VA MISSION Act & VA Community Care Program for Veterans
In 2019, legislation called the MISSION Act was passed to increase a veteran’s ability to access needed healthcare services. The MISSION Act made it easier for veterans to receive all types of medical and behavioral health services from non-VA providers in their communities.1 (top & middle)
What Is The VA MISSION Act?
The MISSION Act was created to provide veterans a wider array of healthcare options in their communities. It was designed to enhance, rather than replace, VA services, with a particular goal of improving veterans’ access to both urgent care and community care.1
The VA implemented this as a replacement for the Veterans Choice Program (VCP), which allowed veterans in some circumstances to be treated in non-VA facilities.1,2 The MISSION Act allows veterans to use community providers that are in the VA network. Veterans who are eligible for community care are not obligated to use it; they can choose a VA facility if that is their preferred option.2
In most cases, veterans who do wish to utilize community care still need to start with the VA to determine if they are eligible before initiating care at a CCP. VA staff will usually make any determinations regarding eligibility.2 In most cases, the VA will coordinate treatment and make appointments for the veteran, though in some cases the veteran may be able to schedule his or her own appointment.2
The MISSION Act improves a veteran’s ability to access community care, streamlines processes and guidelines for better customer service, and requires timely payments to the care provider—all of which improve the experience of treatment-seeking for the veteran.2
Finding a Rehab in the VA Community Care Network
Community care providers (CCPs) are non-VA providers of all types who have agreed to become part of the VA network and accept VA reimbursement for healthcare services provided to veterans. Although the MISSION Act increases a veteran’s ability to access community care, this doesn’t mean that a veteran can go to any provider that he or she chooses.
The provider must be community care provider-certified with the VA. The CCP will be paid by the VA directly.3 There may be a copayment for services, and the veteran may be able to use additional healthcare coverage such as TRICARE, Medicaid, and/or Medicare.4
To locate a CCP you can go through the VA website. The CCP networks are divided into 6 regions across the United States. Regions 1, 2, and 3 are managed by a third-party administrator called Optum. Their website offers a way to search for CCPs.3
Region 4, which covers Nevada and surrounding states is managed by Triwest.3
Regions 5 and 6 cover Alaska, American Samoa, Guam, and the Northern Mariana Islands.3
Community Care Providers in the American Addiction Centers Network
American Addiction Centers, the parent company of Greenhouse Treatment Center, currently has two facilities that are approved by the VA as community care providers.
Each CCP in the AAC network offers a program tailored to the unique needs of veterans who are struggling with addiction and co-occurring mental health disorders. Many of the staff members are veterans, which helps them relate to other veterans’ challenges.
One unique feature of these veterans’ programs is that all patients live together and receive treatment as a group. During the program, the veterans in the program form a “battalion”—a group of people working toward recovery together who understand each other’s struggles and who can act as a lifelong support network.
Community Care Eligibility
Eligibility for community care is not automatic for all veterans. Specific criteria must be met for a veteran to get treatment through a CCP, rather than the VA. The VA makes the final determination if a veteran is eligible for community care, but at least one of the following criteria must be met:5
- A veteran needs treatment that is not available through the VA. For example, a female veteran who requires maternity care, which is not available through the VA, may be eligible to go to a CCP.
- A veteran lives in an area without a full-service VA facility, which would include U.S. territories such as the U.S. Virgin Islands, Guam, and American Samoa, as well as the states of New Hampshire, Hawaii, and Alaska. The veteran is eligible under “grandfathered” distance provisions. Under the Veteran’s Choice Act, veterans who lived more than 40 miles from a VA were generally eligible for community care. If the veteran continues to live in such an area, they may be able to receive community care if they live in Montana, North Dakota, South Dakota, Alaska or Wyoming, or if they live in another state AND received care between June 6, 2017 and June 6, 2018 AND requires care before June 6, 2020.
- The VA is not able to provide care within certain standards of wait time for appointments, which generally means that the VA must be able to provide an appointment for a veteran for general medical or mental health care within 20 days. For specialty care, the days until an appointment must be no more than 28 days. If the VA cannot provide the veteran treatment during this time period and the veteran does not agree to the delay, the veteran can seek care through a community provider.
- It takes the veteran more than 30 minutes to get to a general care appointment or more than 60 minutes for specialty care appointments.
- The veteran needs specialized care that is not available at the VA and the veteran and referring doctor agree that it is in the veteran’s best interest to get this care from a community provider. For example, if the VA does not have an expert on staff to treat a particular type of cancer, and a community provider can give the veteran the expert care, the VA can approve for the veteran to obtain this specialty treatment.
- The VA services provided don’t meet the criteria for what would be considered quality care.
Frequently Asked Questions about Community Care
Some of the most commonly asked questions about community care are included below.5
How does the VA determine if I am eligible for community care?
You can view the section above for general eligibility criteria. The VA will also work with you to determine if you are eligible to receive care with a CCP.
Do my community care appointments have to be authorized in advance?
Generally, yes. The VA must authorize your appointments ahead of time in most cases, unless you are visiting an urgent care center in the VA network.
If I reside close to a VA center, can I still get community care appointments?
Maybe. Under certain circumstances, even if you live close to the VA, you may qualify for community care. For example, if the VA cannot give you a routine care appointment within 20 days, you may be able to obtain a community care authorization through the VA.
Do I have to use community care?
No, you can still choose to access services at the VA, even if you qualify for community care.
The VA doesn’t offer the service I need. Does this mean I can automatically get community care without going through the VA?
No. You may very well be eligible to receive community care through the VA, but you still need to go through the VA to ensure that this is the case.
- U.S. Department of Veteran Affairs. (2019). VA launches new health care options under MISSION Act.
- U.S. Department of Veteran Affairs. (2019). Veteran community care: General information.
- U.S. Department of Veteran Affairs. (2019). Community Care.
- U.S. Department of Veterans Affairs. (2019). Enhanced VA options under the MISSION Act.
- U.S. Department of Veteran Affairs. (2019). Fact sheet: Veteran community care eligibility.