cfr_sections
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316 rows where part_number = 17 and title_number = 38 sorted by section_id
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| section_id ▼ | title_number | title_name | chapter | subchapter | part_number | part_name | subpart | subpart_name | section_number | section_heading | agency | authority | source_citation | amendment_citations | full_text |
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| 38:38:1.0.1.1.19.0.169.1 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.1 Incorporation by reference. | VA | [80 FR 44861, July 28, 2015] | (a) Certain materials are incorporated by reference into this part with the approval of the Director of the Federal Register under 5 U.S.C. 552(a) and 1 CFR part 51. To enforce an edition of a publication other than that specified in this section, VA will provide notice of the change in a rule in the Federal Register and the material will be made available to the public. All approved materials are available for inspection at the Department of Veterans Affairs, Office of Regulation Policy and Management (02REG), 810 Vermont Avenue NW., Room 1068, Washington, DC 20420, call 202-461-4902, or at the National Archives and Records Administration (NARA). For information on the availability of approved materials at NARA, call (202) 741-6030, or go to: http://www.archives.gov/federal_register/code_of_federal_regulations/ibr_locations.html . (b) National Fire Protection Association, 1 Batterymarch Park, Quincy, MA 02269. (For ordering information, call toll-free 1-800-344-3555). (1) NFPA 10, Standard for Portable Fire Extinguishers (2010 edition), Incorporation by Reference (IBR) approved for §§ 17.63, 17.74, and 17.81. (2) NFPA 13, Standard for the Installation of Sprinkler Systems (2010 edition), IBR approved for § 17.74. (3) NFPA 13D, Standard for the Installation of Sprinkler Systems in One- and Two-Family Dwellings and Manufactured Homes (2010 edition), IBR approved for § 17.74. (4) NFPA 13R, Standard for the Installation of Sprinkler Systems in Residential Occupancies Up To and Including Four Stories in Height (2010 edition), IBR approved for § 17.74. (5) NFPA 25, Standard for the Inspection, Testing, and Maintenance of Water-Based Fire Protection Systems (2011 edition), IBR approved for § 17.74. (6) NFPA 30, Flammable and Combustible Liquids Code (2012 edition), IBR approved for § 17.74. (7) NFPA 72, National Fire Alarm and Signaling Code (2010 edition), IBR approved for § 17.74. (8) NFPA 101, Life Safety Code (2012 edition), IBR approved for §§ 17.63, 17.74 (chapters 1 through 11, 24, and section 33.7),… | ||||||
| 38:38:1.0.1.1.19.0.169.2 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.30 Definitions. | VA | [23 FR 6498, Aug. 22, 1958] | When used in Department of Veterans Affairs medical regulations, each of the following terms shall have the meaning ascribed to it in this section: (a) Medical services. The term medical services includes the following: (1) Medical examination, treatment, and rehabilitative services (as defined in 38 U.S.C. 1701(8)). (2) Surgical services, dental services and appliances as authorized in §§ 17.160 through 17.166, optometric and podiatric services, chiropractic services, preventive health care services set forth in 38 U.S.C. 1701(9), noninstitutional extended care, and items and services as authorized in §§ 17.3200 through 17.3250. (3) Consultation, professional counseling, marriage and family counseling, training, and mental health services for the members of the immediate family or legal guardian of the veteran or the individual in whose household the veteran certifies an intention to live, as necessary in connection with the veteran's treatment. (4) Transportation and incidental expenses for any person entitled to such benefits under the provisions of § 70.10 of this chapter. (b) Domiciliary care. The term domiciliary care— (1) Means the furnishing of: (i) A temporary home to a veteran, embracing the furnishing of shelter, food, clothing and other comforts of home, including necessary medical services; or (ii) A day hospital program consisting of intensive supervised rehabilitation and treatment provided in a therapeutic residential setting for residents with mental health or substance use disorders, and co-occurring medical or psychosocial needs such as homelessness and unemployment. (2) Includes travel and incidental expenses pursuant to § 70.10. | ||||||
| 38:38:1.0.1.1.19.0.169.3 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.31 Duty periods defined. | VA | [34 FR 9339, June 13, 1969, as amended at 45 FR 6934, Jan. 31, 1980; 45 FR 43169, June 26, 1980; 48 FR 56580, Dec. 22, 1983; 61 FR 21965, May 13, 1996; 75 FR 54497, Sept. 8, 2010; 78 FR 78260, Dec. 26, 2013] | Definitions of duty periods applicable to eligibility for medical benefits are as follows: (a) Active military, naval, or air service includes: (1) Active duty. (2) Any period of active duty for training during which the individual was disabled from a disease or injury incurred or aggravated in line of duty. (3) Any period of inactive duty training during which the individual was disabled from an injury incurred or aggravated in line of duty. (4) Any period of inactive duty training during which the individual was disabled from an acute myocardial infarction, a cardiac arrest, or a cerebrovascular accident which occurred during such period of inactive duty training. (b) Active duty means: (1) Full-time duty in the Armed Forces, other than active duty for training. (2) Full-time duty, other than for training purposes, as a commissioned officer of the Regular or Reserve Corps of the Public Health Service during the following dates: (i) On or after July 29, 1945; (ii) Before July 29, 1945, under circumstances affording entitlement to full military benefits; or (3) Full-time duty as a commissioned officer of the National Oceanic and Atmospheric Administration or its predecessor organizations, the Coast and Geodetic Survey or the Environmental Science Services Administration, during the following dates: (i) On or after July 29, 1945; (ii) Before July 29, 1945, under the following circumstances: (A) While on transfer to one of the Armed Forces; (B) While, in time of war or national emergency declared by the President, assigned to duty on a project for one of the Armed Forces in an area determined by the Secretary of Defense to be of immediate military hazard; or (C) In the Philippine Islands on December 7, 1941, and continuously in such islands thereafter; or (4) Service as a cadet at the U.S. Military, Air Force, or Coast Guard Academy, or as a midshipman at the U.S. Naval Academy. (5) Service in Women's Army Auxiliary Corps (WAAC). Recognized effective March 18, 1980. (6) Service of any person … | ||||||
| 38:38:1.0.1.1.19.0.170.4 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.32 Informed consent and advance directives. | VA | [62 FR 53961, Oct. 17, 1997, as amended at 70 FR 71774, Nov. 30, 2005; 71 FR 68740, Nov. 28, 2006; 72 FR 10366, Mar. 8, 2007; 74 FR 34503, July 16, 2009; 85 FR 31701, May 27, 2020; 87 FR 6427, Feb. 4, 2022] | (a) Definitions. The following definitions are applicable for purposes of this section: Advance directive. A written statement by a person who has decision-making capacity regarding preferences about future health care decisions if that person becomes unable to make those decisions, in any of the following: (i) Durable power of attorney for health care. A durable power of attorney for health care (DPAHC) is a type of advance directive in which an individual designates another person as an agent to make health care decisions on the individual's behalf. (ii) Living will. A living will is a type of advance directive in which an individual documents personal preferences regarding future treatment options. A living will typically includes preferences about life-sustaining treatment, but it may also include preferences about other types of health care. (iii) Mental health (or psychiatric) advance directive. A mental health or psychiatric advance directive is executed by patients whose future decision-making capacity is at risk due to mental illness. In this type of directive, the individual indicates future mental health treatment preferences. (iv) State-authorized advance directive. A state-authorized advance directive is a non-VA DPAHC, living will, mental health directive, or other advance directive document that is legally recognized by a state. The validity of state-authorized advance directives is determined pursuant to applicable state law. For the purposes of this section, “applicable state law” means the law of the state where the advance directive was signed, the state where the patient resided when the advance directive was signed, the state where the patient now resides, or the state where the patient is receiving treatment. VA will resolve any conflict between those state laws regarding the validity of the advance directive by following the law of the state that gives effect to the wishes expressed by the patient in the advance directive. (v) Department of Defense (DoD) advance medical di… | ||||||
| 38:38:1.0.1.1.19.0.170.5 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.33 Patients' rights. | VA | [47 FR 55486, Dec. 10, 1982. Redesignated at 61 FR 21965, May 13, 1996, as amended at 70 FR 67094, Nov. 4, 2005] | (a) General. (1) Patients have a right to be treated with dignity in a humane environment that affords them both reasonable protection from harm and appropriate privacy with regard to their personal needs. (2) Patients have a right to receive, to the extent of eligibility therefor under the law, prompt and appropriate treatment for any physical or emotional disability. (3) Patients have the right to the least restrictive conditions necessary to achieve treatment purposes. (4) No patient in the Department of Veterans Affairs medical care system, except as otherwise provided by the applicable State law, shall be denied legal rights solely by virtue of being voluntarily admitted or involuntarily committed. Such legal rights include, but are not limited to, the following: (i) The right to hold and to dispose of property except as may be limited in accordance with paragraph (c)(2) of this section; (ii) The right to execute legal instruments (e.g., will); (iii) The right to enter into contractual relationships; (iv) The right to register and vote; (v) The right to marry and to obtain a separation, divorce, or annulment; (vi) The right to hold a professional, occupational, or vehicle operator's license. (b) Residents and inpatients. Subject to paragraphs (c) and (d) of this section, patients admitted on a residential or inpatient care basis to the Department of Veterans Affairs medical care system have the following rights: (1) Visitations and communications. Each patient has the right to communicate freely and privately with persons outside the facility, including government officials, attorneys, and clergymen. To facilitate these communications each patient shall be provided the opportunity to meet with visitors during regularly scheduled visiting hours, convenient and reasonable access to public telephones for making and receiving phone calls, and the opportunity to send and receive unopened mail. (i) Communications with attorneys, law enforcement agencies, or government officials and representative… | ||||||
| 38:38:1.0.1.1.19.0.171.6 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.34 Tentative eligibility determinations. | VA | [35 FR 6586, Apr. 24, 1970. Redesignated at 61 FR 21965, May 13, 1996, as amended at 64 FR 54212, Oct. 6, 1999; 78 FR 28142, May 14, 2013] | Subject to the provisions of §§ 17.36 through 17.38, when an application for hospital care or other medical services, except outpatient dental care, has been filed which requires an adjudication as to service connection or a determination as to any other eligibility prerequisite which cannot immediately be established, the service (including transportation) may be authorized without further delay if it is determined that eligibility for care probably will be established. Tentative eligibility determinations under this section, however, will only be made if: (a) In emergencies. The applicant needs hospital care or other medical services in emergency circumstances, or (b) Based on discharge. The application is filed within 6 months after date of discharge under conditions other than dishonorable, and for a veteran who seeks eligibility based on a period of service that began after September 7, 1980, the veteran must meet the applicable minimum service requirements under 38 U.S.C. 5303A. | ||||||
| 38:38:1.0.1.1.19.0.172.7 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.35 Hospital care and outpatient services in foreign countries. | VA | [83 FR 29448, June 25, 2018] | (a) Under the VA Foreign Medical Program, VA may furnish hospital care and outpatient services to any veteran outside of the United States, without regard to the veteran's citizenship: (1) If necessary for treatment of a service-connected disability, or any disability associated with and held to be aggravating a service-connected disability; (2) If the care and services are furnished to a veteran participating in a rehabilitation program under 38 U.S.C. chapter 31 who requires care and services for the reasons enumerated in § 17.47(i)(2). (b) Under the Foreign Medical Program, the care and services authorized under paragraph (a) of this section are available in the Republic of the Philippines to a veteran who meets the requirements of paragraph (a) of this section. VA may also provide outpatient services to a veteran referenced in paragraph (a)(1) in the VA outpatient clinic in Manila for the treatment of such veteran's service-connected conditions within the limits of the clinic. Non-service connected conditions of a veteran who has a service-connected disability may be treated within the limits of the VA outpatient clinic in Manila. (c) Claims for payment or reimbursement for services not previously authorized by VA under this section are governed by §§ 17.123-17.127 and 17.129-17.132. | ||||||
| 38:38:1.0.1.1.19.0.173.10 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.38 Medical benefits package. | VA | [64 FR 54217, Oct. 6, 1999, as amended at 67 FR 35039, May 17, 2002; 73 FR 36798, June 30, 2008; 75 FR 54030, Sept. 3, 2010; 76 FR 11339, Mar. 2, 1011; 76 FR 26172, May 5, 2011; 76 FR 78571, Dec. 19, 2011; 82 FR 6275, Jan. 19, 2017; 84 FR 26306, June 5, 2019; 86 FR 84259, Dec. 28, 2020; 87 FR 55296, Sept. 9, 2022; 88 FR 24483, Apr. 21, 2023; 90 FR 61328, Dec. 31, 2025] | (a) Subject to paragraphs (b) and (c) of this section, the following hospital, outpatient, and extended care services constitute the “medical benefits package” (basic care and preventive care): (1) Basic care. (i) Outpatient medical, surgical, and mental healthcare, including care for substance abuse. (ii) Inpatient hospital, medical, surgical, and mental healthcare, including care for substance abuse. (iii) Prescription drugs, including over-the-counter drugs and medical and surgical supplies available under the VA national formulary system. (iv) Emergency care in VA facilities; and emergency care in non-VA facilities in accordance with sharing contracts or if authorized by§ 17.52(a)(3), § 17.53, § 17.54, §§ 17.120 through 17.132, or §§ 17.4000 through 17.4040. (v) Bereavement counseling as authorized in § 17.98. (vi) Comprehensive rehabilitative services other than vocational services provided under 38 U.S.C. chapter 31. (vii) Consultation, professional counseling, marriage and family counseling, training, and mental health services for the members of the immediate family or legal guardian of the veteran or the individual in whose household the veteran certifies an intention to live, as necessary and appropriate, in connection with the veteran's treatment as authorized under 38 CFR 71.50. (viii) Prosthetic and rehabilitative items and services as authorized under §§ 17.3200 through 17.3250, and eyeglasses and hearing aids as authorized under § 17.149. (ix) Home health services authorized under 38 U.S.C. 1717 and 1720C. (x) Reconstructive (plastic) surgery required as a result of disease or trauma, but not including cosmetic surgery that is not medically necessary. (xi)(A) Hospice care, palliative care, and institutional respite care; and (B) Noninstitutional extended care services, including but not limited to noninstitutional geriatric evaluation, noninstitutional adult day health care, and noninstitutional respite care. (xii) Payment of beneficiary travel as authorized under 38 CFR part 70. (xi… | ||||||
| 38:38:1.0.1.1.19.0.173.11 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.39 Certain Filipino veterans. | VA | [71 FR 6680, Feb. 9, 2006] | (a) Any Filipino Commonwealth Army veteran, including one who was recognized by authority of the U.S. Army as belonging to organized Filipino guerilla forces, or any new Philippine Scout is eligible for hospital care, nursing home care, and outpatient medical services within the United States in the same manner and subject to the same terms and conditions as apply to U.S. veterans, if such veteran or scout resides in the United States and is a citizen or lawfully admitted to the United States for permanent residence. For purposes of these VA health care benefits, the standards described in 38 CFR 3.42(c) will be accepted as proof of U.S. citizenship or lawful permanent residence. (b) Commonwealth Army Veterans, including those who were recognized by authority of the U.S. Army as belonging to organized Filipino guerilla forces, and new Philippine Scouts are not eligible for VA health care benefits if they do not meet the residency and citizenship requirements described in § 3.42(c). | ||||||
