Guides VA community care
Service-line guide
VA community care for home-based agencies
The Department of Veterans Affairs buys skilled home health, homemaker and home health aide care, respite and home infusion services from community agencies when it cannot deliver them itself. An agency is paid through a regional network administrator or a direct Veterans Care Agreement, under a VA referral that sets what may be billed.
Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Last reviewed October 17, 2026. 48 findings: 31 verified, 15 provisional, 2 disputed. 4 time-sensitive, flagged with a recheck date. How findings are sourced and labelled.
1What it is
The Veterans Community Care Program is codified at 38 CFR 17.4000–17.4040, covering purpose and scope, definitions, Veteran eligibility, designated VA medical service lines, authorized non-VA care, eligible entities and providers, payment rates and designated access standards.
Source: 38 CFR Part 17 (Cornell LII)
What VA buys from agencies
VerifiedVA purchases Skilled Home Health Care from community home health agencies that have a contract with VA, and Homemaker and Home Health Aide care, in which a trained aide supervised by a registered nurse helps with activities of daily living and works for an organization that has a contract with VA.
Source: VA Geriatrics: Home and community based servicesVA Geriatrics: Homemaker and Home Health Aide care
Home Based Primary Care is a VA program: “A VA physician supervises the health care team.” It is not purchased from community agencies.
VA also lists Veteran-Directed Care, Adult Day Health Care, Respite Care (which “pays for a person to come to a Veteran’s home”), Home Telehealth, Palliative Care and Hospice Care. The page does not say which of these are purchased from community agencies.
Home infusion under CCN
ProvisionalUnder the Community Care Network, infusion therapy services include home infusion therapy and Ambulatory Infusion Suite care. No primary VA policy on how home infusion drugs, per diems and nursing are purchased was found.
Not yet confirmed — check with the VA or your regional third-party administrator.
2Who regulates it
VA sets eligibility, authorizes care and pays; regional third-party administrators run the Community Care Network; the state licenses the agency.
VA’s Community Care Network page (last updated July 6, 2026) lists five regions. Optum runs Region 1 (CT, DE, DC, ME, MD, MA, NH, NJ, NY, NC, PA, RI, VT, VA, WV), Region 2 (IL, IN, IA, KS, KY, MI, MN, MO, NE, ND, OH, SD, WI) and Region 3 (AL, AR, FL, GA, LA, MS, OK, SC, TN, Puerto Rico and the U.S. Virgin Islands). TriWest runs Region 4 (AZ, CA, CO, HI, ID, MT, NM, NV, OR, TX, UT, WA, WY, American Samoa, Guam and the Northern Mariana Islands) and Region 5 (Alaska). See the CCN regions map.
Time-sensitive. The regions change when CCN Next Generation begins in 2027; recheck VA’s CCN page in January 2027.
Source: VA: Community Care Network
Agencies join CCN by contracting with the regional administrator, not with VA: Optum for Regions 1–3 (vacommunitycare.com/provider; Region 1 888-901-7407, Region 2 844-839-6108, Region 3 888-901-6613) and TriWest for Regions 4–5 (joinournetwork.triwest.com, ProviderServices@TriWest.com, 877-226-8749).
Source: VA: Community Care Network
High Performing Providers
VerifiedVA designates some CCN providers as High Performing Providers based on administrator measures. Providers cannot apply, and VA schedulers consider the designation when booking.
Source: VA: Community Care Network
CCN Next Generation: two regions
ProvisionalVA issued the CCN Next Generation solicitation (36C10G26R0003) on December 15, 2025, reducing five regions to two: an East network of 29 states, DC, the U.S. Virgin Islands and Puerto Rico, and a West network of 21 states, Guam, American Samoa and the Northern Mariana Islands. It was reported at up to $1 trillion over 10 years, with proposals due March 16, 2026.
Not yet confirmed — check with the VA.
Source: Military Times via Yahoo: VA to reorganize community care contracts (Dec 15, 2025)HigherGov: solicitation 36C10G26R0003GovTribe: CCN Next Gen PWS (West) attachment
CCN Next Generation: award reported
ProvisionalA trade analysis of federal award records reports four contracts awarded August 31, 2026 under one solicitation (Optum Public Sector Solutions, TriWest Healthcare Alliance, Humana Government Business and WellPoint Federal Solutions), with performance from January 2027. Which administrator serves the East or West region from 2027 is not confirmed, and no primary VA announcement was found.
Not yet confirmed — check with the VA.
