Bottom Line: |
The Veterans Community Care Program, a program that allows veterans to receive healthcare from community providers, utilizes the annually updated Veterans Affairs Fee Schedule to establishes fair reimbursement rates. |
The Veterans Community Care Program (VCCP) is a specific benefit offered by the Department of Veterans Affairs (VA) designed to enhance access to quality care for veterans by providing the option for the VA to purchase healthcare services from commercially available sources in a veteran’s local community under specific circumstances. Veterans may utilize this care as approved in advance if the veteran lives a great distance from the closest VA Medical Center (VAMC), if wait times at the local VAMC for an appointment exceed preset standards based on appointment type, or if the needed care is not available within the VA healthcare system. A crucial component of this network is the VA Fee Schedule (VAFS), which is the defined financial framework for the program that establishes reimbursement rate for the services rendered.
The VAFS ensures transparency through its public publication of reimbursement rates for drugs, devices, physician provided services, and procedures associated with hospital, medical, and extended care services for a wide range of healthcare needs, with Alaska having a separate, state-specific fee schedule. The only exception is for dental reimbursement rates, which are considered proprietary and, therefore, not publicly published. The VAFS is updated at least annually (but can be issued with greater frequency as determined appropriate by the VA) with several factors influencing the reimbursement rates including geographic location, type of service, and other market data, such as VA claims data, Medicare fee schedules, TRICARE fee schedules, etc. The VA focuses specifically on maintaining competitive reimbursement rates to attract and retain high-quality providers while also addressing geographic disparities to ensure equitable access to healthcare services for veterans throughout the United States. It should be noted, however, that while a drug, device, procedure or service is assigned a procedure code along with its reimbursement rate, the VA must still agree to pay for that item in advance. Approval for coverage is a separate issue that must be handled through the appropriate authorization process prior to the service being rendered on behalf of the veteran to ensure payment.
The VCCP plays a vital role in expanding access to quality healthcare for veterans across the United States. By leveraging the expertise and resources of community providers, the VCCP ensures that veterans can receive timely and appropriate care. The VAFS serves as a foundational element of the VCCP, ensuring fair and transparent reimbursement for community providers while upholding the VA's commitment to providing high-quality care to all veterans.