| 38:38:1.0.1.1.19.0.173.12 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.40 Additional services for indigents. | VA | [33 FR 5299, Apr. 3, 1968, as amended at 47 FR 58247, Dec. 30, 1982. Redesignated at 61 FR 21965, May 13, 1996] | In addition to the usual medical services agreed upon between the governments of the United States and the Republic of the Philippines to be made available to patients for whom the Department of Veterans Affairs has authorized care at the Veterans Memorial Medical Center, any such patient determined by the U.S. Department of Veterans Affairs to be indigent or without funds may be furnished toilet articles and barber services, including haircutting and shaving necessary for hygienic reasons. | ||||||
| 38:38:1.0.1.1.19.0.173.8 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.36 Enrollment—provision of hospital and outpatient care to veterans. | VA | [64 FR 54212, Oct. 6, 1999, as amended at 67 FR 35039, May 17, 2002; 67 FR 62887, Oct. 9, 2002; 68 FR 2672, Jan. 17, 2003; 74 FR 22834, May 15, 2009; 74 FR 48012, Sept. 21, 2009; 75 FR 52628, Aug. 27, 2010; 76 FR 52274, Aug. 22, 2011; 79 FR 72578, Dec. 3, 2013; 79 FR 57414, Sept. 24, 2014; 81 FR 13997, Mar. 16, 2016; 84 FR 7815, Mar. 5, 2019; 89 FR 45601, May 23, 2024] | (a) Enrollment requirement for veterans. (1) Except as otherwise provided in § 17.37, a veteran must be enrolled in the VA healthcare system as a condition for receiving the 'medical benefits package' set forth in § 17.38. A veteran may apply to be enrolled at any time. (See § 17.36(d)(1).) (2) Except as provided in paragraph (a)(3) of this section, a veteran enrolled under this section and who, if required by law to do so, has agreed to make any applicable copayment is eligible for VA hospital and outpatient care as provided in the “medical benefits package” set forth in § 17.38. A veteran's enrollment status will be recognized throughout the United States. (3) A veteran enrolled based on having a disorder associated with exposure to a toxic substance or radiation, for a disorder associated with service in the Southwest Asia theater of operations during the Gulf War (the period between August 2, 1990, and November 11, 1998), or any illness associated with service in combat in a war after the Gulf War or during a period of hostility after November 11, 1998, as provided in 38 U.S.C. 1710(e), is eligible for VA care provided in the “medical benefits package” set forth in § 17.38 for the disorder. (b) Categories of veterans eligible to be enrolled. The Secretary will determine which categories of veterans are eligible to be enrolled based on the following order of priority: (1) Veterans with a singular or combined rating of 50 percent or greater based on one or more service-connected disabilities or unemployability; and veterans awarded the Medal of Honor. (2) Veterans with a singular or combined rating of 30 percent or 40 percent based on one or more service-connected disabilities. (3) Veterans who are former prisoners of war; veterans awarded the Purple Heart; veterans with a singular or combined rating of 10 percent or 20 percent based on one or more service-connected disabilities; veterans who were discharged or released from active military service for a disability incurred or aggravated in the line… | ||||||
| 38:38:1.0.1.1.19.0.173.9 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.37 Enrollment not required—provision of hospital and outpatient care to veterans. | VA | [64 FR 54217, Oct. 6, 1999, as amended at 67 FR 35039, May 17, 2002; 78 FR 28142, May 14, 2013; 87 FR 8742, Feb. 16, 2022; 88 FR 2536, Jan. 17, 2023] | Even if not enrolled in the VA healthcare system: (a) A veteran rated for service-connected disabilities at 50 percent or greater will receive VA care provided for in the “medical benefits package” set forth in § 17.38. (b) A veteran who has a service-connected disability will receive VA care provided for in the “medical benefits package” set forth in § 17.38 for that service-connected disability. (c) A veteran who was discharged or released from active military service for a disability incurred or aggravated in the line of duty will receive VA care provided for in the “medical benefits package” set forth in § 17.38 for that disability for the 12-month period following discharge or release. (d) When there is a compelling medical need to complete a course of VA treatment started when the veteran was enrolled in the VA healthcare system, a veteran will receive that treatment. (e) Subject to the provisions of § 21.240, a veteran participating in VA's Veteran Readiness and Employment (VR&E) program described in §§ 21.1 through 21.430 will receive VA care provided for in the “medical benefits package” set forth in § 17.38. (f) A veteran may receive care provided for in the 'medical benefits package' based on factors other than veteran status (e.g., a veteran who is a private-hospital patient and is referred to VA for a diagnostic test by that hospital under a sharing contract; a veteran who is a VA employee and is examined to determine physical or mental fitness to perform official duties; a Department of Defense retiree under a sharing agreement). (g) For care not provided within a State, a veteran may receive VA care provided for in the “medical benefits package” set forth in § 17.38 if authorized under the provisions of 38 U.S.C. 1724 and 38 CFR 17.35. (h) Commonwealth Army veterans and new Philippine Scouts may receive care provided for in the “medical benefits package” set forth in § 17.38 if authorized under the provisions of 38 U.S.C. 1724 and 38 CFR 17.35. (i) A veteran may receive certain types of VA… | ||||||
| 38:38:1.0.1.1.19.0.174.13 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.41 Persons eligible for hospital observation and physical examination. | VA | [13 FR 7156, Nov. 27, 1948, as amended at 16 FR 12091, Nov. 30, 1951; 19 FR 6716, Oct. 19, 1954; 32 FR 13813, Oct. 4, 1967; 39 FR 32606, Sept. 10, 1974; 49 FR 5616, Feb. 14, 1984. Redesignated and amended at 61 FR 21965, 21966, May 13, 1996] | Hospitalization for observation and physical (including mental) examination may be effected when requested by an authorized official, or when found necessary in examination of the following persons: (a) Claimants or beneficiaries of VA for purposes of disability compensation, pension, participation in a rehabilitation program under 38 U.S.C. chapter 31, and Government insurance. (38 U.S.C. 1711(a)) (b) Claimants or beneficiaries referred to a diagnostic center for study to determine the clinical identity of an obscure disorder. (c) Employees of the Department of Veterans Affairs when necessary to determine their mental or physical fitness to perform official duties. (d) Claimants or beneficiaries of other Federal agencies: (1) Department of Justice—plaintiffs in Government insurance suits. (2) United States Civil Service Commission—annuitants or applicants for retirement annuity, and such examinations of prospective appointees as may be requested. (3) Office of Workers' Compensation Programs—to determine identity, severity, or persistence of disability. (4) Railroad Retirement Board—applicants for annuity under Public No. 162, 75th Congress. (5) Other Federal agencies. (e) Pensioners of nations allied with the United States in World War I and World War II, upon authorization from accredited officials of the respective governments. | ||||||
| 38:38:1.0.1.1.19.0.174.14 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.42 Examinations on an outpatient basis. | VA | [35 FR 6586, Apr. 24, 1970. Redesignated and amended at 61 FR 21965, 21966, May 13, 1996] | Physical examinations on an outpatient basis may be furnished to applicants who have been tentatively determined to be eligible for Department of Veterans Affairs hospital or domiciliary care to determine their need for such care and to the same categories of persons for whom hospitalization for observation and examination may be authorized under § 17.41. | ||||||
| 38:38:1.0.1.1.19.0.175.15 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.43 Persons entitled to hospital care. | VA | [23 FR 6498, Aug. 22, 1958, as amended at 24 FR 8327, Oct. 14, 1959; 32 FR 6841, May 4, 1967; 34 FR 9340, June 13, 1969; 35 FR 6586, Apr. 24, 1970; 39 FR 32606, Sept. 10, 1974. Redesignated and amended at 61 FR 21965, 21966, May 13, 1996; 64 FR 54218, Oct. 6, 1999; 79 FR 54615, Sept. 12, 2014; 88 FR 32975, May 23, 2023; 89 FR 86248, Oct. 30, 2024] | Hospital care may be provided: (a) Not subject to the eligibility provisions of 38 U.S.C. 1710, 1722, and 1729, and 38 CFR 17.44 and 17.45, for: (1) Persons in the Armed Forces when duly referred with authorization therefor, may be furnished hospital care. Emergency treatment may be rendered, without obtaining formal authorization, to such persons upon their own application, when absent from their commands. Identification of active duty members of the uniformed services will be made by military identification card. (2) Hospital care may be provided, upon authorization, for beneficiaries of the Public Health Service, Office of Workers' Compensation Programs, and other Federal agencies. (3) Pensioners of nations allied with the United States in World War I and World War II may be supplied hospital care when duly authorized. (b) Emergency hospital care may be provided for: (1) Persons having no eligibility, as a humanitarian service. (2) Persons admitted because of presumed discharge or retirement from the Armed Forces, but subsequently found to be ineligible as such. (c) Hospital care when incidental to, and to the extent necessary for, the use of a specialized Department of Veterans Affairs medical resource pursuant to a sharing agreement entered into under § 17.240, may be authorized for any person designated by the other party to the agreement as a patient to be benefited under the agreement. (d) The authorization of services under any provision of this section, except services for eligible veterans, is subject to charges as required by § 17.102. | ||||||
| 38:38:1.0.1.1.19.0.175.16 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.44 Hospital care for certain retirees with chronic disability (Executive Orders 10122, 10400 and 11733). | VA | [34 FR 9340, June 13, 1969, as amended at 39 FR 1841, Jan. 15, 1974; 47 FR 58247, Dec. 30, 1982. Redesignated at 61 FR 21965, May 13, 1996, as amended at 62 FR 17072, Apr. 9, 1997; 88 FR 32975, May 23, 2023] | Hospital care may be furnished when beds are available to members or former members of the uniformed services (Army, Navy, Air Force, Marine Corps, Coast Guard, Coast and Geodetic Survey, now National Oceanic and Atmospheric Administration hereinafter referred to as NOAA, and Public Health Service) temporarily or permanently retired for physical disability or receiving disability retirement pay who require hospital care for chronic diseases and who have no eligibility for hospital care under laws governing the Department of Veterans Affairs, or who having eligibility do not elect hospitalization as Department of Veterans Affairs beneficiaries. Care under this section is subject to the following conditions: (a) Persons defined in this section who are members or former members of the active United States Armed Forces must agree to pay the rate set by the Secretary of Veterans Affairs as prescribed in § 17.102(c), except that no charge will be made for those persons who are members of the Public Health Service, Coast Guard, Coast and Geodetic Survey now NOAA, and enlisted personnel of the Army, Navy, Marine Corps, Air Force, and Space Force. (b) Under this section, the term chronic diseases shall include chronic arthritis, malignancy, psychiatric disorders, poliomyelitis with residuals, neurological disabilities, diseases of the nervous system, severe injuries to the nervous system, including quadriplegia, hemiplegia and paraplegia, tuberculosis, blindness and deafness requiring definitive rehabilitation, disability from major amputation, and other diseases as may be agreed upon from time to time by the Under Secretary for Health and designated officials of the Department of Defense and Department of Health and Human Services. For the purpose of this section, blindness is defined as corrected visual acuity of 20/200 or less in the better eye, or corrected central visual acuity of more than 20/200 if there is a field defect in which the peripheral field has contracted to such an extent that its widest diameter … | ||||||
| 38:38:1.0.1.1.19.0.175.17 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.45 Hospital care for research purposes. | VA | [35 FR 11470, July 17, 1970. Redesignated at 61 FR 21965, May 13, 1996; 79 FR 54615, Sept. 12, 2014] | Subject to § 17.102(g), any person who is a bona fide volunteer may be admitted to a Department of Veterans Affairs hospital when the treatment to be rendered is part of an approved Department of Veterans Affairs research project and there are insufficient veteran-patients suitable for the project. | ||||||
| 38:38:1.0.1.1.19.0.175.18 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.46 Eligibility for hospital, domiciliary or nursing home care of persons discharged or released from active military, naval, or air service. | VA | [24 FR 8328, Oct. 4, 1959, as amended at 30 FR 1787, Feb. 9, 1965; 32 FR 13813, Oct. 4, 1967; 34 FR 9340, June 13, 1969; 39 FR 1841, Jan. 15, 1974; 45 FR 6935, Jan. 31, 1980; 51 FR 25064, July 10, 1986; 52 FR 11259, Apr. 8, 1987; 53 FR 9627, Mar. 24, 1988; 53 FR 32391, Aug. 25, 1988; 56 FR 5757, Feb. 13, 1991. Redesignated and amended at 61 FR 21965, 21966, May 13, 1996; 84 FR 26306, June 5, 2019; 89 FR 86248, Oct. 30, 2024] | (a) In furnishing hospital care on or before June 6, 2019, under 38 U.S.C. 1710(a)(1), VA officials shall: (1) If the veteran is in immediate need of hospitalization, furnish care at VA facility where the veteran applies or, if that facility is incapable of furnishing care, arrange to admit the veteran to the nearest VA medical center, or Department of Defense hospital with which VA has a sharing agreement under 38 U.S.C. 8111, which is capable of providing the needed care, or if VA or DOD facilities are not available, arrange for care on a contract basis if authorized by 38 U.S.C. 1703 and 38 CFR 17.52; or (2) If the veteran needs non-immediate hospitalization, schedule the veteran for admission at VA facility where the veteran applies, if the schedule permits, or refer the veteran for admission or scheduling for admission at the nearest VA medical center, or Department of Defense facility with which VA has a sharing agreement under 38 U.S.C. 8111. (b) Domiciliary care may be furnished when needed to: (1) Any veteran whose annual income does not exceed the maximum annual rate of pension payable to a veteran in need of regular aid and attendance, or (2) Any veteran who the Secretary determines had no adequate means of support. An additional requirement for eligibility for domiciliary care is the ability of the veteran to perform the following: (i) Perform without assistance daily ablutions, such as brushing teeth; bathing; combing hair; body eliminations. (ii) Dress self, with a minimum of assistance. (iii) Proceed to and return from the dining hall without aid. (iv) Feed Self. (v) Secure medical attention on an ambulatory basis or by use of personally propelled wheelchair. (vi) Have voluntary control over body eliminations or control by use of an appropriate prosthesis. (vii) Make rational and competent decisions as to his or her desire to remain or leave the facility. | ||||||
| 38:38:1.0.1.1.19.0.175.19 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.47 Considerations applicable in determining eligibility for hospital care, medical services, nursing home care, or domiciliary care. | VA | [32 FR 13813, Oct. 4, 1967] | (a)(1) For applicants discharged or released for disability incurred or aggravated in line of duty and who are not in receipt of compensation for service-connected or service-aggravated disability, the official records of the Armed Forces relative to findings of line of duty for its purposes will be accepted in determining eligibility for hospital care or medical services. Where the official records of the Armed Forces show a finding of disability not incurred or aggravated in line of duty and evidence is submitted to the Department of Veterans Affairs which permits of a different finding, the decision of the Armed Forces will not be binding upon the Department of Veterans Affairs, which will be free to make its own determination of line of duty incurrence or aggravation upon evidence so submitted. It will be incumbent upon the applicant to present controverting evidence and, until such evidence is presented and a determination favorable to the applicant is made by the Department of Veterans Affairs, the finding of the Armed Forces will control and hospital care or medical services will not be authorized. Such controverting evidence, when received from an applicant, will be referred to the adjudicating agency which would have jurisdiction if the applicant was filing claim for pension or disability compensation, and the determination of such agency as to line of duty, which is promptly to be communicated to the head of the field facility receiving the application for hospital care or medical services , will govern the facility Director's disapproval or approval of such care or services,other eligibility requirements having been met. Where the official records of the Armed Forces show that the disability for which a veteran was discharged or released from the Armed Forces under other than dishonorable conditions was incurred or aggravated in the line of duty, such showing will be accepted for the purpose of determining his or her eligibility for hospital care or medical services, notwithstanding the fact that the D… | ||||||
