02/10/2026

VA Update: 2026 Fee Schedule Available, New Community Care TPAs Coming

The VA has released the 2026 fee schedule, with rates effective January 1, 2026.

Do you know how VA determines their rates? When reimbursing for authorized community care, VA uses the following order to determine which rate applies:

1. Contract-negotiated rate: If a contract-negotiated rate exists, that rate is used.
2. Medicare rate: If no contract-negotiated rate is available, VA uses the Medicare rate published by the Centers for Medicare & Medicaid Services (CMS), including Medicare Administrative Contractor (MAC) rates. For Michigan, this is the WPS rates for Locality 01 (Wayne, Oakland, Macomb, and Washtenaw counties) and Locality 99 (rest of Michigan)
3. VA Fee Schedule rate: If contract-negotiated and Medicare rates are not available, VA applies the VAFS rate.
4. Percentage of billed charges: If no other rate applies, VA reimburses a percentage of the provider’s billed amount.

VA Looking to Improve Health Care Choice and Quality for Veterans

In December, the U.S. Department of Veterans Affairs released a request for proposals (RFP) for new community care contracts that will improve health care choice and quality for Veterans over the next decade.

The VA Community Care program allows Veterans to access health care from non-VA medical providers at the VA’s expense. Community care has been an integral part of caring for Veterans since the World War II era and was enshrined in law by the bipartisan MISSION Act in 2018. Now, about 40% of all VA care is provided through Community Care providers.

In 2018, VA signed contracts with health plans to serve as third-party administrators and manage the program. Many of these contracts are set to expire this year, and a new round of contracts is needed to ensure Veterans have continued access. Michigan is located in Community Care Network Region 2, currently administered by Optum Serve.

The VA is looking to enter into new contracts that will improve health care choice and quality for Veterans over the next decade in the following ways:

• More Choices for Veterans – The new indefinite delivery/indefinite quantity (IDIQ) contract structure will provide more choices by allowing multiple national and regional health plans to compete to serve Veterans. Selected health plans will provide care and benefits uniquely adapted to Veterans and their communities.
• Improved Quality of Care for Veterans – The contracts will require health plans to adhere to broad industry standards of care used by all other major health care systems. This will ensure Veterans get care that has been shown to directly address their medical conditions and maximize their health and wellness.
• Improved VA Oversight of Community Care – The contracts will provide VA with the data, technology and systems to manage Veterans’ care in real-time, drive innovation, and collaborate with the selected health plans to ensure that Veterans receive the highest quality health care.
• Contract Flexibility – The new IDIQ contract structure allows VA to issue multiple, competitive task orders over the life of the contract in order to adjust health plans, regions, contract requirements, and deliverables and ensure that health plans are empowered and accountable. Contractors that do not meet VA requirements can be off-ramped and replaced by other IDIQ health plans to ensure continuity of services and no disruption of care to Veterans or VA operations.

The AAC will continue to monitor the VA’s contracting process and report on how chiropractic care is covered by the new contracted entities. Stay tuned for additional information as it becomes available.

Source:  VA Press Release, “VA to improve health care choice and quality for Veterans with new community care contracts,” December 15, 2025