VETERANS
Veterans Community Care
Introduction
As a Veteran, you may have access to a broader network of medical care outside the U.S. Department of Veteran’s Affairs (VA). An estimated 500,000 Veterans in the VA system have prostate cancer1. It is critical for patients to have more options to get treatment and medical care that may be closer to home and easier to access.- New options for Veterans are available as a result of recently passed legislation for better access and greater choice in health care within the VA and in the Community Care Network.2
- Every Veteran is already enrolled in the Community Care Network, but there are a few steps to get started.
New Care Options for Veterans
The first step is to meet with your VA physician and discuss your care and treatment options. In order for a Veteran to receive care through the VA Community Care Network, a VA staff member must determine if at least one of the following criteria is met:- It is in the Veteran’s best medical interest, as determined by the VA provider.
- A service is needed that is not available at a VA medical facility. Veteran lives in a US state or territory without a full-service VA medical facility.
- Veteran qualifies under the “Grandfather” provision related to distance eligibility for the Veterans Choice Program.
- VA cannot provide care within certain designated access standards
- For average drive time to a specific VA medical facility, the access standards are 30-minute average drive time for primary care, mental health care, and non institutional extended care services or a 60-minute drive for specialty care.
- For appointment wait times at a specific VA medical facility, the access standards are 20 days for primary and mental health care, and non institutional extended care services or 28 days for specialty care.
- Veteran needs care from a VA medical service that VA determines is not providing care that complies with VA’s quality standards.
VETERANS
Important Details
The next step for those who qualify:
Your VA Physician will refer your care to the appropriate provider, either TriWest or Optum (see the below map to determine coverage based on your location). The provider will make your appointments and contact you. You may also be eligible for self-service appointment scheduling. If you have a referral and have not heard from either provider, contact the VA to ensure your referral is correct and has been issued.
If you need to contact TriWest or Optum directly:
call 1-855-PCCCVET (722-2838)
Monday through Friday
8:00 a.m. – 8:00 p.m. in your local time zone
Monday through Friday
8:00 a.m. – 8:00 p.m. in your local time zone
Optum home page:
https://bit.ly/2ZPrPA3
VA Community Care Network
https://bit.ly/2O6eJsT
References:
1) Richman, Mike. VA, Prostate Cancer Foundation seek solutions for aggressive prostate cancer. VA. Published November 13, 2019. Accessed August 18, 2020. https://www.research.va.gov/currents/1119-VA-and-Prostate-Cancer-Foundation-seek-solutions-for-aggressive-prostate-cancer.cfm
2)Text – H.R.6285 – 116th Congress (2019-2020): Veterans’ True Choice Act of 2020. Published March 13, 2020. Accessed August 18, 2020. https://www.congress.gov/bill/116th-congress/house-bill/6285/text?r=2&s=1
3)Community Care – Community Care. VA. Updated August 27, 2020. Accessed August 18, 2020. https://www.va.gov/COMMUNITYCARE/programs/veterans/General_Care.asp
VETERANS
How it works
Example of a Veteran’s journey through the VA Community Care Network
To guide you through this process in more detail, please follow these steps below.Eligibility
1
Veteran seeks care from VA.
2
VA determines, based on community care criteria, that the Veteran is eligible for community care for this medical need.
Appointments
3
VA engages your practice to accept referral and method of delivery (referral packet includes medical record).
4
Once referral is accepted, either VA schedules appointment with community care provider or Veteran schedules appointment.
Getting Care
5
Veteran receives care from your practice.
6
Provider sends medical record to VA.
Billing
7
Provider bills Optum or TriWest for the care.
What About Prescription Medicine?
- For prescription medication, the prescription should be sent to and filled by the nearest VA pharmacy
- Veterans can receive prescription medication for a 14-day or fewer supply that can be filled at a non-VA pharmacy
- A prescription for more than a 14-day supply must be filled by VA
About the ZERO Veterans Initiative
ZERO is committed to bringing the Veterans community the resources, tools, and education needed to fight and prevent the disease.
Funding and Support provided by:
Reference:
4) Urgent Care – Community Care. VA. Updated September 21, 2020. Accessed August 18, 2020. https://www.va.gov/COMMUNITYCARE/programs/veterans/Urgent_Care.asp
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