need to seek outside healthcare in a timely manner. The process has now been enhanced, reducing the wait time and getting the care Veterans need and deserve.

The VCC program is the replacement to the Veterans Choice Program. In order to comply with the MISSION Act of 2018, the VA sunset its Veterans Choice Program, a program that allowed veterans who received their care at the VA to receive services at community-based providers that are not directly linked to the VA system.

The Department of Veterans Affairs in partnership with TriWest launched the Veterans Community Care program, Patient-Centered Community Care in 2013. Improvements were made to ensure healthcare needs with the patient’s need in mind, focusing on accessibility and efficiency.

Additional improvements include:

• Streamlined eligibility criteria– There are six criteria eligible requirements defined in the VCC program eliminating confusion over who qualifies.
• Single community care program– Having a single community care program makes it less complicated for Veterans to find care.
• Improvement of customer service– Total revamp of the internal process, with improved education and communications resources for Veterans, Veterans Service Organizations (VSO) partners, and VA employees involved in community care operations to handle claims and payment.
• New urgent care benefit– Access to immediate care at urgent care clinics and walk-in providers within the VA network, without prior authorization from the VA. It’s just one of the streamline improvements VCC offers.

Six Criteria for Eligibility

The Community Care program is available only by referral from the VAMC. Veterans must be eligible for VA healthcare before asking for a referral through the community care program. The referrer from the VAMC determines eligibility by the following six criteria:

1. The veteran needs a service not readily available at a VA medical center- In this situation, a Veteran needs a specific type of care or service that VA does not provide in-house at any of its medical facilities.

2. The veteran does not live near a VA medical center in the U.S.

3. The veteran falls under the “grandfather” provision from the sunset program, VCP- A Veteran is eligible for VCC if they lived over 40 miles from a VAMC prior to June 6, 2018, still live in the location, and meet all of the following criteria:

• Veteran lives in the states: North Dakota, South Dakota, Montana, Alaska, and Wyoming, OR
• Veteran lives in another state, received care between June 6, 2017 through June 6, 2018 AND
• Requires care before June 6, 2020.

4. The veteran medical center cannot provide driving and wait time standards to the patient- Veterans reserve the right to receive care within a reasonable time which includes appointment, drive and wait time. The standards below are average standards for VAMC facilities. Time exceeding the normal limit warrants VCC services.

Typically, standard appointments are set within 20-28 days. Average access standards to a VA include:

• Primary Care, Mental Health Services, and Non-Institutional Extended Care Services- 30-minute average drive time
• Specialty Care- 60-minute average drive time for specialty care

5. Seeking care from VCC is in the Veteran’s best interest.

6. VA quality standards not met- Patient satisfaction is at the core of VCC. If a patient does not feel they are receiving the best care they need at the VAMC, the VA will evaluate quality standards and refer out to the VCC.

Types of Patient-Centered Community Care Provided:

• Primary Care
• Inpatient Specialty Care
• Outpatient Specialty Care
• Behavioral Health Care
• Limited Newborn Care for Post-Op Enrolled Female Veterans

Not Included in VCC:

• Dental Care
• Nursing Home Care
• Long-Term Acute Care Hospitals (LTAC)
• Homemaker and Home Health Aide Services
• Chronic Dialysis Treatments
• Compensation and Pension Examinations

Finding a Provider

You’ll first need to obtain an authorization through the VA Medical Center for specialty or primary care.

Once the authorization is received, TriWest Healthcare Alliance will contact you to set up an appointment. They do all the provider research. Simply, work with your VAMC for your complete medical file.

Urgent Care Changes

The VCC implemented changes in urgent care accessibility as well. Veterans can visit qualifying non-VA urgent care facilities or walk-in clinics without prior authorization.

Those seeking urgent care facilities or walk-ins can be seen for flu shots, vaccinations, or other non-prolonged care. Keep in mind, follow-up care does require VA authorization.

Medications Through VCC

Veteran patients still need to receive their prescribed medication at a VA pharmacy. There may be situations that arise where medicine is needed right away and the VA pharmacy is unable to fill your prescription.

In this case, a non-VA pharmacy may be available in your area to fill your prescription for up to 14-days. Any limits exceeding 14-days must be VA approved before filled. Reimbursement can be submitted to help pay for any gap in coverage.

Contact Information

TriWest phone lines are open from 8 a.m. to 8 p.m. at 855-PCCCVET (722-2838.) Veterans with hearing or speech disabilities can be accommodated.