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VA Community Care Network Program Guide & FAQs

On this page, you will learn about VA Community Care Program coverage for substance abuse treatment and how to confirm what benefits are available under your specific plan.
If you or a loved one are experiencing a medical emergency, call 9-1-1 immediately.
VA Community Care Program INSURANCE FOR ALCOHOL and DRUG ADDICTION TREATMENT

Provider Overview

VA Community Care Program & American Addiction Centers

Military veterans are one of the most high-risk population groups for developing substance abuse disorders (SUD), particularly when accompanied by co-occurring mental health issues. This is partly due to various stressful aspects of military service and deployments and the unique military culture that might lead to overlooking or oversimplifying potential mental health and SUD issues. Many veterans feel discouraged from seeking treatment out of fear that it would negatively impact their military career. This is why providing adequate help and guidance to military veterans is essential for their wellbeing.1

The largest integrated healthcare system in the U.S., VA Health Administration, maintains a network of healthcare providers that aim to ease veterans back into a healthy lifestyle through programs such as VA Community Care.2 As one of the community care providers (CCP) in this network, the American Addiction Centers (AAC) collaborates with VA toward this goal. Through its Salute to Recovery program, approved by the VA, AAC employs specialized approaches and treatment to help military veterans recover from addiction, as well as any accompanying mental health issues.

What Does the Veterans Affairs Community Care Program Offer?

The VA Community Care is a program that enables veterans to receive health care outside of VA by referring them to providers in the local community. CCPs are generally private treatment facilities that accept VA health insurance. The VA network of private providers serves as a safety net for individuals who can’t receive appropriate care through the Department of Veterans Affairs.3

Veterans are eligible for community care programs when VA is not able to provide the kind of care they need, according to a determined set of conditions. CCPs provide health care on behalf of the VA, so this organization covers the costs of substance abuse treatment.4

However, community care has to be authorized before a veteran can go to a local community provider. VA Community Care eligibility is determined according to a set of criteria, and each veteran’s needs and circumstances are taken into consideration.5

Who Can Qualify for the VA Community Care Program?

Eligibility depends on the individual healthcare needs and circumstances of each veteran and is determined on a case-to-case basis. In most cases, veterans need to get VA approval before they can go to a community provider. The main condition is to be enrolled in VA health care already or be eligible for it. VA staff members are responsible for determining eligibility.6

Eligibility is determined by meeting at least 1 of the 6 requirements. Veterans get approved for community care if:7

  1. The nearest VA facility can’t provide the care or service they need.
  2. There are no VA facilities that provide full-service assistance in the state or territory of the veteran’s residence.
  3. The veteran qualifies under the “Grandfather” eligibility provision regarding Distance Eligibility for VCP.
  4. Healthcare services are not accessible to the veteran, because:
    1. They must drive 30+ minutes for primary, and 60+ minutes for specialty care.
    2. There are no free appointments within 20 days for primary, and 28 days for specialty care.
  5. Both the veteran and referring clinician agree the veteran’s best medical interest requires service from a community provider.
  6. The VA is unable to provide care that meets designated quality standards within their facility.

What Does VA Community Care Entail?

VA Community Care is a program through which the VA provides health care to veterans by referring them to outside local community providers. Veterans may be eligible for these services when the VA can’t provide them with the necessary care, and when certain conditions and eligibility criteria are met. This needs to be authorized by the VA before a veteran can schedule appointments and receive services from community providers.5 

If it’s determined that the VA medical center is unable to provide the necessary service, an appropriate outside provider is found, taking into consideration the veteran’s specific needs and circumstances. VA notifies both the patient and community service provider about the referral. The appointment can be scheduled directly by the veteran, or VA staff members can do it for them. Referral information about the appointment and the veteran’s medical documentation are then sent to the community provider.6

What Are the Costs of Community Care Services?

Any condition, illness, or injury related to your military service (as determined by the VA) makes you eligible for free VA health care. Most medical services are completely free and don’t require any copay. Some veterans are entirely “exempt” from copays depending on their income, disability, or other special eligibility factors. Some services, like readjustment counseling or additional mental health services, including SUD treatment, are provided for free.8

In the case of non-service-connected healthcare services, veterans are typically charged a copayment. Alternatively, if the veteran has other health insurance that may cover treatment, VA may charge them for services, supplies, and medication necessary for the treatment of such conditions.6

Copay rates, as of January 1, 2022, are as follows:8

  • Urgent care: Depending on the priority group and the number of visits, urgent care can be free or require a $30 copay for each additional visit.
  • Outpatient care: $15 for primary care visits to $50 for specialty services or tests.
  • Inpatient care copay rates depend on priority group and the length of stay. 

How’s the Veteran Affairs Community Care Program Different From the VA Choice Program?