| 38:38:1.0.1.1.19.0.175.20 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.48 Compensated Work Therapy/Transitional Residences program. | VA | [70 FR 29627, May 24, 2005, as amended at 79 FR 54615, Sept. 12, 2014] | (a) This section sets forth requirements for persons residing in housing under the Compensated Work Therapy/Transitional Residences program. (b) House managers shall be responsible for coordinating and supervising the day-to-day operations of the facilities. The local VA program coordinator shall select each house manager and may give preference to an individual who is a current or past resident of the facility or the program. A house manager must have the following qualifications: (1) A stable, responsible and caring demeanor; (2) Leadership qualities including the ability to motivate; (3) Effective communication skills including the ability to interact; (4) A willingness to accept feedback; (5) A willingness to follow a chain of command. (c) Each resident admitted to the Transitional Residence, except for a house manager, must also be in the Compensated Work Therapy program. (d) Each resident, except for a house manager, must bi-weekly, in advance, pay a fee to VA for living in the housing. The local VA program coordinator will establish the fee for each resident in accordance with the provisions of paragraph (d)(1) of this section. (1) The total amount of actual operating expenses of the residence (utilities, maintenance, furnishings, appliances, service equipment, all other operating costs) for the previous fiscal year plus 15 percent of that amount equals the total operating budget for the current fiscal year. The total operating budget is to be divided by the average number of beds occupied during the previous fiscal year and the resulting amount is the average yearly amount per bed. The bi-weekly fee shall equal 1/26th of the average yearly amount per bed, except that a resident shall not, on average, pay more than 30 percent of their gross CWT (Compensated Work Therapy) bi-weekly earnings. The VA program manager shall, bi-annually, conduct a review of the factors in this paragraph for determining resident payments. If he or she determines that the payments are too high or too low by more than 5 p… | ||||||
| 38:38:1.0.1.1.19.0.175.21 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.49 Priorities for outpatient medical services and inpatient hospital care. | VA | [67 FR 58529, Sept. 17, 2002] | In scheduling appointments for outpatient medical services and admissions for inpatient hospital care, the Under Secretary for Health shall give priority to: (a) Veterans with service-connected disabilities rated 50 percent or greater based on one or more disabilities or unemployability; and (b) Veterans needing care for a service-connected disability. | ||||||
| 38:38:1.0.1.1.19.0.176.22 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.50 Use of Department of Defense, Public Health Service or other Federal hospitals with beds allocated to the Department of Veterans Affairs. | VA | [79 FR 54615, Sept. 12, 2014] | Hospital facilities operated by the Department of Defense or the Public Health Service (or any other agency of the United States Government) may be used for the care of VA patients pursuant to agreements between VA and the department or agency operating the facility. When such an agreement has been entered into and a bed allocation for VA patients has been provided for in a specific hospital covered by the agreement, care may be authorized within the bed allocation for any veteran eligible under 38 U.S.C. 1710 or § 17.44. Care in a Federal facility not operated by VA, however, shall not be authorized for any military retiree whose sole basis for eligibility is under § 17.44, or, except in Alaska and Hawaii, for any retiree of the uniformed services suffering from a chronic disability whose entitlement is under § 17.44 or § 17.46(a)(2) regardless of whether he or she may have dual eligibility under other provisions of § 17.46. | ||||||
| 38:38:1.0.1.1.19.0.176.23 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.51 Emergency use of Department of Defense, Public Health Service or other Federal hospitals. | VA | [33 FR 19010, Dec. 20, 1968. Redesignated and amended at 61 FR 21965, 21966, May 13, 1996] | Hospital care in facilities operated by the Department of Defense or the Public Health Service (or any other agency of the U.S. Government) which do not have beds allocated for the care of Department of Veterans Affairs patients may be authorized subject to the limitations enumerated in § 17.50 only in emergency circumstances for any veteran otherwise eligible for hospital care under 38 U.S.C. 1710 or 38 CFR 17.46. | ||||||
| 38:38:1.0.1.1.19.0.177.24 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.52 Hospital care and medical services in non-VA facilities. | VA | [51 FR 25066, July 10, 1986, as amended at 53 FR 32391, Aug. 25, 1988; 54 FR 53057, Dec. 27, 1989; 58 FR 32446, June 10, 1993. Redesignated and amended at 61 FR 21965, 21966, May 13, 1996; 62 FR 17072, Apr. 9, 1997; 75 FR 78915, Dec. 17, 2010; 77 FR 70895, Nov. 28, 2012; 78 FR 76063, Dec. 16, 2013; 79 FR 54615, Sept. 12, 2014; 84 FR 26306, June 5, 2019] | (a) When VA facilities or other government facilities are not capable of furnishing economical hospital care or medical services because of geographic inaccessibility or are not capable of furnishing care or services required, VA may contract with non-VA facilities for care in accordance with the provisions of this section. When demand is only for infrequent use, individual authorizations may be used. Care in public or private facilities, however, subject to the provisions of §§ 17.53, 17.54, 17.55 and 17.56, will only be authorized, whether under a contract or an individual authorization, for— (1) Hospital care or medical services to a veteran for the treatment of— (i) A service-connected disability; or (ii) A disability for which a veteran was discharged or released from the active military, naval, or air service or (iii) A disability of a veteran who has a total disability permanent in nature from a service-connected disability, or (iv) For a disability associated with and held to be aggravating a service-connected disability, or (v) For any disability of a veteran participating in a rehabilitation program under 38 U.S.C. ch. 31 and when there is a need for hospital care or medical services for any of the reasons enumerated in § 17.48(i). (2) Medical services for the treatment of any disability of— (i) A veteran who has a service-connected disability rated at 50 percent or more, (ii) A veteran who has been furnished hospital care, nursing home care, domiciliary care, or medical services, and requires medical services to complete treatment incident to such care or services (each authorization for non-VA treatment needed to complete treatment may continue for up to 12 months, and new authorizations may be issued by VA as needed), and (iii) A veteran of the Mexican border period or World War I or who is in receipt of increased pension or additional compensation based on the need for aid and attendance or housebound benefits when it has been determined based on an examination by a physician employed by V… | ||||||
| 38:38:1.0.1.1.19.0.177.25 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.53 Limitations on use of public or private hospitals. | VA | [39 FR 17223, May 14, 1974, as amended at 47 FR 58248, Dec. 30, 1982. Redesignated at 61 FR 21965, May 13, 1996] | The admission of any patient to a private or public hospital at Department of Veterans Affairs expense will only be authorized if a Department of Veterans Affairs medical center or other Federal facility to which the patient would otherwise be eligible for admission is not feasibly available. A Department of Veterans Affairs facility may be considered as not feasibly available when the urgency of the applicant's medical condition, the relative distance of the travel involved, or the nature of the treatment required makes it necessary or economically advisable to use public or private facilities. In those instances where care in public or private hospitals at Department of Veterans Affairs expense is authorized because a Department of Veterans Affairs or other Federal facility was not feasibly available, as defined in this section, the authorization will be continued after admission only for the period of time required to stabilize or improve the patient's condition to the extent that further care is no longer required to satisfy the purpose for which it was initiated. | ||||||
| 38:38:1.0.1.1.19.0.177.26 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.54 [Reserved] | VA | ||||||||
| 38:38:1.0.1.1.19.0.177.27 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.55 Payment for authorized public or private hospital care. | VA | [55 FR 42852, Oct. 24, 1990. Redesignated and amended at 61 FR 21965, 21966, May 13, 1996; 62 FR 17072, Apr. 9, 1997; 63 FR 39515, July 23, 1998; 65 FR 66637, Nov. 7, 2000; 84 FR 26306, June 5, 2019] | Except as otherwise provided in this section, payment for public or private hospital care furnished on or before June 6, 2019, under 38 U.S.C. 1703 and § 17.52, or at any time under 38 U.S.C. 1728 and §§ 17.120 and 17.128 or under 38 U.S.C. 1787 and § 17.410, shall be based on a prospective payment system similar to that used in the Medicare program for paying for similar inpatient hospital services in the community. Payment shall be made using the Centers for Medicare & Medicaid Services (CMS) PRICER for each diagnosis-related group (DRG) applicable to the episode of care. (a) Payment shall be made of the full prospective payment amount per discharge, as determined according to the methodology in subparts D and G of 42 CFR part 412, as appropriate. (b)(1) In the case of a veteran who was transferred to another facility before completion of care, VA shall pay the transferring hospital an amount calculated by the HCFA PRICER for each patient day of care, not to exceed the full DRG rate as provided in paragraph (a) of this section. The hospital that ultimately discharges the patient will receive the full DRG payment. (2) In the case of a veteran who has transferred from a hospital and/or distinct part unit excluded by Medicare from the DRG-based prospective payment system or from a hospital that does not participate in Medicare, the transferring hospital will receive a payment for each patient day of care not to exceed the amount provided in paragraph (i) of this section. (c) VA shall pay the providing facility the full DRG-based rate or reasonable cost, without regard to any copayments or deductible required by any Federal law that is not applicable to VA. (d) If the cost or length of a veteran's care exceeds an applicable threshold amount, as determined by the HCFA PRICER program, VA shall pay, in addition to the amount payable under paragraph (a) of this section, an outlier payment calculated by the HCFA PRICER program, in accordance with subpart F of 42 CFR part 412. (e) In addition to the amount payable … | ||||||
| 38:38:1.0.1.1.19.0.177.28 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.56 VA payment for inpatient and outpatient health care professional services at non-departmental facilities and other medical charges associated with non-VA outpatient care. | VA | [75 FR 78915, Dec. 17, 2010, as amended at 78 FR 26251, May 6, 2013; 78 FR 68364, Nov. 14, 2013; 79 FR 16200, Mar. 25, 2014; 84 FR 26306, June 5, 2019] | (a) Except for health care professional services provided in the state of Alaska (see paragraph (b) of this section), VA will determine the amounts paid under § 17.52 or § 17.120 for health care professional services, and all other medical services associated with non-VA outpatient care, using the applicable method in this section: (1) If a specific amount has been negotiated with a specific provider, VA will pay that amount. (2) If an amount has not been negotiated under paragraph (a)(1) of this section, VA will pay the lowest of the following amounts: (i) The applicable Medicare fee schedule or prospective payment system amount (“Medicare rate”) for the period in which the service was provided (without any changes based on the subsequent development of information under Medicare authorities), subject to the following: (A) In the event of a Medicare waiver, the payment amount will be calculated in accordance with such waiver. (B) In the absence of a Medicare rate or Medicare waiver, payment will be the VA Fee Schedule amount for the period in which the service was provided. The VA Fee Schedule amount is determined by the authorizing VA medical facility, which ranks all billings (if the facility has had at least eight billings) from non-VA facilities under the corresponding procedure code during the previous fiscal year, with billings ranked from the highest to the lowest. The VA Fee Schedule amount is the charge falling at the 75th percentile. If the authorizing facility has not had at least eight such billings, then this paragraph does not apply. (ii) The amount negotiated by a repricing agent if the provider is participating within the repricing agent's network and VA has a contract with that repricing agent. For the purposes of this section, repricing agent means a contractor that seeks to connect VA with discounted rates from non-VA providers as a result of existing contracts that the non-VA provider may have within the commercial health care industry. (iii) The amount that the provider bills the ge… | ||||||
| 38:38:1.0.1.1.19.0.178.29 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.57 Use of community nursing homes. | VA | [51 FR 25067, July 10, 1986. Redesignated and amended at 61 FR 21965, 21966, May 13, 1996 and further redesignated at 63 FR 39515, July 23, 1998; 79 FR 54615, Sept. 12, 2014] | (a) Nursing home care in a contract public or private nursing home facility may be authorized for the following: Any veteran who has been discharged from a hospital under the direct jurisdiction of VA and is currently receiving VA hospital based home health services. (b) To the extent that resources are available and are not otherwise required to assure that VA can furnish needed care and treatment to veterans described in 38 U.S.C. 1710(a)(1) and (a)(2), the Under Secretary for Health may furnish care under this paragraph to any veteran described in 38 U.S.C. 1710(a)(3) if the veteran agrees to pay the United States an amount as determined in 38 U.S.C. 1710(f). | ||||||
| 38:38:1.0.1.1.19.0.178.30 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.58 Evacuation of community nursing homes. | VA | [76 FR 55571, Sept. 8, 2011] | When veterans are evacuated from a community nursing home as the result of an emergency, they may be relocated to another facility that meets certain minimum standards, as set forth in 38 CFR 51.59(c)(1). | ||||||
| 38:38:1.0.1.1.19.0.178.31 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.60 Extensions of community nursing home care beyond six months. | VA | [53 FR 13121, Apr. 21, 1988. Redesignated at 61 FR 21965, May 13, 1996] | Directors of health care facilities may authorize, for any veteran whose hospitalization was not primarily for a service-connected disability, an extension of nursing care in a public or private nursing home care facility at VA expense beyond six months when the need for nursing home care continues to exist and (a) Arrangements for payment of such care through a public assistance program (such as Medicaid) for which the veteran has applied, have been delayed due to unforeseen eligibility problems which can reasonably be expected to be resolved within the extension period, or (b) The veteran has made specific arrangements for private payment for such care, and (1) Such arrangements cannot be effectuated as planned because of unforseen, unavoidable difficulties, such as a temporary obstacle to liquidation of property, and (2) Such difficulties can reasonably be expected to be resolved within the extension period; or (c) The veteran is terminally ill and life expectancy has been medically determined to be less than six months. (d) In no case may an extension under paragraph (a) or (b) of this section exceed 45 days. | ||||||
| 38:38:1.0.1.1.19.0.179.32 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.61 Eligibility. | VA | [54 FR 20842, May 15, 1989. Redesignated and amended at 61 FR 21965, 21966, May 13, 1996; 84 FR 33696, July 15, 2019] | VA health care personnel may assist a veteran by referring such veteran for placement in a privately or publicly-owned community residential care facility if: (a) At the time of initiating the assistance: (1) The veteran is receiving VA medical services on an outpatient basis or VA medical center, domiciliary, or nursing home care; or (2) Such care or services were furnished the veteran within the preceding 12 months; (b) The veteran does not need hospital or nursing home care but is unable to live independently because of medical (including psychiatric) conditions and has no suitable family resources to provide needed monitoring, supervision, and any necessary assistance in the veteran's activities of daily living and instrumental activities of daily living ; and (c) The facility has been approved in accordance with § 17.63 of this part. | ||||||
