VA Community Care Network (VACCN) Program Guide & Coverage

Home / Veteran's Insurance & Benefits for Rehab / VA Community Care Network (VACCN) Program Guide & Coverage
Published July 28, 2021 

 

According to the U.S. Department of Veterans Affairs, there are over 19 million U.S. Veterans as of 2021.1 The health concerns of veterans are unique, especially if they’ve seen combat. It’s not uncommon for them to have co-occurring disorders, such as post-traumatic stress disorder and addiction. In fact, estimates suggest that 1 in 10 of those Veterans has been diagnosed with a substance abuse disorder.2

Unfortunately, some Veterans may be hesitant to use the Department of Veterans Affairs (VA) for treatment of substance abuse. That may be due to long wait times, inconvenient locations, or a variety of other factors. The VA Community Care Network (VACCN) is a program designed to help veterans access critical care in a timely fashion. By connecting veterans with private facilities that work with the VA, the Community Care program helps veterans obtain life-saving healthcare. Ranging from medical care to mental health care to substance abuse rehab, the Community Care Network can be an important part of a veteran’s journey to recovery.

Table of Contents

What Is the VA Community Care Network (CCN)?

The VA Community Care Network is a program that connects veterans with private treatment facilities that work with and accept VA health insurance. As a result, these private Community Care partner facilities can step in and provide veterans with healthcare when the VA facilities are overburdened or do not have the types of programs that would assuage a veteran’s medical needs.

The VACCN is made up of 6 regional networks that cover all 50 states and U.S. territories. Although it isn’t completely deployed as of yet, it is being phased in with the intention of being the preferred network that the VA uses to purchase veteran care from community providers. Statistics are already showing that it’s being utilized more and more. In fact, the proportion of VACCN visits increased from 22.6% to 55.3% between 2015 and 2018.3

As for payments, veterans may be expected to pay copayments just as they would for any other VA service, per the VA Mission Act. However, they do not need to pay any copayment out-of-pocket at the time of care. Instead, any services they receive from a CCN provider will be billed just as any other VA service is billed.4

What Are the Benefits of the VA Community Care Network?

The VACCN is the result of the need for a high-performing, licensed community care program for Veterans who aren’t able to receive care at traditional VA medical centers. The VACCN was created with the shared goal of accountability, transparency, quality, and better coordination between preferred providers, veterans, third-party administrators (TPAs), and the VA itself. 5

Specifically, the VACCN will offer the following benefits for veterans who are seeking specialized care for substance abuse:6

  • Expanded health care services to eligible veterans who aren’t able to receive care from local VA medical centers.
  • Better customer service, as the community care program allows VA staff to work with veterans with support from TPAs.
  • Improved accountability, as TPAs will be monitored to make sure that VA preferred providers meet veterans’ needs and meet specific performance metrics.
  • Improved care coordination as the VACCN will have direct health information sharing capabilities between the VA and preferred providers in the community.
  • Improved referral process that allows VA staff to directly refer Veterans to community providers.
  • Improved scheduling capabilities as veterans can either schedule their own appointments or with the help of the VA.
  • A better way of paying providers, as TPAs will be responsible for directly invoicing the VA for reimbursement and for paying claims submitted by VA-preferred providers.

How Does Community Care Work?

The community care program is intended to help veterans seek care that they can’t get from the VA, whether due to difficulty reaching the VA facility or if the VA facility’s program is full or not available to the veteran. If this happens, the veteran would then start the process of seeking care from an approved community care provider. For example, American Addiction Centers (AAC) is considered to be one of those approved VA preferred providers. If a veteran is unable to obtain substance abuse treatment at a VA facility, they can be approved by the VA to attend treatment at an AAC facility.

The process for veterans seeking care is simple:7

  1. Contact the VA for approval to seek care from a community care program provider. They will determine eligibility.
  2. Once authorized, the veteran can either search for a preferred VA provider themselves or with help from VA staff.
  3. The Veteran schedules the appointment and notifies the VA of the upcoming appointment.
  4. The VA sends a referral to the veteran and to the provider.
  5. The veteran receives care at their scheduled appointment.
  6. The VA preferred provider sends a claim to the TPA for payment from the VA.

It’s important to realize that, despite the ability to receive care from the VA, it’s also beneficial to have private health insurance. Private insurance does not affect eligibility for VA care. Instead, it simply supplements any non-service-related care a veteran may receive. If a veteran does receive care that isn’t covered by the VA, the VA can then bill the private health insurance, whether it’s their own policy or a spouse’s policy under which they’re covered.8 If you are eligible for Medicare or Medicaid, you may be able to use these to help cover the costs of treatment associated with Community Care partners. However, whether or not you can use Medicare or Medicaid depends on whether or not the facility you are attending accepts those insurances. It’s important to communicate with the VA and the Community Care facility you’re thinking about attending to determine the extent of your coverage.

Is VA Community Care Different from VA Benefits?

It’s important to note that the VA Community Care Network is separate from the VA. However, if a veteran meets the VA’s eligibility requirements and the VA cannot provide the care the veteran needs, then the care may be paid for by the VA.

