VA Community Care for Rehab: Referrals and Billing

Key facts at a glance

What it is	VA-paid care from a non-VA provider in the VA community care network
Eligibility	Enrolled in VA health care plus at least one of the six MISSION Act pathways
Referral required?	Yes for scheduled care; no for in-network urgent care; emergencies handled separately
Emergency notification	Notify VA as soon as reasonably possible — within 72 hours is the usual guidance
Billing	You should not be billed beyond any applicable VA copay; the provider bills VA
Copays	Depend on priority group and care type; service-connected conditions are typically copay-free
Most common failure point	Authorization expiring mid-treatment — request renewal early
Free help if stuck	VA patient advocate, and Veterans Service Officers at VSOs and county veterans service offices

Am I eligible?

You must be enrolled in VA health care (or otherwise eligible for VA care), and meet at least one of six pathways: the service is unavailable at VA; you live in a state or territory without a full-service VA facility; you are grandfathered under the old 40-mile criterion; VA cannot meet its access standards; you and your VA clinician agree community care is in your best medical interest; or VA cannot provide care meeting its own quality standards.

For substance use and mental health treatment, the access standards pathway most often applies — these are the services with the longest waits, and mental health benefits from the more generous 20-day and 30-minute thresholds rather than the specialty care standards.

Recent reforms under the Dole Act also simplified referrals for non-VA mental health care where your VA clinician agrees community care is the better option.

How do you get a referral, step by step?

1. Confirm your enrollment. Not enrolled? Apply — eligibility is broader than many veterans assume, particularly after recent toxic-exposure expansions.
2. Ask your VA care team. Community care requires a VA referral. Tell your primary care provider, VA mental health clinician, or the SUD program exactly what you need.
3. Name the grounds explicitly. Do not assume it will be offered. Phrasing that works:
   • “The soonest appointment is 42 days out. That exceeds the 20-day mental health access standard. I would like a community care referral.”
   • “The drive from my home is over an hour each way, which exceeds the drive time standard for mental health care.”
   • “I need intensive outpatient treatment three evenings a week. That is not feasible at this distance. I believe community care is in my best medical interest.”
4. Get the authorization in writing. It should specify the provider or network, the type and level of care, the number of visits, and the date range. Keep a copy.
5. Verify the provider is in the VA community care network before your first visit. VA contracts through third-party administrators, and a provider who accepts your commercial insurance is not automatically in the VA network.
6. Confirm the referral reached the provider. Referrals get lost. One phone call at this stage prevents weeks of delay.
7. Watch your visit count and renew early. Ask about renewal when you are roughly two-thirds through your authorized visits.

How do you avoid billing problems?

• Get authorization before care, except for in-network urgent care and emergencies. Unauthorized care may not be covered and you may be billed directly.
• You should not be billed for authorized community care beyond any applicable VA copay. The provider bills VA, not you.
• If you receive a bill anyway — which happens — do not pay it and do not ignore it. Contact the provider’s billing office and the VA community care office at your facility, and reference your authorization number. Unresolved community care billing has been sent to collections in the past. Document every call with a date and a name.
• Emergency care follows separate rules. Go to the nearest emergency room and notify VA as soon as reasonably possible — within 72 hours is the usual guidance, and timely notification affects coverage.
• Do not use your commercial insurance for authorized community care without checking, as this can create a coordination-of-benefits problem.

What can community care cover for addiction and mental health?

• Medically supervised withdrawal
• Residential substance use treatment
• Partial hospitalization and intensive outpatient programs
• Individual and group therapy
• Psychiatric evaluation and medication management
• Medication for alcohol and opioid use disorder
• PTSD treatment including prolonged exposure, CPT and EMDR
• Dual-diagnosis treatment for co-occurring conditions

Make sure the referral requests the right level of care. An authorization written for outpatient therapy will not cover residential treatment, and correcting it afterward takes weeks. If your assessment indicates residential care, the referral needs to say so.