| 38:38:1.0.1.1.19.0.179.33 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.62 Definitions. | VA | [84 FR 33697, July 15, 2019] | For the purpose of §§ 17.61 through 17.72: Activities of daily living means basic daily tasks an individual performs as part of self-care which may be used as a measurement of the functional status of a person including: walking; bathing, shaving, brushing teeth, combing hair; dressing; eating; getting in or getting out of bed; and toileting. Approving official means the Director or, if designated by the Director, the Associate Director or Chief of Staff of a Department of Veterans Affairs Medical Center or Outpatient Clinic which has jurisdiction to approve a community residential care facility. Community residential care means the monitoring, supervision, and assistance, in accordance with a statement of needed care, of the activities of daily living activities and instrumental activities of daily living, of referred veterans in an approved home in the community by the facility's provider. Hearing official means the Director or, if designated by the Director, the Associate Director or Chief of Staff of a Department of Veterans Affairs Medical Center or Outpatient Clinic which has jurisdiction to approve a community residential care facility. Instrumental activities of daily living are tasks that are not necessary for fundamental functioning, but allow an individual to live independently in a community. Instrumental activities of daily living include: housekeeping and cleaning room; meal preparation; taking medications; laundry; assistance with transportation; shopping—for groceries, clothing or other items; ability to use the telephone; ability to manage finances; writing letters; and obtaining appointments. Oral hearing means the in person testimony of representatives of a community residential care facility and of VA before the hearing official and the review of the written evidence of record by that official. Paper hearing means a review of the written evidence of record by the hearing official. | ||||||
| 38:38:1.0.1.1.19.0.179.34 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.63 Approval of community residential care facilities. | VA | [54 FR 20842, May 15, 1989, as amended at 54 FR 22754, May 26, 1989. Redesignated at 61 FR 21965, May 13, 1996, as amended at 61 FR 63720, Dec. 2, 1996; 69 FR 18803, Apr. 9, 2004; 74 FR 63308, Dec. 3, 2009; 76 FR 10248, Feb. 24, 2011; 82 FR 34415, July 25, 2017; 82 FR 35451, July 31, 2017; 84 FR 33697, July 15, 2019] | The approving official may approve a community residential care facility, based on the report of a VA inspection and on any findings of necessary interim monitoring of the facility, if that facility meets the following standards: (a) Health and safety standards. The facility must: (1) Meet all State and local regulations including construction, maintenance, and sanitation regulations; (2) Meet the requirements in the applicable provisions of NFPA 101 and NFPA 101A (incorporated by reference, see § 17.1) and the other publications referenced in those provisions. The institution shall provide sufficient staff to assist patients in the event of fire or other emergency. Any equivalencies or variances to VA requirements must be approved by the appropriate Veterans Health Administration Veterans Integrated Service Network (VISN) Director; (3) Have safe and functioning systems for heating and/or cooling, as needed (a heating or cooling system is deemed to be needed if VA determines that, in the county, parish, or similar jurisdiction where the facility is located, a majority of community residential care facilities or other extended care facilities have one), hot and cold water, electricity, plumbing, sewage, cooking, laundry, artificial and natural light, and ventilation. (4) Meet the following additional requirements, if the provisions for One and Two-Family Dwellings, as defined in NFPA 101, are applicable to the facility: (i) Portable fire extinguishers must be installed, inspected, and maintained in accordance with NFPA 10 (incorporated by reference, see § 17.1); and (ii) The facility must meet the requirements in section 33.7 of NFPA 101. (b) Level of care. The community residential care facility must provide the resident, at a minimum, a base level of care to include room and board; nutrition consisting of three meals per day and two snacks, or as required to meet special dietary needs; laundry services; transportation (either provided or arranged) to VA and healthcare appointments; and accompanyi… | ||||||
| 38:38:1.0.1.1.19.0.179.35 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.64 [Reserved] | VA | ||||||||
| 38:38:1.0.1.1.19.0.179.36 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.65 Approvals and provisional approvals of community residential care facilities. | VA | [74 FR 63308, Dec. 3, 2009, as amended at 78 FR 32126, May 29, 2013] | (a) An approval of a facility meeting all of the standards in 38 CFR 17.63 based on the report of a VA inspection and any findings of necessary interim monitoring of the facility shall be for a 12-month period. (b) The approving official, based on the report of a VA inspection and on any findings of necessary interim monitoring of the facility, may provide a community residential care facility with a provisional approval if that facility does not meet one or more of the standards in 38 CFR 17.63, provided that the deficiencies do not jeopardize the health or safety of the residents, and that the facility management and VA agree to a plan of correcting the deficiencies in a specified amount of time. A provisional approval shall not be for more than 12 months and shall not be for more time than VA determines is reasonable for correcting the specific deficiencies. (c) An approval may be changed to a provisional approval or terminated under the provisions of §§ 17.66 through 17.71 because of a subsequent failure to meet the standards of § 17.63 and a provisional approval may be terminated under the provisions of §§ 17.66 through 17.71 based on failure to meet the plan of correction or failure otherwise to meet the standards of § 17.63. (d)(1) VA may waive one or more of the standards in 38 CFR 17.63 for the approval of a particular community residential care facility, provided that a VA safety expert certifies that the deficiency does not endanger the life or safety of the residents; the deficiency cannot be corrected as provided in paragraph (b) of this section for provisional approval of the community residential care facility; and granting the waiver is in the best interests of the veteran in the facility and VA's community residential care program. In order to reach the above determinations, the VA safety expert may request supporting documentation from the community residential care facility. (2) In those instances where a waiver is granted, the subject standard is deemed to have been met for purposes of app… | ||||||
| 38:38:1.0.1.1.19.0.179.37 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.66 Notice of noncompliance with VA standards. | VA | [54 FR 20842, May 15, 1989. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996; 78 FR 32126, May 29, 2013] | If the hearing official determines that an approved community residential care facility does not comply with the standards set forth in § 17.63 of this part, the hearing official shall notify the community residential care facility in writing of: (a) The standards which have not been met; (b) The date by which the standards must be met in order to avoid revocation of VA approval; (c) The community residential care facility's opportunity to request an oral or paper hearing under § 17.67 of this part before VA approval is revoked; and (d) The date by which the hearing official must receive the community residential care facility's request for a hearing, which shall not be less than 10 calendar days and not more than 20 calendar days after the date of VA notice of noncompliance, unless the hearing official determines that noncompliance with the standards threatens the lives of community residential care residents in which case the hearing official must receive the community residential care facility's request for an oral or paper hearing within 36 hours of receipt of VA notice. | ||||||
| 38:38:1.0.1.1.19.0.179.38 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.67 Request for a hearing. | VA | [54 FR 20842, May 15, 1989. Redesignated at 61 FR 21965, May 13, 1996] | The community residential care facility operator must specify in writing whether an oral or paper hearing is requested. The request for the hearing must be sent to the hearing official. Timely receipt of a request for a hearing will stay the revocation of VA approval until the hearing official issues a written decision on the community residential care facility's compliance with VA standards. The hearing official may accept a request for a hearing received after the time limit, if the community residential care facility shows that the failure of the request to be received by the hearing official's office by the required date was due to circumstances beyond its control. | ||||||
| 38:38:1.0.1.1.19.0.179.39 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.68 Notice and conduct of hearing. | VA | [54 FR 20842, May 15, 1989. Redesignated at 61 FR 21965, May 13, 1996] | (a) Upon receipt of a request for an oral hearing, the hearing official shall: (1) Notify the community residential care facility operator of the date, time, and location for the hearing; and (2) Notify the community residential care facility operator that written statements and other evidence for the record may be submitted to the hearing official before the date of the hearing. An oral hearing shall be informal. The rules of evidence shall not be followed. Witnesses shall testify under oath or affirmation. A recording or transcript of every oral hearing shall be made. The hearing official may exclude irrelevant, immaterial, or unduly repetitious testimony. (b) Upon the receipt of a community residential care facility's request for a paper hearing, the hearing official shall notify the community residential care facility operator that written statements and other evidence must be submitted to the hearing official by a specified date in order to be considered as part of the record. (c) In all hearings, the community residential care facility operator and VA may be represented by counsel. | ||||||
| 38:38:1.0.1.1.19.0.179.40 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.69 Waiver of opportunity for hearing. | VA | [54 FR 20842, May 15, 1989. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996] | If representatives of a community residential care facility which receive a notice of noncompliance under § 17.66 of this part fail to appear at an oral hearing of which they have been notified or fail to submit written statements for a paper hearing in accordance with § 17.68 of this part, unless the hearing official determines that their failure was due to circumstances beyond their control, the hearing official shall: (a) Consider the representatives of the community residential care facility to have waived their opportunity for a hearing; and, (b) Revoke VA approval of the community residential care facility and notify the community residential care facility of this revocation. | ||||||
| 38:38:1.0.1.1.19.0.179.41 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.70 Written decision following a hearing. | VA | [54 FR 20842, May 15, 1989. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996] | (a) The hearing official shall issue a written decision within 20 days of the completion of the hearing. An oral hearing shall be considered completed when the hearing ceases to receive in person testimony. A paper hearing shall be considered complete on the date by which written statements must be submitted to the hearing official in order to be considered as part of the record. (b) The hearing official's determination of a community residential care facility's noncompliance with VA standards shall be based on the preponderance of the evidence. (c) The written decision shall include: (1) A statement of the facts; (2) A determination whether the community residential care facility complies with the standards set forth in § 17.63 of this part; and (3) A determination of the time period, if any, the community residential care facility shall have to remedy any noncompliance with VA standards before revocation of VA approval occurs. (d) The hearing official's determination of any time period under paragraph (c)(3) of this section shall consider the safety and health of the residents of the community residential care facility and the length of time since the community residential care facility received notice of the noncompliance. | ||||||
| 38:38:1.0.1.1.19.0.179.42 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.71 Revocation of VA approval. | VA | [54 FR 20842, May 15, 1989. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996] | (a) If a hearing official determines under § 17.70 of this part that a community residential care facility does not comply with the standards set forth in § 17.63 of this part and determines that the community residential care facility shall not have further time to remedy the noncompliance, the hearing official shall revoke approval of the community residential care facility and notify the community residential care facility of this revocation. (b) Upon revocation of VA approval, VA health care personnel shall: (1) Cease referring veterans to the community residential care facility; and, (2) Notify any veteran residing in the community residential care facility of the facility's disapproval and request permission to assist in the veteran's removal from the facility. If a veteran has a person or entity authorized by law to give permission on behalf of the veteran, VA health care personnel shall notify that person or entity of the community residential care facility's disapproval and request permission to assist in removing the veteran from the community residential care facility. (c) If the hearing official determines that a community residential care facility fails to comply with the standards set forth in § 17.63 of this part and determines that the community residential care facility shall have an additional time period to remedy the noncompliance, the hearing official shall review at the end of the time period the evidence of the community residential care facility's compliance with the standards which were to have been met by the end of that time period and determine if the community residential care facility complies with the standards. If the community residential care facility fails to comply with these or any other standards, the procedures set forth in §§ 17.66-17.71 of this part shall be followed. | ||||||
| 38:38:1.0.1.1.19.0.179.43 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.72 Availability of information. | VA | [54 FR 20842, May 15, 1989. Redesignated at 61 FR 21965, May 13, 1996] | VA standards will be made available to other Federal, State and local agencies charged with the responsibility of licensing, or otherwise regulating or inspecting community residential care facilities. | ||||||
| 38:38:1.0.1.1.19.0.179.44 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.73 Medical foster homes—general. | VA | [77 FR 5188, Feb. 2, 2012] | (a) Purpose. Through the medical foster home program, VA recognizes and approves certain medical foster homes for the placement of veterans. The choice to become a resident of a medical foster home is a voluntary one on the part of each veteran. VA's role is limited to referring veterans to approved medical foster homes. When a veteran is placed in an approved home, VA will provide inspections to ensure that the home continues to meet the requirements of this part, as well as oversight and medical foster home caregiver training. If a medical foster home does not meet VA's criteria for approval, VA will not refer any veteran to the home or provide any of these services. VA may also provide certain medical benefits to veterans placed in medical foster homes, consistent with the VA program in which the veteran is enrolled. (b) Definitions. For the purposes of this section and § 17.74: Labeled means that the equipment or materials have attached to them a label, symbol, or other identifying mark of an organization recognized as having jurisdiction over the evaluation and periodic inspection of such equipment or materials, and by whose labeling the manufacturer indicates compliance with appropriate standards or performance. Medical foster home means a private home in which a medical foster home caregiver provides care to a veteran resident and: (i) The medical foster home caregiver lives in the medical foster home; (ii) The medical foster home caregiver owns or rents the medical foster home; and (iii) There are not more than three residents receiving care (including veteran and non-veteran residents). Medical foster home caregiver means the primary person who provides care to a veteran resident in a medical foster home. Placement refers to the voluntary decision by a veteran to become a resident in an approved medical foster home. Veteran resident means a veteran residing in an approved medical foster home who meets the eligibility criteria in paragraph (c) of this section. (c) Eligibility. VA heal… | ||||||
