VHA Office of Community Care
Care in the Community
If you are eligible for health care through the Department of Veterans Affairs, our goal is to provide you with the care you need in a VA facility. However, sometimes that isn’t possible: you may live too far from a VA facility, the specialist you need may not be available at your VA, or it may take too long for you to be seen at a VA facility. In those cases, you may be referred to a community provider through the Care in the Community program.
Care in the Community is care provided to eligible Veterans outside of the VA when VA facilities are not feasibly available. All VA Medical Centers (VAMCs) can use this program when needed. The use of non-VA medical care is governed by federal laws containing eligibility criteria and other policies specifying when and why it can be used.
In most cases, having VA pay for care in the community requires pre-authorization. And, any care needed or recommended beyond the scope of that authorization must be approved by the VA facility that authorized the care.
In the event of an emergency, when a VA facility is not the nearest medical facility, do not delay treatment by attempting to request VA payment authorization first. Instead, proceed to the nearest emergency room to get the care you need. Emergency events may be reimbursed on behalf of the Veteran in certain cases. A medical emergency is generally defined as a condition of such a nature that a prudent layperson would reasonably expect a delay in seeking immediate medical attention to be hazardous to life or health.
Eligibility for VA payment of emergency care, as well as deadlines for filing claims, depend upon whether or not you have a service-connected condition and your specific eligibility for non-VA medical care. It is important to inform the non-VA medical facility treating you that you are a Veteran. If inpatient care is required and you desire VA care and payment consideration, always inform the non-VA medical facility staff that you want to transfer to a VA facility when your medical condition stabilizes. It’s important to contact the closest VA facility as soon as possible to find out more about VA payment of your emergency care.
There may be a time when a Veteran requires emergency care. When it is not possible to go to a VA Medical Center, a Veteran may have to seek treatment at the nearest hospital with an emergency room. The Department of Veterans Affairs (VA) is authorized under Title 38 United States Code (U.S.C.) to make payment or reimbursement to a claimant for emergency treatment provided to Veterans meeting specific eligibility criteria.
The Non-VA Medical Care Program Office provides payment authorization for eligible Veterans to obtain routine outpatient medical services, and certain inpatient services, through community providers. This authorization may be granted when it has been determined that direct VA services are either geographically inaccessible or VA facilities are not available to meet a Veteran’s needs. All community services must be preapproved before a Veteran receives treatment.
Patient-Centered Community Care (PC3) is a program that uses health care contracts to develop a network of health care providers to deliver covered care to Veterans. The covered care includes primary care, inpatient specialty care, outpatient specialty care, mental health care, limited emergency care, limited newborn care for enrolled female Veterans following delivery, skilled home health care, and home infusion therapy. Care is available through PC3 when local VA Medical Centers cannot readily provide the needed care to Veterans due to demand exceeding capacity, geographic inaccessibility or other limiting factors.
VA's State Home program provides an economical alternative to constructing, maintaining and operating VA facilities for the provision of care to eligible Veterans. Under this program, the states provide quality care for eligible Veterans in three different types of programs: nursing home, domiciliary, and adult day health care. VA contributions to state home per diem expenses are projected to be $1.07 billion in FY 2014.
The VHA Office of Community Care, Office of Tribal Government Relations (OTGR), and VA Medical Centers (VAMCs) work together to implement the Tribal Reimbursement Agreements Program. The Tribal Reimbursement Agreements Program provides a means for IHS and THP health facilities to receive reimbursement from the VA for direct care services provided to American Indian and Alaskan Native eligible Veterans. This program is part of a larger effort set forth in the VA and IHS Memorandum of Understanding signed in October 2010 to improve access to care and care coordination for our nation’s Native Veterans.
Foreign Medical Program
The Foreign Medical Program, or FMP, provides health care benefits to U.S. Veterans with VA-rated, service-connected conditions who are residing or traveling abroad (excluding the Philippines). Under FMP, VA pays for certain necessary medical services associated with the treatment of those service-connected conditions.
If you have been rated permanently and totally disabled due to a service-connected disability, your dependents may be eligible for the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA). This program is a comprehensive health care program in which the VA shares the cost of covered health care services and supplies with eligible beneficiaries. Surviving spouses and children of certain Veterans are also eligible for CHAMPVA.
• Fact Sheet 20-01: Overview of Non-VA Care
A one-page information document that provides background information on the Care in the Community program.
• Fact Sheet 20-02: Non-VA Emergency Care
Document explaining what VA might be able to do for you if you need emergency care and it is not possible for you to go to a VA Medical Center.
• Fact Sheet 20-05: Ambulance Transport at VA Expense–A Guide for Veterans
Information on payment and authorization critieria for ambulance transport.
• Veterans Choice Program website
VA website containing information about Veterans Choice Program benefits and eligibility.
• VA Health Benefits website
VA website containing information about VA health care benefits and eligibility.
• Health Benefits Explorer
Answer a few questions about your military service to learn about the VA health care benefits you could receive as an enrolled Veteran.