Time-sensitive. Performance is reported to start in January 2027; recheck VA’s CCN page then for regional assignments and provider transition terms.
In practice: Existing network agreements may need to be re-papered with whichever administrator serves the agency’s region from 2027.
Source: GovCon IC: CCN Next Gen award analysis (Oct 5, 2026)
Dental is a separate network
VerifiedVA announced a separate 10-year community care dental network contract, up to $30 billion, with Optum Serve.
3Federal rules
Veteran eligibility for community care is not one rule. The access standards are one pathway among several, they differ by type of service, and each home-based program adds its own conditions.
| Program or pathway | Eligibility or standard | Finding | Source |
|---|---|---|---|
| VCCP: primary care, mental health, non-institutional extended care | 30 minutes average drive time; 20 days from request | Verified | 38 CFR 17.4040 (Cornell LII) |
| VCCP: specialty care | 60 minutes average drive time; 28 days from request | Verified | 38 CFR 17.4040 (Cornell LII) |
| VCCP: other 17.4010 criteria | Service not offered, no full-service VA facility in the state, grandfathered 40-mile rule, best medical interest, quality standards | Provisional | 38 CFR 17.4010 (Cornell LII); 38 CFR Part 17 (Cornell LII) |
| Homemaker and Home Health Aide | Enrolled, qualifies for community care, meets clinical criteria, service available locally; arranged by a VA social worker | Verified | VA Geriatrics: Homemaker and Home Health Aide care |
| Skilled Home Health Care | Homebound or far from VA; delivered by a home health agency under contract with VA | Verified | VA Geriatrics: Home and community based services |
| Veterans Care Agreement | Care not feasibly available through a VA facility, contract or sharing agreement | Verified | 38 CFR 17.4115 (Cornell LII) |
One VCCP eligibility pathway is VA’s designated access standards, which are set per type of service. For primary care, mental health care and non-institutional extended care (which includes home-based extended care), the standard is care within “30 minutes average driving time of the veteran’s residence” and within “20 days of the date of request unless a later date has been agreed to by the veteran” (38 CFR 17.4040). Drive time is calculated with geographic information system software.
In practice: When VA cannot offer home-based extended care within these limits, that is one route to purchasing it in the community; it is not the only route.
Source: 38 CFR 17.4040 (Cornell LII)
For specialty care, the access standard is care within “60 minutes average driving time” and within “28 days of the date of request” (38 CFR 17.4040). The only wait-time exception in the section is a later date the Veteran agrees to in consultation with the VA provider.
Source: 38 CFR 17.4040 (Cornell LII)
38 CFR 17.4010 sets Veteran eligibility for the Veterans Community Care Program. Its criteria are commonly listed as six: the service is not offered by VA, there is no full-service VA medical facility in the Veteran’s state, the grandfathered 40-mile rule, the access standards, the Veteran’s best medical interest, and VA quality standards. The text of 17.4010 was not reviewed for this guide.
Not yet confirmed — check with the VA (38 CFR 17.4010).
Source: 38 CFR 17.4010 (Cornell LII)38 CFR Part 17 (Cornell LII)
Homemaker and Home Health Aide care is for enrolled Veterans who qualify for community care, meet clinical criteria, and live where the service is available. A VA social worker arranges it, the aide works for an organization that has a contract with VA, and a copay may apply depending on service-connected status.
Skilled Home Health Care
VerifiedVA describes Skilled Home Health Care as “short-term health care services” for Veterans who are homebound or live far from VA, “delivered by a community-based home health agency that has a contract with VA”.
A VCA is used for hospital care, medical services or extended care services when care is “not feasibly available to that covered individual through a VA facility, contract, or sharing agreement”, because the medical condition, travel or nature of the care makes those options impracticable or inadvisable (38 CFR 17.4115(a)).
Source: 38 CFR 17.4115 (Cornell LII)
The referral and the SEOC
VerifiedNon-emergent care needs a VA referral built on a Standardized Episode of Care, which gives “a high-level summary of the typical scope of care” and its commonly associated billing codes, mostly Medicare codes subject to NCCI and MUE edits. Services outside the SEOC need VA approval through a Request for Service before care is given.
Which codes a SEOC allows
VerifiedA, E, K, J, L and Q codes are excluded from SEOCs. H, S and T codes appear only where a VA National Clinical Program Office documented coverage. An unlisted code may be billed if it is within the referral’s scope and intent, customary, not experimental and FDA-approved.
