VA Community Care Network (CCN) Enhances Access to Care
The Community Care Network (CCN) is the Department of Veterans Affairs’ (VA) direct link with community providers to ensure eligible Veterans are provided with timely and high-quality care. CCN is a network of high-performing, credentialed community providers that partners with VA to provide health care to Veterans in their local community.
CCN covers all U.S. states and territories with an established set of regional boundaries aligned to state borders to provide local flexibility and increased access to care. VA relies on Third Party Administrators (TPA) to develop and administer regional networks of high-performing, licensed, and contracted health care providers. Every day, TPAs work directly with VA to make sure health care is available to eligible Veterans in the community. TriWest Healthcare Alliance is the TPA for CCN Regions 4 and 5, which encompasses the western part of the country.
CCN is being deployed in a phased approach by VA medical facilities across the country. Once fully implemented, CCN will replace the Patient-Centered Community Care (PC3) network as the preferred national network VA uses to purchase care for Veterans in their community. TriWest currently also manages the PC3 network, which serves as a critical bridge until CCN is fully deployed to ensure Veterans continue to receive the care they need.
VA awarded a contract to Optum, part of UnitedHealth Group, Inc., to serve as the TPA for CCN Regions 1, 2 and 3. VA awarded contracts to TriWest Healthcare Alliance to manage CCN Regions 4 and 5. TriWest continues to manage PC3 in Region 6 at this time.
CCN is comprised of six regional networks that serve as the contract vehicle for VA to purchase care for Veterans from community providers. The existing Patient-Centered Community Care (PC3) network will transition over time to allow for CCN implementation to occur region-by-region in a phased approach, beginning in Region 1 in the northeast.
What is Veteran Affairs (VA) Community Care Network (CCN)?
CCN is comprised of six regional networks. It covers all U.S. states and territories and relies on Third Party Administrators (TPAs) to develop and administer regional networks of high-performing licensed health care providers on behalf of VA.
CCN has an established set of regional boundaries aligned to state boundaries to provide local flexibility and increased access to care. Each CCN regional network serves as the contract vehicle for VA to purchase care in the community. With CCN, there is a focus on transparency, accountability, quality, and increased communications between VA and Veterans.
How does CCN affect Veterans?
CCN is a robust network of community providers that provides Veterans greater choice and accessibility to care outside of VA medical facilities. The CCN contracts are developed with a focus on transparency, accountability, quality and increased communications between VA and Veterans.
VA can directly schedule community care appointments for Veterans through their local medical facility, with support, as needed, from VA’s contracted CCN TPA – Optum for Regions 1, 2 and 3 and TriWest for Region 4. Veterans can also schedule their own appointments with support from local VA medical facility staff, if desired.
Which health care services does CCN include?
Health care services provided as part of CCN include medical, behavioral health, surgical, complementary and integrative health services (CIHS), and dental services for Veterans who are unable to receive care at a local VA medical facility. Durable medical equipment (DME) and prescription medications (up to a 14-day supply) will be provided for immediate needs.
CCN expands coverage for additional services to include dialysis, comprehensive rehabilitation, residential care, home-health care, hospice care, dental, immunizations, and long-term acute care. Under CCN, VA also covers CIHS benefits in the areas of biofeedback, hypnotherapy, massage therapy, Native American healing, relaxation techniques, and tai chi.
Does CCN cover medications prescribed by community providers?
If a provider determines a prescription is immediately required, medications can be prescribed — up to a 14-day supply — and filled at a participating in-network pharmacy for Veterans who were referred care through a CCN provider with an approved referral. Veterans must provide prescription benefit information to a participating CCN pharmacy.
If Veterans do not have an authorization for care through the CCN contractor or utilize a non-CCN participating pharmacy, they will have to pay out of pocket and seek reimbursement through their local VAMC.
For prescriptions of more than a 14-day supply, or if the prescribed medication is not immediately needed, then the community provider must send the prescription to the local VAMC pharmacy for fulfillment.
BEFORE YOU GO TO THE PHARMACY - Print the Pharmacy Billing Flyer (or have it viewable on your mobile device) and take it with you to your in-network pharmacy. When using the flyer, identify the correct region where you are seeking care
Does CCN cover durable medical equipment (DME), orthotics, and prosthetics?
If a provider identifies an immediate need for DME, orthotics or prosthetic items, the provider can provide the DME and submit a bill to Optum in Regions 1, 2, or 3 or TriWest in Region 4. Routine DME, orthotics, and prosthetic items require a consult and can be obtained via the Prosthetics and Sensory Aids Service (PSAS) at the local VAMC.
What happens if I want to receive additional services from my community provider beyond what was requested on my original referral?
Under CCN, community providers must submit a referral request to VA when a Veteran requires care beyond what is included on the original referral. The referral request will be reviewed by VA and if appropriate, a new referral will be issued.
Do I need to have a referral from VA to visit a CCN provider?
Yes. Before a Veteran receives care or services from a CCN participating provider, VA must refer the Veteran to a specific community provider.
Who schedules the appointments with community providers?
Under CCN, VA staff can refer Veterans directly to community providers and schedule community care appointments for Veterans through the local VA medical facility. In some instances, VA medical facility staff may elect to receive scheduling support from Optum or TriWest. Veterans can also choose to schedule their own appointment with support from local VA staff.
I am receiving community care right now, and I like the clinician who is taking care of me. With these changes, will I still be able to see my clinician?
Eligibility for community care will continue to be dependent upon your individual health care needs, care available at a VA medical facility, and other factors. VA staff will work with you to determine if you can continue to see your current community provider, and to confirm his or her participation in Optum or TriWest’s CCN provider networks. Some providers may not be able to or want to join VA’s CCN. In those cases, VA will work with you to find another contracted provider.
Is CCN part of an effort to privatize VA?
No. There is no effort underway to privatize VA. However, VA recognizes that the health care landscape is constantly changing, and VA’s unique population and broad geographic demands require partnerships with community providers to continue VA’s long-standing tradition of offering community care to Veterans since 1945.