A Doctor of Osteopathic Medicine (DO) can legally serve Veterans in two different ways: by participating in the VA Community Care Network (CCN) and, separately, by offering state-authorized medical cannabis evaluations in private practice. This model works when the two roles are kept completely separate—different encounters, documentation, billing, locations, and marketing. Inside VA care, you follow VA referral rules. Outside VA, you follow state law and private-payer rules. The key compliance message: never mix the two.
Hard line (make this unmissable): Cannabis evaluations or certifications must always occur in a separate, private, non-VA encounter and can never be billed to VA/CCN. Breaking this rule risks serious legal and professional consequences.
1) Understanding the Legal Foundation and Policy Backdrop
- DOs as physicians: Doctors of Osteopathic Medicine are fully licensed physicians in all states and D.C., with practice rights equivalent to MDs, subject to state licensure and payer credentialing.
- What CCN is (and isn’t): The Community Care Network is VA’s contracting system to buy community care when VA cannot provide it directly. Care is authorized for specific conditions and timeframes. The VA referral controls what may be delivered and billed. VA/TPA payment is payment in full; balance billing for covered services is not allowed. Non-authorized services cannot be added to the CCN claim.
- VA cannabis policy (high-level): VA clinicians may ask, discuss, and document cannabis use as part of care. But they cannot recommend cannabis, complete state forms, or pay for cannabis. Cannabis remains prohibited on VA property, even where state law allows it.
- Compliance principle: In 2025, always follow the stricter rule. Doing so keeps care safe, compliant, and defensible—and reassures Veterans that you’re working within the highest standards.
Permitted in CCN visits
2) What a DO may do inside a VA-authorized (CCN) encounter
- Treat the Veteran for the conditions listed on the referral (e.g., PTSD, chronic pain, comorbidities) using accepted standards of care.
- Discuss and document cannabis use like any other part of medical history (medications, substances, risks, interactions) and consider it in care planning.
- Request additional services through the VA Request-for-Services (RFS) process, and wait for authorization before providing non-emergent additions.
Prohibited in CCN visits
- Recommending or certifying cannabis use, or completing state paperwork.
- Billing VA/CCN for cannabis counseling aimed at state approval, certifications, or products.
- Adding non-authorized services to the VA claim or balance-billing the Veteran.
- Allowing possession or use of cannabis on VA property, even if state law permits.
3) What a DO may do outside VA (private practice)
Outside VA care, a DO may—where state law allows—perform cannabis evaluations or certifications in a private, non-VA setting. These visits must follow state eligibility, documentation, and consent rules, including renewal timelines.
For example, some states allow licensed practitioners to issue written certifications when they judge that a patient may benefit. Each state defines the qualifying conditions and documentation requirements. Your clinic must confirm the exact rules under where you practice.
Do not blend contexts. If a Veteran is your CCN patient and also wants a cannabis evaluation, you must schedule two separate appointments with separate workflows, consents, and billing. This bright line protects both compliance and trust.
4) Operational guardrails (adopt as clinic SOP)
A. Scheduling and intake
- Label appointments clearly as either “VA-Authorized/CCN” or “Private/Non-VA.”
- Use separate intake forms for cannabis evaluations. Do not co-brand with VA or imply VA coverage.
B. Documentation
- VA charting: Include cannabis use only as history when relevant. Do not mention plans to complete state forms or attach certifications.
- Private charting: Document per state law in your private EHR, separate from VA/CCN records.
C. Billing and claims
- CCN claims: Submit only authorized CPT/HCPCS codes for covered services tied to the referral. No balance billing.
- Cannabis evaluations: Never billed to VA. Use clear self-pay policies that meet state and consumer-protection rules.
D. Patient communications (scripts you can use)
- Front desk: “Because VA does not cover marijuana or certification, that evaluation must be a separate, private appointment. We’re happy to schedule that for you outside your VA visit.”
- Website: “We participate in the VA Community Care Network for authorized care. Medical-cannabis evaluations/certifications are private services, not part of VA care, and are not billed to VA/CCN.”
E. Place-of-service safeguards
- Remind patients that marijuana possession/use is prohibited on VA property.
- If you run both VA-based and off-campus sites, route private cannabis visits to the off-campus location.
5) Identifying Risk Hot-Spots and How to Avoid Them
- Blended encounters: Doing a VA visit and certification in the same slot.
Fix: Separate appointments, staff, workflows, notes, and billing. - Documentation bleed-through: Mentioning “will complete certification forms” in VA notes.
Fix: Keep certification steps entirely out of VA documentation. - Implied VA coverage in marketing: Using phrases like “VA patients certified here.”
Fix: Say “Private, non-VA cannabis evaluations available (where legal); not VA-covered.” - Unauthorized add-ons: Delivering extra services beyond then billing VA.
Fix: Use RFS for additions—never “perform then bill.” - No-show fees under CCN: Charging Veterans for missed VA appointments.
Fix: Apply missed-appointment fees only to private visits.
6) Communication points for Veterans (use in handouts)
- Your VA visit covers the condition(s) on your referral. You won’t be balance-billed for covered services.
- Your clinician can discuss your cannabis use as part of your medical history. This will not affect your VA eligibility.
- Cannabis certifications are not VA services. If you pursue one, it must be a separate, private appointment, not billed to VA.
- No-show fees don’t apply to VA visits. If you can’t make it, call so we can reschedule within your authorization window.
7) Sample policy language (copy/paste to website or intake)
Dual-Role Care Policy (VA Community Care & Private Cannabis Evaluations)
“Our physicians participate in the VA Community Care Network (CCN) to provide authorized care for eligible Veterans. During VA-authorized visits, we follow VA policies: we may discuss and document cannabis use as clinically relevant, but we do not recommend cannabis, complete state forms, or bill VA for cannabis-related services. If you wish to pursue a state medical-cannabis evaluation/certification, that service is offered separately as a private, non-VA appointment and is not covered by VA/CCN.”
8) Compliance FAQs (practice-manager edition)
- Can we list both services on our website? Yes—if you clearly separate them. Use different sections/pages and make it explicit that cannabis evaluations are private and not VA-covered.
- Can we talk about cannabis in a VA visit? Yes. You may discuss use, risks, interactions, and treatment implications. Do not recommend, certify, or complete forms.
- What if the Veteran insists on “doing it while I’m here”? Decline politely and offer a separate, private appointment.
- What if more services are needed than listed? Submit an RFS and wait for VA authorization.
- May we charge no-show fees? Only for private visits. Never for VA-authorized care.
- Is the Virginia example universal? No—it’s illustrative. Each state sets its own practitioner rules, qualifying conditions, and documentation. Always confirm locally.
9) Policy horizon (what could change)
Federal proposals are pending that could allow VA physicians to recommend medical cannabis where state law permits. But until Congress acts, the President signs, and VA issues updated directives, today’s rules remain in force. Build your clinic SOPs around current law, but be ready to revise if VA policy changes.
10) Bottom line
- A DO can be both a CCN provider and a state-authorized cannabis certifier—but never in the same encounter, record, or claim.
- Inside VA care: treat, document, and discuss; do not certify; bill only authorized services.
- Outside VA care: follow state law in a private appointment with separate documentation and billing.
- Clear scripts, separate workflows, and strict documentation protect both compliance and Veterans.
Publisher’s note (read first): This article is for general information only, not legal or medical advice. VA policy allows clinicians to discuss and document cannabis use, but not to recommend, certify, or pay for it. Cannabis evaluations/certifications must happen outside VA care and are never billed to VA/CCN. Laws and policies change—confirm the latest rules with VA, your TPA, state regulators, or counsel before acting.