Referrals arrive through HSRM
VerifiedReferrals typically arrive through HealthShare Referral Manager (HSRM); the referral document is VA Form 10-7080, which states where to submit claims.
Since August 2025, VA has issued one-year authorizations for 30 standardized types of care. The list includes no home health, homemaker or infusion line.
Source: VA Wilmington: yearlong authorizations for 30 services (Aug 5, 2025)VA News: yearlong community care authorizations
TriWest lists unskilled home care authorizations of 30, 90, 180 or 365 days. A 2024 trade association notice said VA would cap home care authorizations at 180 days for authorizations issued after June 28, 2024. The current maximum is not confirmed.
Not yet confirmed — check with the VA or your regional third-party administrator.
Source: TriWest CCN Unskilled Home Health QRG (search excerpt)HCAOA: VA returning to 180-day authorizations (2024)
4Payment
Claims filing limits also differ by program. Only the limits the sources support are shown.
| Program | Filing limit | Finding | Source |
|---|---|---|---|
| Community Care Network (authorized care) | 180 calendar days from the date of service; late claims denied | Provisional | TriWest Provider Pulse, Nov 2023 (search summary); VA: Provider claims |
| CCN reconsideration | 90 days from the original processed date | Provisional | TriWest Provider Pulse, Nov 2023 (search summary) |
| CCN homemaker, aide, in-home respite | Filing within 30 days recommended by TriWest; the CCN limit still applies | Provisional | TriWest CCN Unskilled Home Health QRG (search excerpt) |
| Veterans Care Agreement | Sent directly to VA; no filing limit stated on VA’s VCA page | Provisional | VA: Veterans Care Agreements |
| Pending legislation (HEALTH Act, S. 1315) | Would extend the limit to one year; enactment not confirmed | Provisional | HCAOA: bill would extend VA timely filing to one year |
Rates capped at Medicare
VerifiedVCCP rates follow the contract or agreement and generally may not exceed the applicable Medicare fee schedule or prospective payment amount (38 CFR 17.4035).
Source: 38 CFR 17.4035 (Cornell LII)
Skilled home health: three billing tracks
ProvisionalUnder CCN, skilled home health is bundled (paid under PDGM on a UB-04 type of bill 32X), unbundled (fee-for-service on a CMS-1500 with place of service 12 or a UB-04 type of bill 34X, with the unbundled SEOC referral number) or expanded (“skilled private duty nursing for highly dependent Veterans”, billed hourly or in 15-minute units). Since September 1, 2023, bundled claims without type of bill 32X and the matching referral are rejected.
Not yet confirmed — check with your regional third-party administrator.
Source: TriWest: provider resources (the home health handbook page has moved; search excerpt)TriWest CCN Home Health quick reference guideTriWest Home Health SEOCs quick reference guide
Unskilled home care: capped at the SEOC
ProvisionalHomemaker, home health aide and in-home respite care is available only through CCN, approved by VA, which chooses the SEOC that sets weekly hours. Reimbursement “cannot exceed the number of units authorized”; more units require a new SEOC from VA.
Not yet confirmed — check with your regional third-party administrator.
Source: TriWest CCN Unskilled Home Health QRG (search excerpt)
What a claim must carry
VerifiedClaims for all non-emergent care must carry the authorization number and fall within its scope. The 17-character ICN from the HSRM referral goes in the insured’s ID field. Home health agencies billing with an OASIS treatment authorization code put it in the Prior Authorization segment and use the Referral Number segment on the 837I. EDI payer IDs are 12115 (medical) and 12116 (dental).
Source: VA: Provider claims
Where claims go
VerifiedCCN claims go to Optum for Regions 1–3 and TriWest for Regions 4–5. Claims under a Veterans Care Agreement or local contract, and unauthorized emergency care claims, go to VA as the referral directs.
Source: VA: Provider claims
Claims for care authorized through the Community Care Network must be submitted within 180 calendar days of the date of service; late claims are denied. Claims for Regions 1–3 go to Optum and for Regions 4–5 to TriWest.
Not yet confirmed — check with the VA or your regional third-party administrator.
Source: TriWest Provider Pulse, Nov 2023 (search summary)VA: Provider claims
CCN reconsiderations: 90 days
ProvisionalA reconsideration of a CCN claim must be filed within 90 days of the original processed date.
Not yet confirmed — check with your regional third-party administrator.
For homemaker, home health aide and in-home respite claims, TriWest recommends filing within 30 days of service. This is a recommendation; the deadline is the CCN filing limit.