| 38:38:1.0.1.1.19.0.179.45 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.74 Standards applicable to medical foster homes. | VA | [77 FR 5189, Feb. 2, 2012, as amended at 80 FR 44862, July 28, 2015] | (a) General. A medical foster home must: (1) Meet all applicable state and local regulations, including construction, maintenance, and sanitation regulations. (2) Have safe and functioning systems for heating, hot and cold water, electricity, plumbing, sewage, cooking, laundry, artificial and natural light, and ventilation. Ventilation for cook stoves is not required. (3) Except as otherwise provided in this section, meet the applicable provisions of chapters 1 through 11 and 24, and section 33.7 of NFPA 101 (incorporated by reference, see § 17.1), and the other codes and chapters identified in this section, as applicable. Existing buildings or installations that do not comply with the installation provisions of the codes or standards referenced in paragraph (b)(1) through (5), (b)(8), and (b)(10) of § 17.1 shall be permitted to be continued in service, provided that the lack of conformity with these codes and standards does not present a serious hazard to the occupants. (b) Community residential care facility standards applicable to medical foster homes. Medical foster homes must comply with § 17.63(c), (d), (f), (h), (j) and (k). (c) Activities. The facility must plan and facilitate appropriate recreational and leisure activities. (d) Residents' bedrooms. Each veteran resident must have a bedroom: (1) With a door that closes and latches; (2) That contains a suitable bed and appropriate furniture; and (3) That is single occupancy, unless the veteran agrees to a multi-occupant bedroom. (e) Windows. VA may grant provisional approval for windows used as a secondary means of escape that do not meet the minimum size and dimensions required by chapter 24 of NFPA 101 (incorporated by reference, see § 17.1) if the windows are a minimum of 5.0 square feet (and at least 20 inches wide and at least 22 inches high). The secondary means of escape must be brought into compliance with chapter 24 no later than 60 days after a veteran resident is placed in the home. (f) Special locking devices. Special loc… | ||||||
| 38:38:1.0.1.1.19.0.180.46 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.80 Alcohol and drug dependence or abuse treatment and rehabilitation in residential and nonresidential facilities by contract. | VA | [47 FR 57706, Dec. 28, 1982. Redesignated at 61 FR 21965, May 13, 1996, as amended at 61 FR 56897, Nov. 5, 1996] | (a) Alcohol and drug dependence or abuse treatment and rehabilitation may be authorized by contract in nonresidential facilities and in residential facilities provided by halfway houses, therapeutic communities, psychiatric residential treatment centers and other community-based treatment facilities, when considered to be medically advantageous and cost effective for the following: (1) Veterans who have been or are being furnished care by professional staff over which the Secretary has jurisdiction and such transitional care is reasonably necessary to continue treatment; (2) Persons in the Armed Forces who, upon discharge therefrom will become eligible veterans, when duly referred with authorization for Department of Veterans Affairs medical center hospital care in preparation for treatment and rehabilitation in this program under the following limitations: (i) Such persons may be accepted by transfer only during the last 30 days of such person's enlistment or tour of duty, (ii) The person requests transfer in writing for treatment for a specified period of time during the last 30 days of such person's enlistment period or tour of duty, (iii) Treatment does not extend beyond the period of time specified in the request unless such person requests in writing an extension for a further specified period of time and such request is approved by the Department of Veterans Affairs Medical Center Director authorizing treatment and rehabilitation, (iv) Such care and treatment will be provided as if the person were a veteran, subject to reimbursement by the respective military service for the costs of hospital care and control treatment provided while the person is an active duty member. (b) The maximum period for one treatment episode is limited to 60 days. The Department of Veterans Affairs Medical Center Director may authorize one 30-day extension. (c) Any person who has been discharged or released from active military, naval or air service, and who, upon application for treatment and rehabilitative services unde… | ||||||
| 38:38:1.0.1.1.19.0.180.47 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.81 Contracts for residential treatment services for veterans with alcohol or drug dependence or abuse disabilities. | VA | [47 FR 57707, Dec. 28, 1982. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996; 61 FR 63720, Dec. 2, 1996; 69 FR 18803, Apr. 9, 2004; 76 FR 10249, Feb. 24, 2011] | (a) Contracts for treatment services authorized under § 17.80(a) may be awarded in accordance with applicable Department of Veterans Affairs and Federal procurement procedures. Such contracts will be awarded only after the quality and effectiveness, including adequate protection for the safety of the residents of the contractor's program, has been determined and then only to contractors, determined by the Under Secretary for Health or designee to meet the following requirements. (1) Meet fire safety requirements as follows: (i) The building must meet the requirements in the applicable provisions of NFPA 101 (incorporated by reference, see § 17.1) and the other publications referenced in those provisions. Any equivalencies or variances to VA requirements must be approved by the appropriate Veterans Health Administration Veterans Integrated Service Network (VISN) Director. (ii) Where applicable, the home must have a current occupancy permit issued by the local and state governments in the jurisdiction where the home is located. (iii) All Department of Veterans Affairs sponsored residents will be mentally and physically capable of leaving the building, unaided, in the event of an emergency. Halfway house, therapeutic community and other residential program management must agree that all the other residents in any building housing veterans will also have such capability. (iv) There must be at least one staff member on duty 24 hours a day. (v) The facility must meet the following additional requirements, if the provisions for One and Two-Family Dwellings, as defined in NFPA 101, are applicable to the facility: (A) Portable fire extinguishers shall be installed, inspected, and maintained in accordance with NFPA 10 (incorporated by reference, see § 17.1). (B) The facility shall meet the requirements in section 33.7 of NFPA 101. (vi) An annual fire and safety inspection shall be conducted at the halfway house or residential facility by qualified Department of Veterans Affairs personnel. If a review of past D… | ||||||
| 38:38:1.0.1.1.19.0.180.48 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.82 Contracts for outpatient services for veterans with alcohol or drug dependence or abuse disabilities. | VA | [47 FR 57708, Dec. 28, 1982. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996; 61 FR 63720, Dec. 2, 1996; 62 FR 17072, Apr. 9, 1997; 69 FR 18803, Apr. 9, 2004; 76 FR 10249, Feb. 24, 2011] | (a) Contracts for treatment services authorized under § 17.80 may be awarded in accordance with applicable Department of Veterans Affairs and Federal procurement procedures. Such contracts will be awarded only after the quality and effectiveness, including adequate protection for the safety of the participants of the contractor's program, has been determined and then only to contractors determined by the Under Secretary for Health or designee to be fully capable of meeting the following standards: (1) The following minimum fire safety requirements must be met: (i) The building must meet the requirements in the applicable provisions of the NFPA 101 (incorporated by reference, see § 17.1) and the other publications referenced in those provisions. Any equivalencies or variances to VA requirements must be approved by the appropriate Veterans Health Administration Veterans Integrated Service Network (VISN) Director. (ii) Where applicable, the facility must have a current occupancy permit issued by the local and state governments in the jurisdiction where the home is located. (iii) All Department of Veterans Affairs sponsored patients will be mentally and physically capable of leaving the building, unaided, in the event of an emergency. (iv) As a minimum, fire exit drills must be held at least quarterly, and a written plan for evacuation in the event of fire shall be developed and reviewed annually. The plan shall outline the duties, responsibilities and actions to be taken by the staff in the event of a fire emergency. This plan shall be implemented during fire exit drills. (v) An annual fire and safety inspection shall be conducted at the facility by qualified Department of Veterans Affairs personnel. If a review of past Department of Veterans Affairs inspections or inspections made by the local authorities indicates that a fire and safety inspection would not be necessary, then the visit to the facility may be waived. (2) Conform to existing standards of State safety codes and local and/or State health and … | ||||||
| 38:38:1.0.1.1.19.0.180.49 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.83 Limitations on payment for alcohol and drug dependence or abuse treatment and rehabilitation. | VA | [47 FR 57708, Dec. 28, 1982. Redesignated at 61 FR 21965, May 13, 1996] | The authority to enter into contracts shall be effective for any fiscal year only to such extent or in such amounts as are provided in appropriation acts, and payments shall not exceed these amounts. | ||||||
| 38:38:1.0.1.1.19.0.181.50 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.85 Treatment of research-related injuries to human subjects. | VA | [63 FR 11124, Mar. 6, 1998] | (a) VA medical facilities shall provide necessary medical treatment to a research subject injured as a result of participation in a research project approved by a VA Research and Development Committee and conducted under the supervision of one or more VA employees. This section does not apply to: (1) Treatment for injuries due to noncompliance by a subject with study procedures, or (2) Research conducted for VA under a contract with an individual or a non-VA institution. Veterans who are injured as a result of participation in such research may be eligible for care from VA under other provisions of this part. (b) Except in the following situations, care for VA research subjects under this section shall be provided in VA medical facilities. (1) If VA medical facilities are not capable of furnishing economical care or are not capable of furnishing the care or services required, VA medical facility directors shall contract for the needed care. (2) If inpatient care must be provided to a non-veteran under this section, VA medical facility directors may contract for such care. (3) If a research subject needs treatment in a medical emergency for a condition covered by this section, VA medical facility directors shall provide reasonable reimbursement for the emergency treatment in a non-VA facility. (c) For purposes of this section, “VA employee” means any person appointed by VA as an officer or employee and acting within the scope of his or her appointment (VA appoints officers and employees under title 5 and title 38 of the United States Code). | ||||||
| 38:38:1.0.1.1.19.0.182.51 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.86 Provision of hospital care and medical services during certain disasters and emergencies under 38 U.S.C. 1785. | VA | [73 FR 26946, May 12, 2008, as amended at 88 FR 32975, May 23, 2023] | (a) This section sets forth regulations regarding the provision of hospital care and medical services under 38 U.S.C. 1785. (b) During and immediately following a disaster or emergency referred to in paragraph (c) of this section, VA under 38 U.S.C. 1785 may furnish hospital care and medical services to individuals (including those who otherwise do not have VA eligibility for such care and services) responding to, involved in, or otherwise affected by that disaster or emergency. (c) For purposes of this section, a disaster or emergency means: (1) A major disaster or emergency declared by the President under the Robert T. Stafford Disaster Relief and Emergency Assistance Act (42 U.S.C. 5121 et seq. ) (Stafford Act); or (2) A disaster or emergency in which the National Disaster Medical System established pursuant to section 2811(b) of the Public Health Service Act (42 U.S.C. 300hh-11(b)) is activated either by the Secretary of Health and Human Services under paragraph (3)(A) of that section or as otherwise authorized by law. (d) For purposes of paragraph (b) of this section, the terms hospital care and medical services have the meanings given such terms by 38 U.S.C. 1701(5) and 1701(6). (e) The cost of care for medical care and services provided under this section will be determined in accordance with the following: (1) If the care is provided to an officer or employee of a non-VA Federal agency VA will charge the rate agreed upon by the Secretary and the head of such department or agency or the Secretary concerned. If no such rate has been agreed to, VA will charge the Inter-Agency Rate as prescribed in § 17.102(c). (2) If the care is provided to a member of the Armed Forces VA will charge the rate agreed upon by the Secretary and the head of such branch or the Secretary concerned. If no such rate has been agreed to, VA will charge the Inter-Agency Rate as prescribed in § 17.102(c). (3) If the care is authorized under a sharing agreement as described in 38 U.S.C. 8111 or 8153 or § 17.240, VA will… | ||||||
| 38:38:1.0.1.1.19.0.183.52 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.90 Medical care for veterans receiving vocational training under 38 U.S.C. chapter 15. | VA | [51 FR 19330, May 29, 1986, as amended at 56 FR 3422, Jan. 30, 1991. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996; 79 FR 54615, Sept. 12, 2014] | Hospital care, nursing home care and medical services may be provided to any veteran who is participating in a vocational training program under 38 U.S.C. chapter 15. (a) For purposes of determining eligibility for this medical benefit, the term participating in a vocational training program under 38 U.S.C. chapter 15 means the same as the term participating in a rehabilitation program under 38 U.S.C. chapter 31 as defined in § 17.47(i). Eligibility for such medical care will continue only while the veteran is participating in the vocational training program. (b) The term hospital care and medical services means class V dental care, priority III medical services, nursing home care and non-VA hospital care and/or fee medical/dental care if VA is unable to provide the required medical care economically at VA or other government facilities because of geographic inaccessibility or because of the unavailability of the required services at VA facilities. | ||||||
| 38:38:1.0.1.1.19.0.183.53 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.91 Protection of health-care eligibility. | VA | [51 FR 19330, May 29, 1986. Redesignated at 61 FR 21965, May 13, 1996] | Any veteran whose entitlement to VA pension is terminated by reason of income from work or training shall, subject to paragraphs (a) and (b) of this section, retain for 3 years after the termination, the eligibility for hospital care, nursing home care and medical services (not including dental) which the veteran otherwise would have had if the pension had not been terminated as a result of the veteran's receipt of earnings from activity performed for remuneration or gain by the veteran but only if the veteran's annual income from sources other than such earnings would, taken alone, not result in the termination of the veteran's pension. (a) A veteran who participates in a vocational training program under 38 U.S.C. chapter 15 is eligible for the one-time 3 year retention of hospital care, nursing home care and medical services benefits at any time that the veteran's pension is terminated by reason of income from the veteran's employment. (b) A veteran who does not participate in a vocational training program under 38 U.S.C. chapter 15 is eligible for the one-time 3 year retention of hospital care and medical services benefits only if the veteran's pension is terminated by reason of income from the veteran's employment during the period February 1, 1985 through January 31, 1989. | ||||||
| 38:38:1.0.1.1.19.0.184.54 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.92 Outpatient care for research purposes. | VA | [35 FR 11470, July 17, 1970. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996] | Subject to the provisions of § 17.101, any person who is a bona fide volunteer may be furnished outpatient treatment when the treatment to be rendered is part of an approved Department of Veterans Affairs research project and there are insufficient veteran-patients suitable for the project. | ||||||
