Veterans needing healthcare often turn to Veterans Medical Centers (VAMCs). However, sometimes timely access to care outside the VA system becomes necessary. The Veterans Community Care (VCC) program is designed to enhance this access, aiming to reduce wait times and ensure veterans receive the care they deserve, acting as a vital Acute Care Program Vcc option.
The VCC program emerged as the successor to the Veterans Choice Program, aligning with the MISSION Act of 2018. This act mandated the VA to replace the Veterans Choice Program, which previously allowed veterans to seek care from community-based providers outside the direct VA network. Understanding the acute care program vcc means understanding this evolution.
Launched in 2013 as Patient-Centered Community Care in partnership with TriWest, the Department of Veterans Affairs continuously refined the VCC program. These improvements prioritize the patient’s needs, focusing on making healthcare more accessible and efficient, solidifying its role as an important acute care program vcc resource.
Several key enhancements were introduced to improve the acute care program vcc:
- Simplified Eligibility: The VCC program clearly defines six eligibility criteria, removing previous ambiguities about veteran qualification for community care.
- Unified Community Care: Consolidating various initiatives into a single community care program simplifies the process for veterans seeking outside care, making the acute care program vcc easier to navigate.
- Enhanced Customer Service: A comprehensive overhaul of internal processes included better education and communication for veterans, Veterans Service Organizations (VSO) partners, and VA staff involved in community care. This ensures smoother claims processing and payments within the acute care program vcc.
- New Urgent Care Benefit: Veterans now have direct access to urgent care clinics and walk-in providers within the VA network for immediate care needs without pre-authorization, a significant improvement within the acute care program vcc.
Eligibility for the Community Care Program
Referral from a VAMC is mandatory to access the Community Care program, an essential step to utilize the acute care program vcc benefits. Veterans must first be eligible for VA healthcare before seeking a community care referral. VAMC referrers determine eligibility based on these six criteria:
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Service Not Available at VA Center: If a veteran requires a specific medical service or care type that the VA does not offer at any of its facilities, they become eligible for the acute care program vcc.
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Distance from VA Medical Center: Veterans who reside a significant distance from a VA medical center in the U.S. may qualify for community care, making the acute care program vcc more accessible geographically.
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Grandfather Provision from VCP: Veterans previously under the Veterans Choice Program (VCP) may still be eligible. Specifically, if a veteran lived over 40 miles from a VAMC before June 6, 2018, still resides there, and meets further criteria:
- Residing in North Dakota, South Dakota, Montana, Alaska, or Wyoming, OR
- Residing in another state, having received care between June 6, 2017, and June 6, 2018, AND requiring care before June 6, 2020. This grandfather clause ensures continued access to the acute care program vcc for those previously reliant on VCP.
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Unmet VA Wait Time Standards: Veterans have the right to timely care, including appointment scheduling, travel, and wait times. Exceeding standard wait times at VAMCs justifies VCC services. Typical VA access standards include:
- Primary Care, Mental Health, and Non-Institutional Extended Care: 30-minute average drive time.
- Specialty Care: 60-minute average drive time.
- Standard appointments should be within 20-28 days. If these timeframes aren’t met, the acute care program vcc becomes a viable option.
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Best Interest of the Veteran: When community care is deemed to be in the veteran’s best medical interest, referral to the acute care program vcc is warranted.
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VA Quality Standards Not Met: If a veteran feels they are not receiving adequate care at the VAMC, the VA will assess quality standards. If these standards are not met, a referral to the VCC, as an acute care program vcc alternative, will be considered.
Types of Patient-Centered Community Care
The VCC program, acting as an acute care program vcc resource, provides various care types, including:
- Primary Care
- Inpatient Specialty Care
- Outpatient Specialty Care
- Behavioral Health Care
- Limited Newborn Care for Post-Operative Enrolled Female Veterans
Services Not Covered by VCC
It’s important to note what the acute care program vcc does not include:
- Dental Care
- Nursing Home Care
- Long-Term Acute Care Hospitals (LTAC)
- Homemaker and Home Health Aide Services
- Chronic Dialysis Treatments
- Compensation and Pension Examinations
How to Find a Provider
To utilize the acute care program vcc, veterans must first obtain authorization from their VA Medical Center for primary or specialty care.
Once authorized, TriWest Healthcare Alliance will contact the veteran to schedule an appointment. TriWest handles provider research, simplifying the process. Veterans should ensure their VAMC has their complete medical file to facilitate a smooth referral to the acute care program vcc.
Urgent Care Access Improvements
The VCC program has significantly improved urgent care access, a crucial component of an acute care program vcc. Veterans can now visit participating non-VA urgent care facilities or walk-in clinics without prior VA authorization for immediate needs.
These urgent care facilities and walk-in clinics can address needs like flu shots, vaccinations, and other non-prolonged care requirements, enhancing the acute care program vcc’s responsiveness. However, follow-up care still necessitates VA authorization.
Medications Through VCC
Typically, veterans using the acute care program vcc must still obtain prescriptions from a VA pharmacy. However, in situations requiring immediate medication when a VA pharmacy cannot fulfill the prescription, a local non-VA pharmacy may dispense up to a 14-day supply. For medication needs exceeding 14 days, VA approval is necessary prior to filling the prescription. Veterans can seek reimbursement for any coverage gaps encountered.
Contact Information for VCC
For further assistance, TriWest phone lines are available from 8 a.m. to 8 p.m. at 855-PCCCVET (722-2838). Services are also available for veterans with hearing or speech disabilities seeking information about the acute care program vcc.
