Community care: when VA must let you see a local doctor

What it is

The Veterans Community Care Program lets VA pay for care from a private, in-network provider near you when VA cannot give you timely or nearby care.

Who qualifies

You must be enrolled in or eligible for VA health care and have approval from your VA health care team before the care. Then at least one of these must apply:

• VA does not offer the service you need
• You live in a state or territory without a full-service VA medical facility
• Your VA provider agrees community care is in your best medical interest
• VA cannot meet its quality standards for the service
• You qualify under the 40-mile distance rule that applied on 6 June 2018, in certain states
• VA cannot give you care within its access standards (below)

The access standards

VA's own page lists these as a 30-minute average drive time or 20-day wait for primary care and mental health, and a 60-minute average drive time or 28-day wait for specialty care. The federal rule (38 CFR 17.4040) states the test as VA lacking a facility within the drive time and being unable to offer an appointment within the wait time.

How to get it, step by step

1. Find an in-network community provider yourself, or ask your VA health care team to help.
2. Ask your VA health care team for a referral. VA says the review takes up to 14 days.
3. Schedule the appointment yourself or have your VA team do it. If you schedule it, tell your team within two weeks.
4. VA sends an authorization letter with an authorization number and the approved provider and length of care.
5. Go to the appointment. VA shares your records with the provider. Bring any scans or images they ask for.
6. Track your approved visits. When they run out or the authorization is about to expire, ask your provider to submit a Request for Service, or ask your VA team for a new referral.

Provider says "we're waiting on VA"?

Precertification ended on September 8, 2026. VA's Community Care page says VA no longer requires precertification before providing authorized care, that the change has no impact on claims processing or payment, and that the VA Precertification Portal is offline.

• Care inside your referral and its Standardized Episode of Care (SEOC) can go ahead. VA describes an SEOC as a high-level summary of the typical scope of care and billing codes for a referral. It is not a full list of every service.
• Care outside it still needs a Request for Service (RFS). VA says the community provider submits an RFS when you need additional visits or time beyond the active referral (including when an authorization is about to expire), a new specialty referral, or a procedure or service not in the original SEOC. The provider must sign it. VA says it processes requests within 3 business days and notifies the provider.
• This is not open-ended authorization. Care that the referral or SEOC does not cover still goes through the RFS process.

Ask your provider:

1. Is this care already inside my referral and SEOC?
2. Are you waiting on the old precertification step? It no longer exists.
3. Was an RFS submitted for the additional care? If so, when?

If you get no clear answer, call your VA community care office or the VA health benefits hotline listed below.

Make sure your community care records reach VA

Records from a community provider do not always make it into your VA chart. VA's own Inspector General looked at this in a report issued August 7, 2025 (number 24-02154-154).

• What VA expects. The community provider returns your records to VA after the visit. A 2020 VA News notice encouraged providers to send documentation within 30 days of the service. It lists HealthShare Referral Manager, the Veterans Health Information Exchange, encrypted email and e-fax as ways to do it.
• What the Inspector General found. Of nearly 3 million community care consults closed from October 2023 to April 2024, over 2.4 million (82 percent) had medical records attached. Staff often received records by e-fax and then renamed and uploaded the files by hand. 62 facilities imported 90 percent or more of records for completed consults, but 11 facilities imported fewer than 60 percent.
• VA's backstop. If records do not arrive, VA staff are supposed to request them three times within 90 days of the appointment, then close the consult.

What you can do:

1. At the visit, ask the provider to send your notes, test results and imaging to VA, and ask for your own copy.
2. A few weeks later, look in your online VA records at My HealtheVet on VA.gov. VA says it shows care summaries and notes, lab and test results. VA does not say whether community care records appear there.
3. If they are not there, ask your VA care team whether the records were received. You can also send your own copies to your VA care team through My HealtheVet Secure Messaging. VA says this needs a Premium account and allows up to 4 files per message, 6 MB each and 10 MB total, in formats that include PDF, JPG and PNG. VA's FAQ names test results, procedures and health care summaries from non-VA providers as examples.
4. To get a copy of your VA record, use VA Form 10-5345a at the release of information office of the facility where you were treated. VA says most requests are completed within 30 days.
5. If you have a claim, you can upload your own copies as evidence. See Upload Photos and Evidence for Your VA Claim.

If a community provider will not give you your records. Under HIPAA you generally have the right to inspect and get a copy of your records from a covered provider, and HealthIT.gov says the provider has 30 days from your request. If a provider denies access, you can file a complaint with the HHS Office for Civil Rights. HHS says to file generally within 180 days of when you knew or should have known about the problem, and it can excuse a late complaint for good cause.

VA is replacing its older records system, which VA's own page calls VistA/CPRS, with a new system it calls the Federal EHR (built on Oracle Health). Federal News Network reported 14 sites running the new system in June 2026. Which one your facility uses depends on where you are treated. VA says patients keep using My HealtheVet either way.

If VA says no

You can appeal a medical treatment decision through VA's Clinical Appeals process, which is reviewed by the facility's chief medical officer. See the link below.

Where to call and where to go

Phone

• VA health benefits hotline: 877-222-8387, Monday through Friday, 8:00 a.m. to 8:00 p.m. ET. Source: va.gov/health-care/how-to-apply
• Community care questions on approved appointments: Monday through Friday, 8:00 a.m. to 9:00 p.m. ET (TTY: 711). The number is on the VA referral steps page.
• MyVA411 main line, 24/7: 1-800-698-2411. Source: va.gov/contact-us

Official pages

• VA: Community care eligibility
• How to get community care referrals and schedule appointments
• Clinical appeals of medical treatment decisions
• Find your VA health facility