| 38:38:1.0.1.1.19.0.184.55 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.93 Eligibility for outpatient services. | VA | [55 FR 20150, May 15, 1990, as amended at 58 FR 25565, Apr. 27, 1993. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996; 64 FR 54218, Oct. 6, 1999; 79 FR 54615, Sept. 12, 2014] | (a) VA shall furnish on an ambulatory or outpatient basis medical services as are needed, to the following applicants under the conditions stated, except that applications for dental treatment must also meet the provisions of § 17.161. (1) For compensation and pension examinations. A compensation and pension examination shall be performed for any veteran who is directed to have such an examination by VA. (2) For adjunct treatment. Subject to the provisions of §§ 17.36 through 17.38, medical services on an ambulatory or outpatient basis shall be provided to veteans for an adjunct nonservice-connected condition associated with and held to be aggravating a disability from a disease or injury adjudicated as being service-connected. (b) The term “shall furnish” in this section and 38 U.S.C. 1710(a)(1) and (a)(2) means that, if the veteran is in immediate need of outpatient medical services, VA shall furnish care at the VA facility where the veteran applies. If the needed medical services are not available there, VA shall arrange for care at the nearest VA medical facility or Department of Defense facility (with which VA has a sharing agreement) that can provide the needed care. If VA and Department of Defense facilities are not available, VA shall arrange for care on a fee basis, but only if the veteran is eligible to receive medical services in non-VA facilities under § 17.52. If the veteran is not in immediate need of outpatient medical services, VA shall schedule the veteran for care where the veteran applied, if the schedule there permits, or refer the veteran for scheduling to the nearest VA medical center or Department of Defense facility (with which VA has a sharing agreement). (c) VA may furnish on an ambulatory or outpatient basis medical services as needed to the following applicants, except that applications for dental treatment must also meet the provisions of § 17.123. (1) For veterans participating in a rehabilitation program under 38 U.S.C. chapter 31. Medical services on an ambulatory or ou… | ||||||
| 38:38:1.0.1.1.19.0.184.56 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.94 Outpatient medical services for military retirees and other beneficiaries. | VA | [32 FR 13815, Oct. 4, 1967, as amended at 45 FR 6937, Jan. 31, 1980; 47 FR 58249, Dec. 30, 1982. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996] | Outpatient medical services for military retirees and other beneficiaries for which charges shall be made as required by § 17.101, may be authorized for persons properly referred by authorized officials of other Federal agencies for which the Secretary of Veterans Affairs may agree to render such service under the conditions stipulated by the Secretary and pensioners of nations allied with the United States in World War I and World War II when duly authorized. | ||||||
| 38:38:1.0.1.1.19.0.184.57 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.95 Outpatient medical services for Department of Veterans Affairs employees and others in emergencies. | VA | [47 FR 58249, Dec. 30, 1982. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996; 79 FR 54615, Sept. 12, 2014] | Outpatient medical services for which charges shall be made as required by § 17.102 may be authorized for employees of the Department of Veterans Affairs, their families, and the general public in emergencies, subject to conditions stipulated by the Secretary of Veterans Affairs. | ||||||
| 38:38:1.0.1.1.19.0.184.58 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.96 Medication prescribed by non-VA physicians. | VA | [68 FR 43929, July 25, 2003, as amended at 74 FR 44291, Aug. 28, 2009; 78 FR 42456, July 16, 2013; 79 FR 54615, Sept. 12, 2014; 81 FR 46602, July 18, 2016] | Any prescription, which is not part of authorized Department of Veterans Affairs hospital or outpatient care, for drugs and medicines ordered by a private or non-Department of Veterans Affairs doctor of medicine or doctor of osteopathy duly licensed to practice in the jurisdiction where the prescription is written, shall be filled by a Department of Veterans Affairs pharmacy or a non-VA pharmacy under contract with VA, including non-VA pharmacy in a state home under contract with VA for filling prescriptions for patients in state homes, provided: (a) The prescription is for: (1) A veteran who by reason of being permanently housebound or in need of regular aid and attendance is in receipt of increased compensation under 38 U.S.C. chapter 11, or increased pension under § 3.1(u) (Section 306 Pension) or § 3.1(w) (Improved Pension), of this chapter, as a veteran of a period of war as defined by 38 U.S.C. 101(11) (or, although eligible for such pension, is in receipt of compensation as the greater benefit), or (2) A veteran in need of regular aid and attendance who was formerly in receipt of increased pension as described in paragraph (a)(1) of this section whose pension has been discontinued solely by reason of excess income, but only so long as such veteran's annual income does not exceed the maximum annual income limitation by more than $ 1,000, and (b) The drugs and medicines are prescribed as specific therapy in the treatment of any of the veteran's illnesses or injuries. | ||||||
| 38:38:1.0.1.1.19.0.184.59 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.97 [Reserved] | VA | ||||||||
| 38:38:1.0.1.1.19.0.184.60 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.98 Mental health services. | VA | [53 FR 7186, Mar. 7, 1988. Redesignated and amended at 61 FR 21965, 21967, May 13, 1996; 79 FR 54616, Sept. 12, 2014] | (a) Following the death of a veteran, bereavement counseling involving services defined in 38 U.S.C. 1783, may be furnished to persons who were receiving mental health services in connection with treatment of the veteran under 38 U.S.C. 1710, 1712A, 1717, or 1781, prior to the veteran's death, but may only be furnished in instances where the veteran's death had been unexpected or occurred while the veteran was participating in a VA hospice or similar program. Bereavement counseling may be provided only to assist individuals with the emotional and psychological stress accompanying the veteran's death, and only for a limited period of time, as determined by the Medical Center Director, but not to exceed 60 days. The Medical Center Director may approve a longer period of time when medically indicated. (b) For purposes of paragraph (a) of this section, an unexpected death is one which occurs when in the course of an illness the provider of care did not or could not have anticipated the timing of the death. Ordinarily, the provider of care can anticipate the patient's death and can inform the patient and family of the immediacy and certainty of death. If that has not taken place, a death can be described as unexpected. | ||||||
| 38:38:1.0.1.1.19.0.185.61 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.100 Requirements for provider-based status. | VA | [85 FR 53174, Aug. 28, 2020] | (a) Scope. This section establishes the criteria that VA uses to determine whether a VA medical facility is designated as provider-based for purposes of billing for non-service-connected and non-special treatment authority conditions. (b) Definitions. For purposes of this section: Community Based Outpatient Clinic (CBOC). A CBOC is a VA-operated, VA-funded, or VA-reimbursed site of care that is not located within a VA Medical Center. A CBOC can provide primary, specialty, subspecialty, mental health, or any combination of health care delivery services that can be appropriately provided in an outpatient setting. Community Living Center (CLC). A CLC is a component of the spectrum of long-term care that provides a skilled nursing environment and houses a variety of specialty programs for persons needing short and long stay services. VA CLCs are typically located on, or near a VA medical facility and are VA-owned and operated, but may be free-standing in the community. Facility. A facility is a point of care where individuals can seek VA health care services, to include a VA Medical Center, CBOC, Health Care Center, CLC, and Other Outpatient Services site. Health Care Center (HCC). An HCC is a VA-owned, VA-leased, VA-contracted or shared clinic that is operational at least five days per week and provides primary care, mental health care, on site specialty services, and performs ambulatory surgery and/or invasive procedures that may require moderate sedation or general anesthesia. Main provider. A main provider (or parent facility/hospital or provider-based hospital (PBH)) is a provider that either creates, or acquires ownership of, another facility to deliver additional health care services under its name, ownership, and financial and administrative control. For example, VA Medical Centers and HCCs can be main providers. Other Outpatient Services (OOS). A site that provides outpatient services to veterans, but does not meet the definition of a CBOC or HCC per this section. Prospective Payment System… | ||||||
| 38:38:1.0.1.1.19.0.185.62 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.101 Collection or recovery by VA for medical care or services provided or furnished to a veteran for a non-service connected disability. | VA | [68 FR 70715, Dec. 19, 2003, as amended at 69 FR 1061, Jan. 7, 2004; 72 FR 68072, Dec. 4, 2007; 75 FR 61623, Oct. 6, 2010; 83 FR 31454, July 6, 2018; 85 FR 53176, Aug. 28, 2020; 86 FR 16053, Mar. 26, 2021] | (a)(1) General. This section covers collection or recovery by VA, under 38 U.S.C. 1729, for medical care or services provided or furnished to a veteran: (i) For a nonservice-connected disability for which the veteran is entitled to care (or the payment of expenses of care) under a health plan contract; (ii) For a nonservice-connected disability incurred incident to the veteran's employment and covered under a worker's compensation law or plan that provides reimbursement or indemnification for such care and services; or (iii) For a nonservice-connected disability incurred as a result of a motor vehicle accident in a State that requires automobile accident reparations insurance. (2) Methodologies. Based on the methodologies set forth in this section, the charges billed will include the following types of charges, as appropriate: Acute inpatient facility charges; skilled nursing facility/sub-acute inpatient facility charges; partial hospitalization facility charges; outpatient facility charges; physician and other professional charges, including professional charges for anesthesia services and dental services; pathology and laboratory charges; observation care facility charges; ambulance and other emergency transportation charges; and charges for durable medical equipment, drugs, injectables, and other medical services, items, and supplies identified by HCPCS Level II codes. In addition, the charges billed for prescription drugs not administered during treatment will be the amount determined under paragraph (m) of this section. Data for calculating actual charge amounts based on the methodologies set forth in this section will either be published in a notice in the Federal Register or will be posted on the Internet site of the Veterans Health Administration Office of Community Care, currently at https://www.va.gov/COMMUNITYCARE, under “Payer Rates and Charges. For care for which VA has established a charge, VA will bill using its most recent published or posted charge. For care for which VA has not estab… | ||||||
| 38:38:1.0.1.1.19.0.185.63 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.102 Charges for care or services. | VA | [88 FR 32975, May 23, 2023] | Subject to the methodology set forth in paragraph (c) of this section, and notwithstanding the provisions of § 17.101, VA shall charge for VA care and services provided in the circumstances described as follows: (a) For hospital care or medical services provided: (1) As a humanitarian service in a medical emergency in accordance with 38 U.S.C. 1784 or 38 U.S.C. 1784A; (2) During and immediately following a disaster or emergency in accordance with 38 U.S.C. 1785 and § 17.86; (3) While attending a national convention of an organization recognized under 38 U.S.C. 5902, for emergency medical treatment, in accordance with 38 U.S.C. 1711; (4) In error, on the basis of eligibility as a non-veteran recipient of VA hospital care and medical services under title 38 U.S.C., and such an individual subsequently is determined not to have been eligible for such care or services; (5) To a beneficiary of the Department of Defense or other Federal agency, to include for inpatient or outpatient care or services authorized for a member of the Armed Forces on active duty, a beneficiary or designee of any other Federal agency, and members or former members of a uniformed service who are entitled to retired or retainer pay, or equivalent pay; or (6) To a retiree of the uniformed services with a chronic disability for hospital care identified in Executive Orders 10122, 10400, and 11733 as well as § 17.44. (b) For hospital care, medical services, domiciliary care, or nursing home care provided: (1) In error, on the basis of eligibility for such care and services as a veteran under §§ 17.34, 17.36, or 17.37, and such an individual was subsequently determined not to have been eligible for such care or services. (2) To a discharged member of the armed forces of a nation allied with the United States in World War I or World War II in accordance with 38 U.S.C. 109. (3) Under a sharing agreement in accordance with 38 U.S.C. 8111 or 8153 and 17.240. (4) Under any other provision of law that authorizes VA to provide care. (c) Unless… | ||||||
| 38:38:1.0.1.1.19.0.185.64 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.103 Referrals of compromise settlement offers. | VA | [39 FR 26403, July 19, 1974, as amended at 47 FR 58250, Dec. 30, 1982. Redesignated and amended at 61 FR 21966, 21967, May 13, 1996; 62 FR 17072, Apr. 9, 1997; 80 FR 23241, Apr. 27, 2015] | Any offer to compromise or settle any charges or claim for $20,000 or less asserted by the Department of Veterans Affairs in connection with the medical program shall be referred as follows: (a) To Chief Financial Officers of the Consolidated Patient Account Centers. If the debt represents charges made under §§ 17.108, 17.110, or 17.111, the compromise offer shall be referred to the Chief Financial Officer of the Consolidated Patient Account Center (CPAC) for application of the collection standards in § 1.900 et seq. of this chapter, provided: (1) The debt does not exceed $1,000, and (2) There has been a previous denial of waiver of the debt by the CPAC Committee on Waivers and Compromises. (b) To Regional Counsel. If the debt in any amount represents charges for medical services for which there is or may be a claim against a third party tort-feasor or under workers' compensation laws or Pub. L. 87-693; 76 Stat. 593 (see § 1.903 of this chapter) or involves a claim contemplated by § 1.902 of this chapter over which the Department of Veterans Affairs lacks jurisdiction, the compromise offer (or request for waiver or proposal to terminate or suspend collection action) shall be promptly referred to the field station Regional Counsel having jurisdiction in the area in which the claim arose, or (c) To Committee on Waivers and Compromises. If one of the following situations contemplated in paragraph (c)(1) through (3) of this section applies (1) If the debt represents charges made under § 17.101(a), but is not of a type contemplated in paragraph (a) of this section, or (2) If the debt represents charges for medical services made under § 17.101(b), or (3) A claim arising in connection with any transaction of the Veterans Health Administration for which the instructions in paragraph (a) or (b) of this section or in § 17.105(c) are not applicable, then, the compromise offer should be referred for disposition under § 1.900 et seq. of this chapter to the field station Committee on Waivers and Compromises w… | ||||||
| 38:38:1.0.1.1.19.0.185.65 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.104 Terminations and suspensions. | VA | [34 FR 7807, May 16, 1969, as amended at 39 FR 26403, July 19, 1974. Redesignated and amended at 61 FR 21966, 21967, May 13, 1996; 80 FR 23241, Apr. 27, 2015] | Any proposal to suspend or terminate collection action on any charges or claim for $20,000 or less asserted by the Department of Veterans Affairs in connection with the medical program shall be referred as follows: (a) Of charges for medical services. If the debt represents charges made under §§ 17.108, 17.110, or 17.111 questions concerning suspension or termination of collection action shall be referred to the Chief Financial Officer of the Consolidated Patient Account Center for application of the collection standards in § 1.900 et seq. of this chapter, or (b) Of other debts. If the debt is of a type other than those contemplated in paragraph (a) of this section, questions concerning suspension or termination of collection action shall be referred in accordance with the same referral procedures for compromise offers (except the Fiscal activity shall make final determinations in terminations or suspensions involving claims of $150 or less pursuant to the provisions of § 1.900 et seq. of this chapter.) | ||||||
