Navigating care in the community

Getting the care you need is easier than ever

Veterans referred by VA to community care for eligible standardized types of care will receive 12 full months of uninterrupted treatment.

VA announced earlier this month that it will extend the length of new VA community care authorizations to one year for 30 standardized types of care.

“That’s absolutely fabulous,” said Rick Doering, of Webster, Wisconsin.

Doering joined the Navy in 1967. He went to training in Memphis for a year, then was assigned as a navigator to a squadron of carrier-based refueling planes. 

“We would provide in-flight refueling for fighters and bombers headed inland to North Vietnam. We would also refuel the same planes on the way back to the ship,” he said. They also used electronic countermeasures to detect surface-to-air missiles and jam them. 

It was a good job, but tough for those who were married, so in 1976 he accepted a civilian position and put the military behind him. 

“For a long time, I had health problems but didn’t come to VA for help because I thought others needed it more than I did,” said Doering. 

About 10 years ago, his condition related to agent orange exposure worsened. He was diagnosed with prostate cancer, and he finally established care with VA. His primary care provider was just under an hour away from his home at the Rice Lake Community Based Outpatient Clinic (CBOC). But Doering needed specialty care that wasn’t available at the CBOC, so he started using Care in the Community. 

“I have four specialists that I see on a regular basis, and I’m about to get another one this month. I have lots of things going on,” he said. “Keeping up with all of the community care paperwork has been challenging.”

Acknowledging those administrative challenges, the Minneapolis VA stepped in and gave Doering a helping hand. 

“I cannot say enough about the social worker assigned to my case. I know it is not practical for every Vet to be lucky enough to work with one, but my social worker was heaven sent, and helped me tremendously,” said Doering.

Benefits of the new policy

The change announced by VA this month means Veterans referred by VA to community care for eligible standardized types of care will receive 12 full months of uninterrupted treatment at VA expense before having to obtain a VA reauthorization. Prior to the change, some VA community care specialty referrals were reevaluated every 90 to 180 days.

The list of year-long community care authorizations for standardized types of care includes: 

• Cardiology
• Dermatology
• Endocrinology
• Neurology and Otology
• Otolaryngology or ENT
• Gastroenterology
• Urogynecology
• Addiction Psychiatry Outpatient
• Family & Couples Psychotherapy Outpatient
• Mental Health Outpatient
• Nephrology
• Neurology
• Nutrition Intervention Services
• Oncology and Hematology
• Neuro-Ophthalmology
• Oculoplastic
• Eye Care Examination
• Optometry Routine
• Orthopedic Hand
• Orthopedic General
• Orthopedic Spine
• Pain Management
• Podiatry
• Podiatry DS
• Addiction Medicine Outpatient
• Pulmonary
• Physical Medicine & Rehabilitation (Physiatry)
• Rheumatology
• Sleep Medicine
• Urology

While the paperwork will be lighter for all who are eligible for community care, eligibility requirements remain the same. Veterans must be enrolled in or eligible for VA health care, and one of these must be true: 

• You need a service that we don’t provide at any VA health facility, or
• You live in a state or territory that doesn’t have a full-service VA health facility, or
• You and your VA provider agree that getting care from an in-network community provider is in your best medical interest, or
• We can’t provide the service you need in a way that meets our quality standards, or
• You qualified under the 40-mile distance requirement as of June 6, 2018, and you live in Alaska, Montana, North Dakota, South Dakota, Wyoming, or another location that would still make you eligible under these requirements, or
• We can’t provide the care you need within our standards for drive and wait times. For primary care, mental health and extended outpatient care: 30-minute average drive time or 20-day wait time. For specialty care: 60-minute average drive time or 28-day wait time 

It’s never too late to apply for the VA health care you’ve earned. If you are a Veteran or know a Veteran who has not yet applied for their VA health care benefits, learn how to get started.

This article was originally published on the VA Minneapolis Health care System site and has been edited for style and clarity.