To comply with the MISSION Act of 2018, the Veterans Choice Program (VCP) was replaced by a program called Veterans Community Care (VCC). VCP officially ended on June 6, 2019. The new VCC Program has simplified the process of providing health care to veterans to make the needed services more readily available.9

In comparison to the old VCP, the VCC program offers more choices to veterans:9

  • Expanded eligibility criteria comprise six requirements. New standards for drive and wait times offer easier access to community healthcare services.
  • The billing process is simplified by having a single community care program, enabling timely payments to community providers and making it easier and faster to find appropriate care.
  • Improved coordination and customer service. The internal process was reorganized to provide better coordination between VA and community providers, which makes scheduling appointments easier.
  • Better urgent care benefits. Access to immediate/urgent care at clinics and providers within the VA network without waiting for VA authorization for minor injuries and illnesses.

What Benefits Can the VA Community Care Program Network Offer?

Eligible veterans have access to a wide range of essential health benefits and medical assistance. All enrolled veterans get a Medical Benefits Package, which includes:10

You can check eligibility by visiting the Basic Medical Benefits Package for Veterans web page or by calling the Veterans Community Care program phone number: 877-881-7618. This program may also give you access to some specialized healthcare programs like Mental Health Services.10 

Both general and specialty mental health services are provided to veterans to treat a wide range of mental health conditions including SUDs, PTSD, and other mental health issues in outpatient and inpatient settings. Some veterans might have access to additional benefits based on their unique circumstances and needs.10 

It’s also possible to combine VA coverage with another insurance plan the veteran might have, so they might even cover private treatment centers with luxury amenities.5 Even when insurance doesn’t fully cover the needed substance abuse recovery services, this shouldn’t discourage you from getting help. It’s possible to find other ways to finance your treatment when it comes to serious matters like addiction. For instance, most rehab centers will typically accept cash.

What Types of Treatment Are Available to Veterans?

When treating veterans with substance abuse issues, it’s essential to focus on improving all aspects of one’s life. The stress of military service can have a significant impact on social connections. Veterans may feel like they don’t belong to a community outside the military. This is why it’s essential to work on communication skills, conflict resolution, and rebuilding relationships with loved ones by attending family or couples counseling.11  

Practicing more balanced and helpful thoughts and strengthening the motivation to change is the focus of evidence-based approaches, like:12 

  • Cognitive-behavioral therapy (CBT).
  • Dialectical behavior therapy (DBT).
  • Motivational interviewing (MI). 

After the initial steps of the intake and the assessment performed by trained professionals, there are various elements and approaches incorporated into SUD treatment, including:13

  • Safe, medically monitored detoxification.
  • Individual counseling and therapy.
  • Group and/or family therapy.
  • Relapse prevention skills.
  • Coping skills, to manage everyday life stressors.
  • Nature therapy and wellness activities.
  • Holistic approaches and therapies.

How to Find VA Community Care Network Providers

Eligible veterans can usually choose and alternate between VA medical facilities or community providers when they need medical care. If they choose to receive community care, a VA staff member will ask about their preferences when selecting a community provider. However, they must select a provider from the VA’s network. The veteran should, before scheduling an appointment, confirm with VA staff that they are authorized for community care.6

Veterans have several options for scheduling an appointment, depending on the service they need. A staff member can do it for them, or they can do it themselves. Instead of going through a VA community care provider list, they can use the VA facility locator tool to find both VA facilities and community care providers. After scheduling the appointment, the veteran should notify the VA about it so they can send the referral and patient’s medical documentation to the provider.6

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Sources
  1. National Institute on Drug Abuse. (2019). Substance Use and Military Life DrugFacts.
  2. U.S. Department of Veterans Affairs. (2021). About VHA.
  3. U.S. Department of Veterans Affairs. (2019). How to become a VA community provider.
  4. U.S. Department of Veterans Affairs. (2021). Community Care Overview.
  5. U.S. Department of Veterans Affairs. (2021). Veterans Overview.
  6. U.S. Department of Veteran Affairs. (2021). Community Care.
  7. U.S. Department of Veterans Affairs Administration. (2019). Veteran community care eligibility.
  8. U.S. Department of Veterans Affairs. (2021). 2022 VA health care copay rates.
  9. U.S. Department of Veterans Affairs. (2019). Veteran Community Care: Previous and Current State.
  10. Benefits.gov. (2021). What Medical Benefits are Available for Veterans and Their Families?.
  11. Teeters, J. B., Lancaster, C. L., Brown, D. G., & Back, S. E. (2017). Substance use disorders in military veterans: prevalence and treatment challenges. Substance abuse and rehabilitation, 8, 69–77.
  12. U.S. Department of Veterans Affairs (2021). Substance use: Treatment.
  13. National Institute on Drug Abuse. (2018). Principles of Drug Addiction Treatment: A Research-Based Guide (Third Edition): Drug Addiction Treatment in the United States.
  14. Benefits.gov. Pharmacy Service.
  15. U.S. Department of Veterans Affairs. (2021). File a Claim for Veteran Care.
  16. U.S. Department of Veterans Affairs. (2021). Provider Education and Training Resources.
  17. U.S. Department of Veteran Affairs. Office of Public and Intergovernmental Affairs. (2019). VA launches new health care options under MISSION Act.
  18. U.S. Department of Veterans Affairs. (2019). Information for Dependents.
  19. Benefits.gov. (2021). What Medical Benefits are Available for Veterans and Their Families?.
  20. U.S. Department of Veterans Affairs. (2022). Patient-Centered Community Care–Information for Providers.
  21. Hynes, D. M., Edwards, S., Hickok, A., Niederhausen, M., Weaver, F.M., Tarlov, E., N … Laliberte, A. (2021). Veterans’ Use of Veterans Health Administration Primary Care in an Era of Expanding Choice. Medical Care, 59, S292-S300.