If the care is authorized from a VA-preferred provider in the VACCN, then the VA covers that payment. However, if the care they receive isn’t related to a service-related ailment, then they may be charged a copay.4 Alternatively, the VA may bill the Veteran’s private health insurance, if they have it.8

How Much Does Community Care Cost?

The cost of care from the VACCN varies, depending primarily on the patient’s needs and the community care facility they attend. The cost also depends upon the veteran’s income on file in the VA’s health care system.9 The veteran does not have to pay this copay upfront. Instead, it is billed to the veteran after they receive care.4 It’s important for veterans to communicate with the VA and relevant community care partners to determine the cost of treatment.

Does VA Community Care Affect Medicaid or Medicare Coverage?

The VA’s community care program does not affect Medicaid or Medicare. Unlike private health insurance, the VA cannot bill Medicare or Medicaid for services rendered. However, the VA may bill any Medicare supplemental health insurance held by the veteran if they receive non-service-related care.8

Am I Eligible for Community Care?

In order to be considered eligible for substance abuse treatment at a community care facility, a veteran has to receive approval, which is dependent upon their personal health care needs and circumstances. There is no need to enroll in the community care program, but the veteran still must be eligible for VA care and enrolled in the VA health care system.

Specifically, a veteran must meet one of six criteria in order to be considered eligible for care from the VACCN:10

  • The care the veteran needs isn’t available from the nearest VA medical facility.
  • The veteran lives in a U.S. state or territory that lacks a full-service VA medical facility.
  • The veteran cannot meet any of the access standards:
    • A 30-minute or less drive time for primary care;
    • A 60-minute or less drive time for specialty care;
    • The ability to book an appointment within 20 days for primary care; or
    • The ability to book an appointment within 28 days for specialty care.
  • The services saught are in the best medical interest of the veteran;
  • The VA can’t provide care within the designated access standards; or
  • A particular VA healthcare service is not meeting quality standards.

Can My Family Members Go to Community Care Providers?

Yes, there are some situations in which family members of veterans may be able to seek care from Community Care program providers. The programs that may allow family members to seek care from the VACCN include the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA) and the Camp Lejeune Family Member Program (CLFMP), among others. These programs may reimburse any costs that family members (beneficiaries) may be required to pay out-of-pocket for their care.11

How Do I Find a VA Community Care Network Provider?

Before seeking out a CCN provider, it is important to make an appointment with the VA for prior authorization. Only after receiving authorization can you search for a VA-preferred provider, using the Veteran Affair’s location finder.

After finding a provider, then you can schedule an appointment. After scheduling the appointment, it is also important to inform the VA of your appointment, at which point they’ll send your referral to the provider.

Do I Need a Referral from the VA to Visit a CCN Provider?

Yes, you need a referral from the VA in order to visit a CCN provider. The referral is what authorizes the Veteran to obtain care from the community provider. In the absence of a referral, the VA cannot pay for care received.

Do not contact the CCN provider directly for the referral. Instead, contact the VA first. The VA will then send a referral both to you and to the selected community provider. Then, you are free to schedule the appointment.

What are the CCN Regional Networks?

The VACCN has an established set of 6 regional boundaries across the United States in an effort to optimize access to healthcare for veterans. Each regional network serves as the contract vehicle for VA to purchase care within the community. The regional networks were created with a focus on transparency, accountability, quality, and increased communications between the VA and veterans seeking substance abuse treatment at a community care facility.

How Do Rehab Programs Qualify for the Community Care Network?

Rehab programs for veterans with addiction and co-occurring mental health diagnoses are typically covered by the VA thanks to The MISSION Act, which makes coverage more accessible to veterans. One such rebab program is AAC’s Salute to Recovery, created exclusively to allow veterans to seek treatment that is specifically tailored to their needs.

In order for AAC (or any provider) to be considered a VACCN Community Care partner, the provider is held to exceptional standards of care. American Addiction Centers (AAC) is a Community Care Partner, which means that veterans can receive excellent care from any of our facilities when they require rehab for substance abuse, providing its authorization from the VA.

Sources

  1. Pew Research Center. (2021). The changing face of America’s veteran population.
  2. National Institute on Drug Abuse. (2019). Substance Use and Military Life DrugFacts.
  3. 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, p S292-S300.
  4. U.S. Department of Veterans Affairs. (2019). Veteran Community Care: Billing and Payments.
  5. U.S. Department of Veterans Affairs. (2021). Community Care Network.
  6. U.S. Department of Veterans Affairs. (2021). Community Care Network (CCN) Fact Sheet.
  7. U.S. Department of Veterans Affairs. (2021). Community Care.
  8. U.S. Department of Veterans Affairs. (2020). Community Care: Health Insurance.
  9. U.S. Department of Veterans Affairs. (2019). Copayments.
  10. U.S. Department of Veterans Affairs. (2019). Veteran Community Care Eligibility.
  11. U.S. Department of Veterans Affairs. (2019). Information for Dependents.