Note: This article is one in a series on VA’s progress implementing the VA MISSION Act of 2018.
Under the VA MISSION Act, it will be easier for eligible Veterans to find a community provider in VA’s network, make an appointment, and get timely, high-quality care.
Veterans may have experienced issues with scheduling appointments and receiving care in the past. These problems are being addressed by making it easier for Veterans to schedule community care appointments themselves, with the help of a VA staff member, or with the help of a third-party administrator (TPA). VA is also rolling out new technology that improves communication and coordination between Veterans, community providers, and VA employees.
While accessing community care will become easier in the future, it’s important to know that Veterans eligible for community care will generally still have the option to choose to receive care from a VA medical facility or community provider.
After a Veteran is determined to need treatment and found eligible for community care, he or she will generally have the option of choosing to receive care from a VA medical facility or community provider.
Finding a Community Provider
Community care is available from a broad range of community providers in VA’s network. VA’s network includes providers that participate in regional community care networks that are managed for VA by Third Party Administrators under contract with VA, as well as other community providers with whom VA contracts directly.
A VA staff member will discuss with an eligible Veteran who chooses to receive community care his or her preferences for getting care. For example, a Veteran may want to find a community provider that can see them sooner and is located near his or her home. Based on the discussion between the Veteran and the care team, VA will work with the Veteran to accommodate his or her preferences and select a community provider in VA’s network that’s currently available to provide that care.
Community providers in VA’s network can be found using VA’s Provider Locator, available from the following web address: https://www.va.gov/find-locations/. Note: Not all community providers in VA’s network and listed in VA’s Provider Locator will be available to provide community care, and VA might not be able to accommodate a Veteran’s preferences. If a Veteran expresses a preference for a specific community care provider in VA’s network, VA will determine if that provider is currently available to provide that care, and, if not, inform the Veteran and work with the Veteran to identify alternatives.
If none of the community providers in VA’s network are feasibly available, VA will work to add a provider to the network. If there is a specific community provider the Veteran would like to see that is not in VA’s network, VA may be able to add the provider to its network. However, this may take some time, and not all providers may want to be part of VA’s network. To see if it would be possible to add the provider to VA’s network, a VA staff member will work with the Veteran to find out more information about the specific community provider and determine next steps.
VA will send a referral to the Veteran and to the selected community provider. VA will also send any pertinent medical documentation to the community provider to ensure proper care coordination.
The VA referral is important because it authorizes the Veteran to receive care from the community provider. Without the referral, VA has not authorized and cannot pay for the care in most circumstances.
Once a referral is sent to the Veteran and the selected community provider, an appointment can be scheduled.
Veterans have several options when it comes to scheduling an appointment with a community provider. Depending on the type of care a Veteran needs, a VA staff member will work with the Veteran to determine which options are available.
- Veteran Directly Schedules Appointment – After a community care consult has been approved and a referral is sent to the selected provider, Veterans can directly contact the community provider in VA’s network to schedule an appointment. Afterwards, the Veteran provides the appointment information to a VA staff member as soon as possible in order to ensure tracking and continuity of care.
- Veteran Uses VA Online Scheduling to Schedule Appointment – Veterans may be able to request an appointment online using VA Online Scheduling for routine exams for Primary Care, Nutrition, Podiatry, Optometry, Audiology and Hearing Aid Support. VA Online Scheduling is accessible through MyHealtheVet (https://www.myhealth.va.gov/mhv-portal-web/keeping-up-with-your-va-appointments).
- VA Staff Member Schedules Appointment – Veterans can provide their appointment preferences (such as the specific provider, location, date, and time of day) to a VA staff member. Based on the Veteran’s preferences and the community provider’s availability, a VA staff member will work to schedule the appointment.
- VA TPA – In some cases for specific VA medical facilities, Veterans can provide their appointment preferences (such as the specific provider, location, date, and time of day) to a TPA. Based on the Veteran’s preferences and the community provider’s availability, the TPA will work to schedule the appointment.
When the Veteran arrives for the appointment, the community provider should have the appointment, VA referral, and pertinent medical documentation on file and be ready to see the Veteran.
VA will pay for or fill prescriptions written by community providers. For prescription medication longer than a 14-day supply, the prescription must be submitted to VA to be filled.
Note: As applicable, VA copayments apply for medication prescribed by a community provider.
The process and information above represents improvements to current practices rather than any major changes to how Veterans currently find a community provider, make an appointment, or receive community care. As VA continues to implement improvements to community care, Veterans can expect overall customer service to improve.
Written by VHA Office of Community Care