VA Community Care Referrals Lack Standard Scheduling Timeframes, with New Outpatient Surgical Appointments Averaging 41 Days vs. 28-Day Target

The VA's Community Care Program, created by the 2018 MISSION Act to allow veterans to receive care from private-sector providers when VA wait times or distances are excessive, has failed to establish standard timeframes within which referred appointments must actually occur. A January 2025 GAO report found that the Referral Coordination Initiative -- intended to improve scheduling timeliness -- was implemented inconsistently across VA facilities and lacked clear program direction. As of July 2025, new outpatient surgical appointments averaged 41 days, exceeding the VA's 28-day access standard by 46%. An August 2024 GAO audit found 'weaknesses in VA's oversight of the community care contracts,' with the responsible office lacking 'a clear and complete set of documents to guide oversight.' Until May 2025, community care consults required review and approval by a second physician, adding bureaucratic delays to an already slow process. Why it matters: Veterans who are told they qualify for community care still face weeks-long waits because no binding scheduling standard exists, so the legal promise of the MISSION Act -- that veterans would get timely care outside the VA when VA care was unavailable -- becomes an unfulfilled administrative referral, so veterans bounce between the VA and community providers in a coordination gap where neither system takes ownership of timely scheduling, so urgent conditions like cancer biopsies, cardiac evaluations, and orthopedic injuries progress during bureaucratic limbo, so the MISSION Act's $billions in annual community care spending produces worse timeliness outcomes than the in-house VA care it was meant to supplement. The structural root cause is that the MISSION Act mandated access standards for determining when a veteran qualifies for community care, but did not mandate corresponding scheduling standards for how quickly that care must be delivered once authorized -- creating a system where eligibility is rigorously measured but actual appointment timeliness is neither tracked nor enforced.