VA Community Care Network: Getting Care Outside the VA
The VA Community Care Network (CCN) is the contracting and administrative framework through which the Department of Veterans Affairs pays for healthcare delivered by private-sector ("community") providers when VA facilities cannot meet a veteran's medical needs. Established under the VA MISSION Act of 2018 (Pub. L. 115-182), the CCN replaced the older Veterans Choice Program and reorganized community care delivery into six regional contract networks managed by third-party administrators. Understanding when VA authorizes outside care — and what conditions govern that authorization — is essential for any enrolled veteran seeking specialists, hospitals, or services unavailable through a VA medical center.
Definition and scope
The Community Care Network operates as the procurement structure beneath the broader Veterans Community Care Program (VCCP), the statutory mechanism codified at 38 U.S.C. § 1703. VA contracts with regional third-party administrators — not a single national managed care organization — to build and manage provider networks across six geographic regions covering all 50 states, the District of Columbia, Puerto Rico, the U.S. Virgin Islands, and Guam. Implementing regulations appear at 38 C.F.R. Part 17, subpart B.
The CCN is available only to veterans already enrolled in VA healthcare. It does not extend to dependents or survivors. Eligible services span primary care, mental health, specialty care, emergency care, and certain dental and maternity services. Crucially, the CCN is not a self-referral system — the veteran must receive VA authorization before receiving non-emergency community care, or risk bearing the cost personally.
The program's national footprint reflects the scale of VA's beneficiary population. According to the VA National Center for Veterans Analysis and Statistics, approximately 18.6 million veterans were living in the United States as of 2022, and VA has steadily expanded community care utilization as part of its MISSION Act implementation obligations. For veterans exploring the full range of programs available to them, the VA Benefits Overview provides orientation across healthcare, compensation, and other entitlements tracked across veteransauthority.com.
How it works
When a veteran needs care that VA cannot provide internally, the process follows a defined sequence:
- Referral request initiated — The veteran or their VA primary care team identifies a clinical need that a VA facility cannot meet within required standards.
- Eligibility determination — VA reviews whether one of the statutory eligibility criteria under 38 U.S.C. § 1703(d) is satisfied (detailed under Decision Boundaries below).
- Authorization issued — VA generates a referral authorization, typically transmitted to the regional CCN administrator (such as Optum Public Sector Solutions or TriWest Healthcare Alliance, depending on the region).
- Provider selection — The veteran selects an in-network community provider or, in limited circumstances, an out-of-network provider if no in-network option is reasonably accessible.
- Care delivered — The community provider renders services and bills the CCN administrator directly. The veteran generally pays no copay for authorized care, though copay rules mirror standard VA cost-sharing schedules based on the veteran's VA healthcare eligibility priority group.
- Claims adjudicated — The third-party administrator processes the claim and reimburses the community provider at rates set by VA, which are pegged to Medicare rates plus a percentage established in the CCN contract.
Emergency care operates differently: veterans may seek emergency treatment at any community hospital and notify VA within 72 hours. VA's obligation to cover unauthorized emergency care depends on additional conditions, including whether VA or another federal facility was not feasibly available.
Common scenarios
Three situations account for the majority of CCN authorizations in practice:
Access standard not met — VA establishes drive-time and appointment-wait standards. As of the MISSION Act implementation, VA's access standards set a 30-minute average drive time for primary care and mental health services, and a 60-minute standard for specialty care. If the nearest VA facility exceeds these thresholds, the veteran qualifies for community care. Appointment-wait thresholds are 20 days for primary care and mental health, and 28 days for specialty care, per VA's published access standards.
VA does not offer the service — Certain specialties — such as in vitro fertilization, some dental procedures, or highly specialized surgical subspecialties — may not be available at a given VA medical center. In these cases, VA may authorize community care regardless of geographic proximity.
Veteran's best medical interest — A VA provider may determine, based on clinical judgment, that community care is in the veteran's best medical interest. This criterion gives VA clinicians discretion to authorize outside care even when access standards are technically met.
Veterans managing service-connected mental health conditions or PTSD treatment frequently use CCN pathways to access community psychologists, psychiatrists, or counselors when VA wait times exceed the 20-day threshold.
Decision boundaries
The CCN authorization decision turns on six statutory eligibility criteria established under 38 U.S.C. § 1703(d). A veteran qualifies for community care if any one of the following conditions is met:
| Criterion | Description |
|---|---|
| Access standard not met | Drive time or wait time exceeds VA thresholds |
| Service not available at VA | The required service is not clinically offered |
| Best medical interest | VA clinician determines community care is clinically preferable |
| Qualifying veteran status | Certain veterans, such as those in highly rural areas, qualify categorically |
| State without full-service VA | Veterans in states with no full-service VA medical center |
| Unprecedented or unusual circumstances | Residual catchall for VA Secretary discretion |
CCN vs. Veterans Choice Program — The predecessor Veterans Choice Program, authorized by the Veterans Access, Choice, and Accountability Act of 2014 (Pub. L. 113-146), used a rigid 40-mile straight-line distance test and a 30-day wait threshold. The MISSION Act replaced those criteria with the more nuanced drive-time and appointment-wait standards above, and gave VA expanded authority to authorize care on medical-interest grounds — a significant structural difference that broadened access eligibility.
Veterans who are denied community care authorization may request a clinical appeal through their VA facility or escalate through the VA patient advocate system. Denials based on eligibility determinations — as opposed to clinical decisions — may also be addressed through the VA appeals process framework, though community care authorization disputes follow administrative rather than Board of Veterans' Appeals procedures.