| 38:38:1.0.1.1.19.0.185.66 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.105 Waivers. | VA | [39 FR 26403, July 19, 1974. Redesignated and amended at 61 FR 21966, 21967, May 13, 1996; 69 FR 62204, Oct. 25, 2004; 80 FR 23241, Apr. 27, 2015; 84 FR 26017, June 5, 2019] | Applications or requests for waiver of debts or claims asserted by the Department of Veterans Affairs in connection with the medical program generally will be denied by the facility Fiscal activity on the basis there is no legal authority to waive debts, unless the question of waiver should be referred as follows: (a) Of charges for medical services. If the debt represents charges made under § 17.102, the application or request for waiver should be referred for disposition under § 1.900 et seq. of this chapter to the field facility Committee on Waivers and Compromises which shall take final action, or (b) Of claims against third persons and other claims. If the debt is of a type contemplated in § 17.103(b), the waiver question should be referred in accordance with the same referral procedures for compromise offers in such categories of claims, or (c) Of charges for copayments. If the debt represents charges for outpatient medical care, inpatient hospital care, medication or extended care services copayments made under §§ 17.108, 17.110, 17.111, or 17.4600, the claimant must request a waiver by submitting VA Form 5655 (Financial Status Report) to the Consolidated Patient Account Center (CPAC) Chief Financial Officer. The claimant must submit this form within the time period provided in § 1.963(b) of this chapter and may request a hearing under § 1.966(a) of this chapter. The CPAC Chief Financial Officer may extend the time period for submitting a claim if the Chairperson of the Committee on Waivers and Compromises could do so under § 1.963(b) of this chapter. The CPAC Chief Financial Officer will apply the standard “equity and good conscience” in accordance with §§ 1.965 and 1.966(a) of this chapter, and may waive all or part of the claimant's debts. A decision by the CPAC Chief Financial Officer under this provision is final (except that the decision may be reversed or modified based on new and material evidence, fraud, a change in law or interpretation of law, or clear and unmistakable error shown by … | ||||||
| 38:38:1.0.1.1.19.0.185.67 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.106 VA collection rules; third-party payers. | VA | [76 FR 37204, June 24, 2011, as amended at 79 FR 54616, Sept. 12, 2014; 85 FR 53176, Aug. 28, 2020; 86 FR 16055, Mar. 26, 2021] | (a)(1) General rule. VA has the right to recover or collect reasonable charges from a third-party payer for medical care and services provided for a nonservice-connected disability in or through any VA facility to a veteran who is also a beneficiary under the third-party payer's plan. VA's right to recover or collect is limited to the extent that the beneficiary or a nongovernment provider of care or services would be eligible to receive reimbursement or indemnification from the third-party payer if the beneficiary were to incur the costs on the beneficiary's own behalf. (2) Definitions. For the purposes of this section: Automobile liability insurance means insurance against legal liability for health and medical expenses resulting from personal injuries arising from operation of a motor vehicle. Automobile liability insurance includes: (A) Circumstances in which liability benefits are paid to an injured party only when the insured party's tortious acts are the cause of the injuries; and (B) Uninsured and underinsured coverage, in which there is a third-party tortfeasor who caused the injuries ( i.e. , benefits are not paid on a no-fault basis), but the insured party is not the tortfeasor. Health-plan contract means any plan, policy, program, contract, or liability arrangement that provides compensation, coverage, or indemnification for expenses incurred by a beneficiary for medical care or services, items, products, and supplies. It includes but is not limited to: (A) Any plan offered by an insurer, reinsurer, employer, corporation, organization, trust, organized health care group or other entity. (B) Any plan for which the beneficiary pays a premium to an issuing agent as well as any plan to which the beneficiary is entitled as a result of employment or membership in or association with an organization or group. (C) Any Employee Retirement Income and Security Act (ERISA) plan. (D) Any Multiple Employer Trust (MET). (E) Any Multiple Employer Welfare Arrangement (MEWA). (F) Any Health Maintenance… | ||||||
| 38:38:1.0.1.1.19.0.186.68 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.107 VA response to disruptive behavior of patients. | VA | [75 FR 69883, Nov. 16, 2010. Redesignated at 76 FR 37204, June 24, 2011; 79 FR 54616, Sept. 12, 2014] | (a) Definition. For the purposes of this section: VA medical facility means VA medical centers, outpatient clinics, and domiciliaries. (b) Response to disruptive patients. The time, place, and/or manner of the provision of a patient's medical care may be restricted by written order of the Chief of Staff of the VA Medical Center of jurisdiction or his or her designee if: (1) The Chief of Staff or designee determines pursuant to paragraph (c) of this section that the patient's behavior at a VA medical facility has jeopardized or could jeopardize the health or safety of other patients, VA staff, or guests at the facility, or otherwise interfere with the delivery of safe medical care to another patient at the facility; (2) The order is narrowly tailored to address the patient's disruptive behavior and avoid undue interference with the patient's care; (3) The order is signed by the Chief of Staff or designee, and a copy is entered into the patient's permanent medical record; (4) The patient receives a copy of the order and written notice of the procedure for appealing the order to the Network Director of jurisdiction as soon as possible after issuance; and (5) The order contains an effective date and any appropriate limits on the duration of or conditions for continuing the restrictions. The Chief of Staff or designee may order restrictions for a definite period or until the conditions for removing conditions specified in the order are satisfied. Unless otherwise stated, the restrictions imposed by an order will take effect upon issuance by the Chief of Staff or designee. Any order issued by the Chief of Staff or designee shall include a summary of the pertinent facts and the bases for the Chief of Staff's or designee's determination regarding the need for restrictions. (c) Evaluation of disruptive behavior. In making determinations under paragraph (b) of this section, the Chief of Staff or designee must consider all pertinent facts, including any prior counseling of the patient regarding his or her dis… | ||||||
| 38:38:1.0.1.1.19.0.187.69 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.108 Copayments for inpatient hospital care and outpatient medical care. | VA | [66 FR 63448, Dec. 6, 2001, as amended at 68 FR 60854, Oct. 24, 2003; 70 FR 22596, May 2, 2005; 73 FR 20532, Apr. 16, 2008; 75 FR 54030, Sept. 3, 2010; 76 FR 52274, Aug. 22, 2011; 77 FR 13198, Mar. 6, 2012; 78 FR 28143, May 14, 2013; 79 FR 57414, Sept. 24, 2014; 79 FR 65584, Nov. 5, 2014; 79 FR 70939, Nov. 28, 2014; 84 FR 7815, Mar. 5, 2019; 84 FR 26017, 26306, June 5, 2019; 86 FR 52076, Sept. 20, 2021; 88 FR 2536, Jan. 17, 2023; 88 FR 19871, Apr. 4, 2023; 88 FR 21478, Apr. 11, 2023; 89 FR 45601, May 23, 2024] | (a) General. This section sets forth requirements regarding copayments for inpatient hospital care and outpatient medical care provided to veterans by VA. (b) Copayments for inpatient hospital care. (1) Except as provided in paragraphs (d) or (e) of this section, a veteran, as a condition of receiving inpatient hospital care provided by VA (provided either directly by VA or obtained by VA by contract, provider agreement, or sharing agreement), must agree to pay VA (and is obligated to pay VA) the applicable copayment, as set forth in paragraph (b)(2), (b)(3), or (b)(4) of this section. (2) The copayment for inpatient hospital care shall be, during any 365-day period, a copayment equaling the sum of: (i) $10 for every day the veteran receives inpatient hospital care, and (ii) The lesser of: (A) The sum of the inpatient Medicare deductible for the first 90 days of care and one-half of the inpatient Medicare deductible for each subsequent 90 days of care (or fraction thereof) after the first 90 days of such care during such 365-day period, or (B) VA's cost of providing the care. (3) The copayment for inpatient hospital care for veterans enrolled in priority category 7 shall be 20 percent of the amount computed under paragraph (b)(2) of this section. (4) For inpatient hospital care furnished through the Veterans Choice Program under §§ 17.1500 through 17.1540, or the Veterans Community Care Program under §§ 17.4000 through 17.4040, the copayment amount at the time of furnishing such care or services by a non-VA entity or provider is $0. VA will determine and assess the veteran's copayment amount at the end of the billing process, but at no time will a veteran's copayment be more than the amount identified in paragraph (b)(2) or (3) of this section. The requirement that a veteran agree to pay the copayment would be met by submitting to VA a signed VA Form 10-10EZ. This is the application form for enrollment in the VA healthcare system and also is the document used for providing means-test information annu… | ||||||
| 38:38:1.0.1.1.19.0.187.70 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.109 Presumptive eligibility for psychosis and mental illness other than psychosis. | VA | [78 FR 28143, May 14, 2013] | (a) Psychosis. Eligibility for benefits under this part is established by this section for treatment of an active psychosis, and such condition is exempted from copayments under §§ 17.108, 17.110, and 17.111 for any veteran of World War II, the Korean conflict, the Vietnam era, or the Persian Gulf War who developed such psychosis: (1) Within 2 years after discharge or release from the active military, naval, or air service; and (2) Before the following date associated with the war or conflict in which he or she served: (i) World War II: July 26, 1949. (ii) Korean conflict: February 1, 1957. (iii) Vietnam era: May 8, 1977. (iv) Persian Gulf War: The end of the 2-year period beginning on the last day of the Persian Gulf War. (b) Mental illness (other than psychosis). Eligibility under this part is established by this section for treatment of an active mental illness (other than psychosis), and such condition is exempted from copayments under §§ 17.108, 17.110, and 17.111 for any veteran of the Persian Gulf War who developed such mental illness other than psychosis: (1) Within 2 years after discharge or release from the active military, naval, or air service; and (2) Before the end of the 2-year period beginning on the last day of the Persian Gulf War. (c) No minimum service required. Eligibility for care and waiver of copayments will be established under this section without regard to the veteran's length of active-duty service. | ||||||
| 38:38:1.0.1.1.19.0.187.71 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.110 Copayments for medication. | VA | [66 FR 63451, Dec. 6, 2001, as amended at 74 FR 69285, Dec. 31, 2009; 75 FR 32672, June 9, 2010; 75 FR 54030, Sept. 3, 2010; 76 FR 52274, Aug. 22, 2011; 76 FR 78826, Dec. 20, 2011; 77 FR 76867, Dec. 31, 2012; 78 FR 28143, May 14, 2013; 78 FR 79317, Dec. 30, 2013; 79 FR 57414, Sept. 24, 2014; 79 FR 63821, Oct. 27, 2014; 79 FR 65585, Nov. 5, 2014; 80 FR 55545, Sept. 16, 2015; 81 FR 88120, Dec. 7, 2016; 81 FR 89390, Dec. 12, 2016; 84 FR 7815, Mar. 5, 2019; 84 FR 26306, June 5, 2019; 86 FR 52076, Sept. 20, 2021; 88 FR 2536, Jan. 17, 2023; 88 FR 19872, Apr. 4, 2023; 88 FR 21478, Apr. 11, 2023] | (a) General. This section sets forth requirements regarding copayments for medications provided to veterans by VA. For purposes of this section, the term “medication” means prescription and over-the-counter medications, as determined by the Food and Drug Administration (FDA), but does not mean medical supplies, oral nutritional supplements, or medical devices. Oral nutritional supplements are commercially prepared nutritionally enhanced products used to supplement the intake of individuals who cannot meet nutrient needs by diet alone. (b) Copayments. (1) Copayment amount. Unless exempted under paragraph (c) of this section, a veteran is obligated to pay VA a copayment for each 30-day or less supply of medication provided by VA on an outpatient basis (other than medication administered during treatment). (i) For each 30-day or less supply of Tier 1 medications, the copayment amount is $5. (ii) For each 30-day or less supply of Tier 2 medications, the copayment amount is $8. (iii) For each 30-day or less supply of Tier 3 medications, the copayment amount is $11. (iv) For purposes of this section: (A) Multi-source medication is any one of the following: ( 1 ) A medication that has been and remains approved by the FDA— ( i ) Under sections 505(b)(2) or 505(j) of the Food, Drug, and Cosmetic Act (FDCA, 21 U.S.C. 355), and that has been granted an A-rating in the current version of the FDA's Approved Drug Products with Therapeutic Equivalence Evaluations (the Orange Book); or ( ii ) Under section 351(k) of the Public Health Service Act (PHSA, 42 U.S.C. 262), and that has been granted an I or B rating in the current version of the FDA's Lists of Licensed Biological Products with Reference Product Exclusivity and Biosimilarity or Interchangeability Evaluations (the Purple Book). FDA determines both therapeutic equivalence for drugs and interchangeability for biological products. ( 2 ) A medication that— ( i ) Has been and remains approved by the FDA pursuant to FDCA section 505(b)(1) or PHSA section 35… | ||||||
| 38:38:1.0.1.1.19.0.187.72 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.111 Copayments for extended care services. | VA | [67 FR 35040, May 17, 2002, as amended at 69 FR 39846, July 1, 2004; 76 FR 52274, Aug. 22, 2011; 78 FR 28143, May 14, 2013; 78 FR 70864, Nov. 27, 2013; 79 FR 57414, Sept. 24, 2014; 79 FR 65585, Nov. 5, 2014; 84 FR 7815, Mar. 5, 2019; 84 FR 26307, June 5, 2019; 88 FR 19872, Apr. 4, 2023; 88 FR 21478, Apr. 11, 2023] | (a) General. This section sets forth requirements regarding copayments for extended care services provided to veterans by VA (either directly by VA or paid for by VA). (b) Copayments. (1) Unless exempted under paragraph (f) of this section, as a condition of receiving extended care services from VA, a veteran must agree to pay VA and is obligated to pay VA a copayment as specified by this section. A veteran has no obligation to pay a copayment for the first 21 days of extended care services that VA provided the veteran in any 12-month period (the 12-month period begins on the date that VA first provided extended care services to the veteran). However, for each day that extended care services are provided beyond the first 21 days, a veteran is obligated to pay VA the copayment amount set forth below to the extent the veteran has available resources. Available resources are based on monthly calculations, as determined under paragraph (d) of this section. The following sets forth the extended care services provided by VA and the corresponding copayment amount per day: (i) Adult day health care—$15. (ii) Domiciliary care—$5. (iii) Institutional respite care—$97. (iv) Institutional geriatric evaluation—$97. (v) Non-institutional geriatric evaluation—$15. (vi) Non-institutional respite care—$15. (vii) Nursing home care—$97. (2) For purposes of counting the number of days for which a veteran is obligated to make a copayment under this section, VA will count each day that adult day health care, non-institutional geriatric evaluation, and non-institutional respite care are provided and will count each full day and partial day for each inpatient stay except for the day of discharge. (3) For hospital care and medical services considered non-institutional care furnished through the Veterans Choice Program under §§ 17.1500 through 17.1540, as well as extended care services furnished through the Veterans Community Care Program under §§ 17.4000 through 17.4040, the copayment amount at the time of furnishing such c… | ||||||