Not yet confirmed — check with your regional third-party administrator.
Source: TriWest CCN Unskilled Home Health QRG (search excerpt)
Claims under a Veterans Care Agreement go directly to VA by EDI or mail, and status can be checked on the VA Customer Engagement Portal. VA’s VCA page does not state a filing limit for these claims.
Not yet confirmed — check with the referring VA medical facility.
Source: VA: Veterans Care Agreements
Pending bill: a one-year filing limit
ProvisionalThe HEALTH Act (S. 1315) would extend timely filing for VA community care claims from 180 days to one year. Whether it has been enacted is not confirmed.
Not yet confirmed — check with Congress.gov.
Time-sensitive. Recheck the bill’s status on Congress.gov in January 2027.
Source: HCAOA: bill would extend VA timely filing to one year
5How states differ
All-Payer Model states
VerifiedIn states under an All-Payer Model agreement (SSA §1814(b)(3), effective on or after January 1, 2014), the Medicare rate used as the cap is calculated from that agreement’s rates.
Source: 38 CFR 17.4035 (Cornell LII)38 CFR 17.4120 (Cornell LII)
Highly rural areas
VerifiedIn a highly rural area, a county with “fewer than seven individuals residing in that county per square mile”, rates may exceed the Medicare cap. VA may also deviate where limiting payment is “not practicable”.
Source: 38 CFR 17.4035 (Cornell LII)38 CFR 17.4120 (Cornell LII)
Alaska
VerifiedAlaska is exempt from the Medicare-based rate rules; where a contract sets no rate, the VA Alaska Fee Schedule applies. Alaska is its own CCN region (Region 5).
Source: 38 CFR 17.4035 (Cornell LII)VA: Community Care Network
Local VA practice
VerifiedHomemaker and Home Health Aide “services may vary by location” and depend on local availability.
State licensure is the baseline
ProvisionalVHA refers to home health agencies that are state-licensed or CMS-certified for the level of care and buys only from agencies in good standing with state licensing bodies. State rules are on the state home health license map.
Not yet confirmed — check with the VA.
6How to start
Network route
VerifiedContact the regional administrator for the agency’s state (see CCN regions) and contract with it; VA then sends referrals through HSRM.
Veterans Care Agreement route
VerifiedVCAs are used “in limited situations where VA Community Care Network (CCN) services are not provided or are not sufficient.” Contact the nearest VA medical facility, which decides whether a VCA is needed; complete credentialing through RLDatix/Verge Health; sign VA Form 10-10171. Referrals begin only after credentialing and signature.
Source: VA: Veterans Care Agreements
VCA certification
VerifiedApplicants document licenses and may be asked for legal name, NPI, TIN, taxonomy and addresses. VA must deny an entity excluded under SSA §§1128 or 1128A, listed on the SAM exclusions list, or barred for fraudulent claims. VA decides within 120 calendar days where practicable; certification lasts 3 years, and recertification is due at least 60 days before expiry (38 CFR 17.4110).
Source: 38 CFR 17.4110 (Cornell LII)
VCA payment
VerifiedVA pays VCA claims directly: Medicare-recognized services at Medicare rates, others by the VA fee schedule or billed charges. “VA is not responsible for payments prior to approval of a VCA,” and providers may not bill the Veteran or other insurance.
Source: VA: Veterans Care Agreements38 CFR 17.4120 (Cornell LII)
Reporting changes under a VCA
Disputed38 CFR 17.4110 requires changes affecting eligibility to be reported within 30 calendar days; VA’s VCA page says changes must be reported within 10 business days under the agreement.
Not yet confirmed — check with the referring VA medical facility.
In practice: The shorter period satisfies both.
Source: 38 CFR 17.4110 (Cornell LII)VA: Veterans Care Agreements
Pending bill: the ACCESS Act
ProvisionalThe Veterans’ ACCESS Act of 2025 (H.R. 740) would codify the access standards in statute, extend them to extended care services other than nursing home care, and bar VA from using telehealth availability to deny eligibility. Whether it has been enacted is not confirmed.
Not yet confirmed — check with Congress.gov.
Time-sensitive. Recheck the bill’s status on Congress.gov in January 2027.
Source: Congress.gov: H.R. 740 (119th Congress) textHouse Committee on Veterans’ Affairs: ACCESS Act
7Common pitfalls
Drawn from the authorization and claims rules above.
Care outside the authorization
ProvisionalCare after the authorization expires, units beyond the SEOC, and services outside its scope without an approved Request for Service are not paid.
