Community Care Overview

Eligibility for Community Care Outside VA

You must meet both of these requirements:

• You’re enrolled in or eligible for VA health care, and
• You have approval from your VA health care team before you get care from a community provider (except for certain cases like urgent or emergency care)

And you must meet at least one of these requirements:

• You need a service that we don’t provide at any VA health facility, or
• You live in a state or territory that doesn’t have a full-service VA health facility, or
• You qualified under the 40-mile distance requirement on June 6, 2018, and live in a location that would still make you eligible under these requirements, or
• We can’t provide the care you need within our standards for drive and wait times, or
• You and your VA provider agree that getting care from an in-network community provider is in your best medical interest.

Process to get care with an in-network community provider

Find an in-network community provider - search or ask your VA health care team to find a provider for you.

Get a referral from your VA health care team - Ask your VA health care team for a referral to the community provider.

Schedule your appointment - schedule your appointment yourself. Or you can ask your VA health care team to schedule for you.

Make sure you have your authorization letter - After you schedule an appointment, we’ll send you your authorization letter. This letter is your approval for community care.

Go to your appointment - We’ll share your medical records with the community provider. But be sure to bring copies of any images (like CT scans or MRIs) that the provider asks you to bring with you.

Keep track of ongoing appointments and referrals - If we approve you for continued care, you can schedule follow-up appointments with the provider.

Community Urgent Care Services

If you believe you are experiencing an emergency, a life-threatening illness or medical episode, such as a heart attack or stroke, call 911 and go to the nearest hospital.

You may be eligible for coverage of an emergency visit and/or admission, even if admitted to a non-VA facility. Please notify VA to see if you qualify.

Notification within 72 hours of your illness or episode must be made by you or someone on your behalf (such as a loved one or medical staff at another facility). Please call to speak with the Eligibility Office.

In addition, notification of your PACT must also be made.

Urgent Care MUST be In-Network. To identify if the Urgent Care is In-Network, a Veteran can go online - https://www.va.gov/resources/getting-urgent-care-at-va-or-in-network-community-providers

Community Care Business Manager

Office:

FDR Campus: 2094 Albany Post Rd. | Montrose, NY 10548

Castle Point Campus: 41 Castle Point Rd. | Wappingers Falls, NY 12590