Primary care, mental health & non-institutional extended care
If VA cannot schedule the needed appointment within 20 days from the date of request, the Veteran may meet the wait-time access standard.
VA Community Care
THE MISSION ACT
The VA MISSION Act expanded access to community care for eligible Veterans when VA cannot provide the needed care under certain circumstances. Community care is part of VA care—not a separate private insurance program—and, in most cases, VA approval is required before treatment with a community provider.
The rule Veterans usually need to know first
WHEN VA CANNOT PROVIDE THE CARE SOON ENOUGH
A Veteran may be eligible for VA Community Care when VA cannot provide the needed care within its designated access standards. In most planned-care situations, VA still has to approve the community care and issue the referral before treatment begins.
Specialty care
If VA cannot schedule specialty care within 28 days from the date of request, the Veteran may meet the wait-time access standard.
30 MINUTESaverage drive time for primary care, mental health and non-institutional extended care
60 MINUTESaverage drive time for specialty care
Important: These are VA access standards for eligibility for community care. They are not a promise that a particular residential bed must be produced within 20 days. The specific level of care, referral and authorization still have to be established unless a separate urgent or emergency-care rule applies.
Other ways a Veteran may qualify
WAIT TIME IS NOT THE ONLY PATHWAY
Service unavailableVA does not provide the needed service at a VA facility.
Best medical interestThe Veteran and VA provider agree community care is in the Veteran’s best medical interest.
Quality standardsVA determines the needed service cannot be provided to its required quality standard.
No full-service VA facilityThe Veteran lives in a qualifying state or territory without a full-service VA medical facility.
Grandfathered Choice eligibilityCertain Veterans who qualified under the former distance rules may remain eligible.
How community care usually works
ELIGIBILITY IS NOT THE SAME AS AUTHORIZATION
Meeting an eligibility criterion does not automatically create an authorization for a specific provider or episode of care. In most non-emergency cases, VA must approve the community care and coordinate the referral before treatment begins.
01
VA identifies the need
A VA care team determines what service is needed and whether community care criteria apply.
02
VA approves community care
VA authorizes the care and creates or routes the referral through the appropriate Community Care pathway.
03
In-network provider
The Veteran generally receives authorized care from a provider participating in VA’s Community Care Network.
04
Care and claims follow the authorization
The provider documents and bills according to the authorized episode and applicable VA/network requirements.
Urgent and emergency care are different
DO NOT CONFUSE COMMUNITY CARE WITH EMERGENCY ACCESS
Urgent care and emergency care follow separate rules. Eligible Veterans may use in-network urgent care without a referral when they meet VA urgent-care eligibility requirements. For a medical emergency, Veterans should seek immediate emergency care; VA payment depends on the applicable emergency-care rules and eligibility. Emergent suicidal crisis care may fall under the COMPACT Act rather than ordinary MISSION Act community-care referral rules.
For questions about a planned referral, contact your VA care team or Community Care office.
Understanding Veteran care pathways