Not yet confirmed — check with the VA or your regional third-party administrator.
Source: VA: Standardized Episodes of CareTriWest CCN Unskilled Home Health QRG (search excerpt)
Wrong bill type
ProvisionalBundled skilled care billed without type of bill 32X and the matching bundled referral is rejected; unbundled care bills on 34X or a CMS-1500 with place of service 12.
Not yet confirmed — check with your regional third-party administrator.
Source: TriWest: provider resources (the home health handbook page has moved; search excerpt)TriWest CCN Home Health quick reference guide
Claims sent to the administrator instead of VA (or the reverse), or missing the authorization number or ICN, do not process as the referral directs.
Source: VA: Provider claims
VA does not pay for care before the VCA is approved, and a VCA provider may not bill the Veteran or the Veteran’s other insurance.
Source: VA: Veterans Care Agreements
Oversight attention
VerifiedVA OIG testimony in February 2025 summarized more than 50 community care reports with recurring issues in timeliness, coordination, “inadequate oversight of the quality of care” and data; a March 2025 inspection reviewed skilled home health claims.
Source: VA OIG testimony, Feb 12, 2025VA OIG report 24-02106-80 (Mar 19, 2025)
Official sources
- 38 CFR Part 17 (Cornell LII)
- VA Geriatrics: Home and community based services
- VA Geriatrics: Homemaker and Home Health Aide care
- TriWest CCN infusion page (excerpt)
- VA: Community Care Network
- Military Times via Yahoo: VA to reorganize community care contracts (Dec 15, 2025)
- HigherGov: solicitation 36C10G26R0003
- GovTribe: CCN Next Gen PWS (West) attachment
- GovCon IC: CCN Next Gen award analysis (Oct 5, 2026)
- VA News: community care dental contract
- 38 CFR 17.4040 (Cornell LII)
- 38 CFR 17.4010 (Cornell LII)
- 38 CFR 17.4115 (Cornell LII)
- VA: Standardized Episodes of Care
- VA: Provider claims
- VA: Veterans Care Agreements
- VA Wilmington: yearlong authorizations for 30 services (Aug 5, 2025)
- VA News: yearlong community care authorizations
- TriWest CCN Unskilled Home Health QRG (search excerpt)
- HCAOA: VA returning to 180-day authorizations (2024)
- 38 CFR 17.4035 (Cornell LII)
- TriWest: provider resources (the home health handbook page has moved; search excerpt)
- TriWest CCN Home Health quick reference guide
- TriWest Home Health SEOCs quick reference guide
- TriWest Provider Pulse, Nov 2023 (search summary)
- HCAOA: bill would extend VA timely filing to one year
- 38 CFR 17.4120 (Cornell LII)
- VA OIG report 19-07316-262 (2020, search summary)
- 38 CFR 17.4110 (Cornell LII)
- Congress.gov: H.R. 740 (119th Congress) text
- House Committee on Veterans’ Affairs: ACCESS Act
- VA OIG testimony, Feb 12, 2025
- VA OIG report 24-02106-80 (Mar 19, 2025)
Revision history
| Date | Change |
|---|---|
| 2026-10-17 | First published |
About this guide. Published and maintained by Paloma Health Technologies; Findings are cited to official sources, dated and status-labelled; see the editorial policy. Educational summary, last reviewed October 17, 2026. Not legal advice — confirm with the state licensing agency or counsel.
Questions
VA community care: common questions
Is there one rule for when a Veteran can get community care?
No. The access standards in 38 CFR 17.4040 are one eligibility pathway and differ by service: 30 minutes and 20 days for primary care, mental health and non-institutional extended care, 60 minutes and 28 days for specialty care. Home-based programs such as Homemaker and Home Health Aide care add their own conditions.
How does an agency join the Community Care Network?
By contracting with the regional administrator, not with VA. VA’s CCN page lists Optum for Regions 1–3 and TriWest for Regions 4–5.
What is a Veterans Care Agreement?
A direct agreement with VA used when care is not feasibly available through a VA facility, contract or sharing agreement. The provider is credentialed, signs VA Form 10-10171, and is certified for 3 years.
What does VA pay for community care?
Rates follow the contract or agreement and generally may not exceed Medicare rates, with exceptions for All-Payer Model states, highly rural counties, practicability deviations and Alaska.
Does the one-year authorization apply to home care?
No. The 30 types of care VA moved to one-year authorizations in August 2025 include no home health, homemaker or infusion line.