Veterans Affairs Community Care Program Frequently Asked Questions
On September 4, 2013, TriWest Healthcare Alliance (TriWest) was awarded a 5-year contract by the Department of Veterans Affairs (VA) to administer the VA Community Care program.
The purpose of the program is to enhance access to health care services for Veterans by making a quality provider network available closer to a Veteran's home. Access to care through the Community Care program is only available to eligible Veterans following a referral from a VA Medical Center that is processed by TriWest.
Frequently Asked Questions
What types of care may be provided to me through the Community Care program?
- Primary Care
- Inpatient Specialty Care
- Outpatient Specialty Care
- Behavioral Health Care
- Limited Newborn Care for Enrolled Female Veterans Following Delivery
What types of care are not included in the Community Care program?
- Dental Care
- Nursing Home Care
- Long-Term Acute Care Hospitals (LTAC)
- Homemaker and Home Health Aide Services
- Chronic Dialysis Treatments
- Compensation and Pension Examinations
In general, what are the determining factors for a VA facility to initiate an authorization for care through the Community Care program?
- Care will be made available through the Community Care program when a local VA Medical Center (VAMC) determines it cannot readily provide the needed care due to a lack of available specialists, geographic inaccessibility and other factors.
What is TriWest's role under the Community Care program?
- Provide a network of civilian providers and facilities that meet quality standards.
- Help ensure Veterans are seen quickly within required access-to-care commute times to include the coordination of the initial appointment setting with the Veteran and the provider.
- TriWest ensures that medical documentation from appointments with Community Care program-contracted providers is routed in a timely manner to the Veteran's servicing VAMC.
Who do I contact if I have questions about my appointment provided by TriWest through the Community Care program?
- For questions relating to your appointment with a TriWest provider, please call TriWest between the hours of 8:00 a.m. and 8:00 p.m. (in your local time zone) at 855-PCCCVET (722-2838).
How are the Community Care program contracts managed?
- The Community Care program contracts are organized regionally. A central VA Project Management Office supports the contracts with regional teams consisting of subject matter experts in contract management, claims processing, field operations and other appropriate areas.
What are TriWest's service areas under the Community Care program?
- VA Region 3 – Veterans Integrated Service Networks (VISNs) 9, 15, 16, 17 and 19
- VA Region 5A – VISN 22 (excluding Hawaii and the Pacific Islands)
- VA Region 5B – VISN 21 (including Hawaii, Guam, American Samoa, and Northern Mariana Islands)
- VA Region 6 – VISN 20 (Alaska)
What determines my eligibility for care under the Community Care program?
- Eligibility is determined by your local VAMC.
- You must be enrolled in the VA Health Care System and receive a care referral from a provider at your servicing VAMC. For any questions concerning eligibility, please contact your local VA facility.
What communication options are available for Veterans with hearing or speech disabilities?
TriWest Healthcare Alliance is pleased to offer options to help Veterans with hearing or speech disabilities communicate telephonically.
711 for Telecommunications Relay Service: Our Contact Centers accommodate calls from the Telecommunications Relay Service (TRS). TRS is available in every state, as well as Guam, American Samoa, and Northern Mariana Islands, at no additional cost to the caller, and provides basic relay services to hearing or speech disabled individuals using text telephone (TTY) devices. To communicate with TriWest using this service, please use your TTY or dial 711 on your telephone.
AT&T National Relay Service: Our Contact Centers also accommodate calls from the AT&T National Relay Service. The AT&T National Relay Service is available at no additional cost to the caller and covers a range of communication methods. To communicate with TriWest using this service, please use the following resources:
- TTY Users: (800) 855-2880
- Voice Users: (800) 855-2881
- PC (ASCII) Users: (800) 855-2882
- Telebraille Users: (800) 855-2883
Are medications covered under the Community Care program?
- All medications prescribed for you must be obtained from a VA pharmacy unless your provider has identified an urgent need for you to start taking a medication immediately and there is no time to get your medications from VA pharmacy.
- If you need to obtain a prescription medication from a non-VA pharmacy you will be given a prescription for a 14-day supply of the medication, without a refill, to fill at a non-VA pharmacy. You will need to pay for the prescription and then contact VA for reimbursement of the cost.
- If the provider wants you to continue taking the medication more than 14 days, you will be given a second prescription that you will need to have filled at your VA pharmacy.
- If the prescription is for a non-formulary medication you will be reimbursed for the 14-day supply and your provider will need to follow the process to have the remaining supply of your non-formulary prescription approved by VA.
- Special Note: If you are participating in a Human Subject Research study and are enrolled in a clinical trial you will be referred to your respective Non-VA Care Office for authorization and coordination.