Southern California specifics

For most Orange County residents, the nearest full-service VA medical centers are Long Beach and Loma Linda, with community-based outpatient clinics distributed unevenly. Depending on where you live and on traffic, drive times routinely exceed the 30-minute mental health standard — and Southern California traffic makes average drive time a genuinely different number from map distance, which is worth pointing out when you request a referral.

Vet Centers are a separate and often faster route: free readjustment counseling, individual and group therapy, and MST counseling, with broad eligibility and no community care authorization needed. Records are kept separate from VA medical records.

What if you get stuck?

• VA patient advocate at your facility — resolving exactly this is their job.
• Veterans Service Officers at VSOs (DAV, VFW, American Legion, PVA) and county veterans service offices. Free, experienced, and frequently effective at unsticking a stalled referral.
• Request the denial reason in writing, including which eligibility pathway was evaluated. Denials are sometimes based on a misreading of the access standard.
• Ask for reconsideration and escalate to the VISN level if needed.

If you are in crisis while waiting, do not wait. Veterans Crisis Line: 988, press 1, or text 838255. Available 24/7 regardless of enrollment or discharge status.

Premier Health Group and community care

Premier operates the full continuum, which matters for community care specifically: a single course of treatment can step down through levels of care without a new provider, a new intake and a new referral at each stage.

Call (888) 224-0269 with your authorization details and we will tell you plainly what it covers and whether we are the right fit. If we are not in the right network for your authorization, we will say so rather than waste your time. See also our Veteran Program.

Which level of care is right for this?

Premier Health Group operates a full continuum across five Southern California facilities, so the answer is determined by a clinical assessment rather than by which program has a bed open.

If this describes your situation	Recommended level of care
Authorization for medically supervised withdrawal	Detox at Brier Lane
Authorization for residential treatment	Residential at Brier Lane or 5th Street
Authorization for partial hospitalization	PHP at Calle Azteca or Mountain View
Authorization for intensive outpatient	IOP at Calle Azteca or Mountain View
Authorization for outpatient therapy and psychiatric care	Outpatient at 4th Street

Frequently asked questions

Do I need a VA referral before I go?

For scheduled care, yes. Without authorization you risk being billed directly. The exceptions are in-network urgent care, which needs no prior authorization, and emergencies — go to the nearest ER and notify VA as soon as you can.

How long does authorization take?

It varies by facility and by how straightforward the request is — days in good cases, weeks in others. Following up by phone genuinely speeds it up, and a Veterans Service Officer can help if it stalls.

Can I keep my VA provider and add a community provider?

Often yes. Community care is generally episode- or service-specific rather than an all-or-nothing switch. Many veterans keep VA primary care while receiving substance use or mental health treatment in the community.

Will I have a copay?

Possibly, depending on your priority group and the type of care — the same copay structure that applies to VA care. Service-connected conditions are typically copay-free. Ask your VA community care office for specifics before starting.

What if my authorization runs out mid-treatment?

This is the most common failure point. Ask about renewal when you are roughly two-thirds through your authorized visits and have your provider submit continued-care documentation early. Do not wait for the final visit.

I got a bill for care VA was supposed to pay for. What do I do?

Do not pay it and do not ignore it. Contact both the provider’s billing office and the VA community care office at your facility, reference your authorization number, and document every call with a date and a name. This is a known administrative problem and it is resolvable.

Sources

• US Department of Veterans Affairs — community care eligibility, referrals and billing: va.gov
• VA MISSION Act of 2018, Public Law 115-182 — Veterans Community Care Program
• VA — urgent care benefit conditions and copay structure
• VA Vet Centers — readjustment counseling eligibility and record confidentiality
• Veterans Crisis Line — 988 press 1: veteranscrisisline.net

Related guides

• The VA MISSION Act
• Alcohol use disorder in veterans
• Caregiver support
• Orange County rehab guide
• Dual diagnosis treatment

← All Addiction Resources