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Frequently asked questions

Does the VA Cover Prescription Medication?
Prescriptions for enrolled veterans are usually filled by the nearest VA pharmacy. Only VA can fill prescriptions for more than two weeks’ worth of medication.6 It’s also possible to send VA prescriptions to veterans’ homes from a consolidated mail-out pharmacy.14 Copay is determined according to priority groups. Group 1 is exempt from copay for any medications, while other priority groups have to copay for:8 Medications for non-service-connected conditions. Over-the-counter medications. The cost for medications received during a stay at a VA or other approved healthcare facility is covered by inpatient care copay. Veterans with a service-connected rating of 40% or less and an income below the national average may qualify for free medications.8
How Does VA Authorize Eligibility?
Authorization review is the process of determining the eligibility of each veteran to be enrolled in the VA community care program. This is done by contacting VA staff to submit claim information. When the VA commission determines that conditions are met, veterans get approved for such medical care.6 It’s important to note that all non-urgent care requires authorization in advance. A private facility can approve only emergency care. Only in this case, the eligibility information is provided after the patient has been admitted for care and the VA has been notified. Until the claim is reviewed and authorized, VA isn’t typically liable for paying any medical expenses.15
How Does AAC Work With VA to Offer Quality Care and Treatment for Veterans?
Providers that want to join the Veterans Affairs Community Care Network are held to exceptional standards of care. Since AAC is a Community Care Partner, veterans and their families can rest assured that all the AAC facilities offer the highest standard of care regarding substance abuse treatment. When military veterans get approved for community care, the VA may cover their treatment at one of the numerous AAC facilities across the U.S.16 Thanks to The MISSION Act, SUD treatment programs for veterans are covered by the VA, along with co-occurring mental health diagnoses. AAC’s Salute to Recovery is one of the exclusively designed programs that offer specifically tailored treatment for veterans. The focus of this program is treating co-occurring disorders, to help veterans suffering from addiction and mental health issues like PTSD, depression, and anxiety.17 If you’re unsure about the severity of your issues, free addiction hotlines can guide you in the right direction. You can get the information you need and be certain that the confidentiality of your medical information is guaranteed by law. AAC admissions navigators can also provide information about payment options, or you can check your coverage by submitting an online form.
Do Veterans’ Family Members Get Coverage for Community Care Services?
There are cases in which the VA provides coverage for healthcare services to family members of military veterans. This also depends on a set of conditions and eligibility requirements. If a specified service is covered, the VA usually reimburses the costs after it’s provided.18  Family members can use community care services through the Health Care Benefits for Dependents (CHAMPVA) program. The VA shares the cost of treatment with eligible beneficiaries of this program. To be eligible for CHAMPVA, the spouse or child of a veteran can’t be eligible for TRICARE/CHAMPUS, and the veteran must belong to one of these categories:19 Rated permanently disabled by a VA regional office. Died from a service-connected disability. Deceased veteran with a permanent service-connected disability at the time of death. Died in the line of duty (however, these family members are usually eligible for TRICARE, not CHAMPVA). You can check your eligibility on the CHAMPVA benefits page or use Benefit Finder to look for other options and programs you might be eligible for.19
What Are the Community Care Regional Networks?
Regional CCNs are the VA's connection to private healthcare providers. All 50 states and U.S. territories are divided into five regional networks. Each group of states forms a network that VA can use to acquire and administer healthcare services from community providers.20 VA CCN is still not fully implemented, but the transition is being phased in, region-by-region, so the VA can manage the network to its full potential. Between 2015 and 2018, the proportion of VA CCN visits has increased from 22.6% to 55.3% and VA aims to make it the preferred VA network.21
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