| 38:38:1.0.1.1.19.0.188.73 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.112 Services or ceremonies on Department of Veterans Affairs hospital or center reservations. | VA | [35 FR 2389, Feb. 3, 1970. Redesignated at 61 FR 21966, May 13, 1996, and further redesignated at 67 FR 35040, May 17, 2002] | (a) Services or ceremonies on Department of Veterans Affairs hospital or center reservations are subject to the following limitations: (1) All activities must be conducted with proper decorum, and not interfere with the care and treatment of patients. Organizations must provide assurance that their members will obey all rules in effect at the hospital or center involved, and act in a dignified and proper manner; (2) Partisan activities are inappropriate and all activities must be nonpartisan in nature. An activity will be considered partisan and therefore inappropriate if it includes commentary in support of, or in opposition to, or attempts to influence, any current policy of the Government of the United States or any State of the United States. If the activity is closely related to partisan activities being conducted outside the hospital or center reservations, it will be considered partisan and therefore inappropriate. (b) Requests for permission to hold services or ceremonies will be addressed to the Secretary, or the Director of the Department of Veterans Affairs hospital or center involved. Such applications will describe the proposed activity in sufficient detail to enable a determination as to whether it meets the standards set forth in paragraph (a) of this section. If permission is granted, the Director of the hospital or center involved will assign an appropriate time, and render assistance where appropriate. No organization will be given exclusive permission to use the hospital or center reservation on any particular occasion. Where several requests are received for separate activities, the Director will schedule each so as to avoid overlapping or interference, or require appropriate modifications in the scope or timing of the activity. | ||||||
| 38:38:1.0.1.1.19.0.189.74 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.113 Conditions of custody. | VA | [39 FR 1843, Jan. 15, 1974. Redesignated and amended at 61 FR 21966, 21967, May 13, 1996, and further redesignated at 67 FR 35039, May 17, 2002] | When the personal effects of a patient who has been or is hospitalized or receiving nursing home care in a Department of Veterans Affairs hospital or center were or are duly delivered to a designated location for custody and loss of such personal effects has occurred or occurs by fire, earthquake, or other natural disaster, either during such storage or during laundering, reimbursement will be made as provided in §§ 17.113 and 17.114. | ||||||
| 38:38:1.0.1.1.19.0.189.75 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.114 Submittal of claim for reimbursement. | VA | [39 FR 1843, Jan. 15, 1974, as amended at 49 FR 5616, Feb. 14, 1984. Redesignated at 61 FR 21966, May 13, 1996, and further redesignated at 67 FR 35039, May 17, 2002] | The claim for reimbursement for personal effects damaged or destroyed will be submitted by the patient to the Director. The patient will separately list and evaluate each article with a notation as to its condition at the time of the fire, earthquake, or other natural disaster i.e. , whether new, worn, etc. The date of the fire, earthquake, or other natural disaster will be stated. It will be certified by a responsible official that each article listed was stored in a designated location at the time of loss by fire, earthquake, or other natural disaster or was in process of laundering. The patient will further state whether the loss of each article was complete or partial, permitting of some further use of the article. The responsible official will certify that the amount of reimbursement claimed on each article of personal effects is not in excess of the fair value thereof at time of loss. The certification will be prepared in triplicate, signed by the responsible officer who made it, and countersigned by the Director of the medical center. After the above papers have been secured, voucher will be prepared, signed, and certified, and forwarded to the Fiscal Officer for approval, payment to be made in accordance with fiscal procedure. The original list of property and certificate are to be attached to voucher. | ||||||
| 38:38:1.0.1.1.19.0.189.76 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.115 Claims in cases of incompetent patients. | VA | [39 FR 1843, Jan. 15, 1974, as amended at 49 FR 5616, Feb. 14, 1984. Redesignated and amended at 61 FR 21966, 21967, May 13, 1996, and further redesignated at 67 FR 35039, May 17, 2002] | Where the patient is insane and incompetent, the patient will not be required to make claim for reimbursement for personal effects lost by fire, earthquake, or other natural disaster as required under the provisions of § 17.113. The responsible official will make claim for the patient, adding the certification in all details as provided for in § 17.113. After countersignature of this certification by the Director, payment will be made as provided in § 17.113, and the amount thereby disbursed will be turned over to the Director for custody. | ||||||
| 38:38:1.0.1.1.19.0.190.77 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.116 Adjudication of claims. | VA | [28 FR 5083, May 22, 1963, as amended at 39 FR 1843, Jan. 15, 1974; 49 FR 5616, Feb. 14, 1984. Redesignated and amended at 61 FR 21965, May 13, 1996, and further redesignated at 67 FR 35039, May 17, 2002] | Claims comprehended. Claims for reimbursing Department of Veterans Affairs employees for cost of repairing or replacing their personal property damaged or destroyed by patients or members while such employees are engaged in the performance of their official duties will be adjudicated by the Director of the medical center concerned. Such claims will be considered under the following conditions, both of which must have existed and, if either one is lacking, reimbursement or payment for the cost or repair of the damaged article will not be authorized: (a) The claim must be for an item of personal property normally used by the employee in his or her day to day employment, e.g., eyeglasses, hearing aids, clothing, etc., and, (b) Such personal property was damaged or destroyed by a patient or domiciliary member while the employee was engaged in the performance of official duties. Reimbursement or payment as provided in this paragraph will be made in a fair and reasonable amount, taking into consideration the condition and reasonable value of the article at the time it was damaged or destroyed. | ||||||
| 38:38:1.0.1.1.19.0.191.78 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.120 Payment or reimbursement for emergency treatment furnished by non-VA providers to certain veterans with service-connected disabilities. | VA | [39 FR 1844, Jan. 15, 1974, as amended at 49 FR 5616, Feb. 14, 1984; 51 FR 8672, Mar. 13, 1986; 56 FR 3422, Jan. 30, 1991. Redesignated at 61 FR 21966, May 13, 1996; 76 FR 79070, Dec. 21, 2011; 80 FR 79484, Dec. 22, 2015; 85 FR 84259, Dec. 28, 2020] | To the extent allowable, payment or reimbursement of the expenses of emergency treatment, not previously authorized, in a private or public (or Federal) hospital not operated by the Department of Veterans Affairs, or of any emergency treatment not previously authorized including transportation will be paid on the basis of a claim timely filed, under the following circumstances: (a) For veterans with service connected disabilities. Emergency treatment not previously authorized was rendered to a veteran in need of such emergency treatment: (1) For an adjudicated service-connected disability; (2) For nonservice-connected disabilities associated with and held to be aggravating an adjudicated service-connected disability; (3) For any disability of a veteran who has a total disability permanent in nature resulting from a service-connected disability (does not apply outside of the States, Territories, and possessions of the United States, the District of Columbia, and the Commonwealth of Puerto Rico); or (4) For any illness, injury or dental condition in the case of a veteran who is participating in a rehabilitation program under 38 U.S.C. ch. 31 and who is medically determined to be in need of hospital care or medical services for any of the reasons enumerated in § 17.47(i)(2); and (b) In a medical emergency. Emergency treatment not previously authorized including medical services, professional services, ambulance services, ancillary care and medication (including a short course of medication related to and necessary for the treatment of the emergency condition that is provided directly to or prescribed for the patient for use after the emergency condition is stabilized and the patient is discharged) was rendered in a medical emergency of such nature that a prudent layperson would have reasonably expected that delay in seeking immediate medical attention would have been hazardous to life or health. This standard is met by an emergency medical condition manifesting itself by acute symptoms of sufficient seve… | ||||||
| 38:38:1.0.1.1.19.0.191.79 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.121 Limitations on payment or reimbursement of the costs of emergency treatment not previously authorized. | VA | [76 FR 79071, Dec. 21, 2011] | (a) Emergency Treatment. Except as provided in paragraph (b) of this section, VA will not approve claims for payment or reimbursement of the costs of emergency treatment not previously authorized for any period beyond the date on which the medical emergency ended. For this purpose, VA considers that an emergency ends when the designated VA clinician at the VA facility has determined that, based on sound medical judgment, the veteran who received emergency treatment: (1) Could have been transferred from the non-VA facility to a VA medical center (or other Federal facility that VA has an agreement with to furnish health care services for veterans) for continuation of treatment, or (2) Could have reported to a VA medical center (or other Federal facility that VA has an agreement with to furnish health care services for veterans) for continuation of treatment. (b) Continued non-emergency treatment. Claims for payment or reimbursement of the costs of emergency treatment not previously authorized may only be approved for continued, non-emergency treatment, if: (1) The non-VA facility notified VA at the time the veteran could be safely transferred to a VA facility (or other Federal facility that VA has an agreement with to furnish health care services for veterans), and the transfer of the veteran was not accepted; and (2) The non-VA facility made and documented reasonable attempts to request transfer of the veteran to a VA facility (or to another Federal facility that VA has an agreement with to furnish health care services for veterans), which means the non-VA facility contacted either the VA Transfer Coordinator, Administrative Officer of the Day, or designated staff responsible for accepting transfer of patients, at a local VA (or other Federal facility) and documented such contact in the veteran's progress/physicians' notes, discharge summary, or other applicable medical record. (c) Refusal of transfer. If a stabilized veteran who requires continued non-emergency treatment refuses to be transferred to a… | ||||||
| 38:38:1.0.1.1.19.0.191.80 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.122 [Reserved] | VA | ||||||||
| 38:38:1.0.1.1.19.0.191.81 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.123 Claimants. | VA | [39 FR 1844, Jan. 15, 1974, as amended at 45 FR 53807, Aug. 13, 1980. Redesignated at 61 FR 21966, May 13, 1996] | A claim for payment or reimbursement of services not previously authorized may be filed by the veteran who received the services (or his/her guardian) or by the hospital, clinic, or community resource which provided the services, or by a person other than the veteran who paid for the services. | ||||||
| 38:38:1.0.1.1.19.0.191.82 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.124 Preparation of claims. | VA | [33 FR 19011, Dec. 20, 1968, as amended at 39 FR 1844, Jan. 15, 1974. Redesignated at 61 FR 21966, May 13, 1996] | Claims for costs of services not previously authorized shall be on such forms as shall be prescribed and shall include the following: (a) The claimant shall specify the amount claimed and furnish bills, vouchers, invoices, or receipts or other documentary evidence establishing that such amount was paid or is owed, and (b) The claimant shall provide an explanation of the circumstances necessitating the use of community medical care, services, or supplies instead of Department of Veterans Affairs care, services, or supplies, and (c) The claimant shall furnish such other evidence or statements as are deemed necessary and requested for adjudication of the claim. | ||||||
| 38:38:1.0.1.1.19.0.191.83 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.125 Where to file claims. | VA | [83 FR 29448, June 25, 2018] | Generally, VA must preauthorize VA payment for health care services provided in the community when such care is provided in a State as that term is defined in 38 U.S.C. 101(20). (a) Where VA payment for such services has not been authorized in advance, claims for payment for such health care services provided in a State should be submitted to the VA medical facility nearest to where those services were provided. (b) Claims for payment for hospital care and outpatient services authorized under § 17.35(a) and provided in Canada must be submitted to Veterans Affairs Canada, Foreign Countries Operations Unit, 2323 Riverside Dr., 2nd Floor, Ottawa, Ontario, Canada K1A OP5. (c) All other claims for payment for hospital care and outpatient services authorized under § 17.35(a) and provided outside a State must be submitted to the Foreign Medical Program, P.O. Box 469061, Denver, CO 80246-9061. | ||||||
| 38:38:1.0.1.1.19.0.191.84 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.126 Timely filing. | VA | [33 FR 19012, Dec. 20, 1968, as amended at 39 FR 1844, Jan. 15, 1974; 45 FR 53807, Aug. 13, 1980; 51 FR 8673, Mar. 13, 1986. Redesignated at 61 FR 21966, May 13, 1996] | Claims for payment or reimbursement of the expenses of medical care or services not previously authorized must be filed within the following time limits: (a) A claim must be filed within 2 years after the date the care or services were rendered (and in the case of continuous care, payment will not be made for any part of the care rendered more than 2 years prior to filing claim), or (b) In the case of case or services rendered prior to a VA adjudication allowing service-connection: (1) The claim must be filed within 2 years of the date the veteran was notified by VA of the allowance of the award of service-connection. (2) VA payment may be made for care related to the service-connected disability received only within a 2-year period prior to the date the veteran filed the original or reopened claim which resulted in the award of service-connection but never prior to the effective date of the award of service-connection within that 2-year period. (3) VA payment will never be made for any care received beyond this 2-year period whether service connected or not. | ||||||
| 38:38:1.0.1.1.19.0.191.85 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.127 Date of filing claims. | VA | [39 FR 1844, Jan. 15, 1974. Redesignated at 61 FR 21966, May 13, 1996] | The date of filing any claim for payment or reimbursement of the expenses of medical care and services not previously authorized shall be the postmark date of a formal claim, or the date of any preceding telephone call, telegram, or other communication constituting an informal claim. | ||||||
| 38:38:1.0.1.1.19.0.191.86 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.128 Allowable rates and fees. | VA | [63 FR 39515, July 23, 1998] | When it has been determined that a veteran has received public or private hospital care or outpatient medical services, the expenses of which may be paid under § 17.120 of this part, the payment of such expenses shall be paid in accordance with §§ 17.55 and 17.56 of this part. | ||||||
| 38:38:1.0.1.1.19.0.191.87 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.129 Retroactive payments prohibited. | VA | [39 FR 1844, Jan. 15, 1974. Redesignated and amended at 61 FR 21966, 21968, May 13, 1996] | When a claim for payment or reimbursement of expenses of services not previously authorized has not been timely filed in accordance with the provisions of § 17.126, the expenses of any such care or services rendered prior to the date of filing the claim shall not be paid or reimbursed. In no event will a bill or claim be paid or allowed for any care or services rendered prior to the effective date of any law, or amendment to the law, under which eligibility for the medical services at Department of Veterans Affairs expense has been established. | ||||||
| 38:38:1.0.1.1.19.0.191.88 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.130 Payment for treatment dependent upon preference prohibited. | VA | [39 FR 1844, Jan. 15, 1974. Redesignated at 61 FR 21966, May 13, 1996] | No reimbursement or payment of services not previously authorized will be made when such treatment was procured through private sources in preference to available Government facilities. | ||||||
| 38:38:1.0.1.1.19.0.191.89 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.131 Payment of abandoned claims prohibited. | VA | [33 FR 19012, Dec. 20, 1968. Redesignated at 61 FR 21966, May 13, 1996] | Any informal claim for the payment or reimbursement of medical expenses which is not followed by a formal claim, or any formal claim which is not followed by necessary supporting evidence, within 1 year from the date of the request for a formal claim or supporting evidence shall be deemed abandoned, and payment or reimbursement shall not be authorized on the basis of such abandoned claim or any future claim for the same expenses. For the purpose of this section, time limitations shall be computed from the date following the date of request for a formal claim or supporting evidence. | ||||||
| 38:38:1.0.1.1.19.0.191.90 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.132 Appeals. | VA | [33 FR 19012, Dec. 20, 1968. Redesignated at 61 FR 21966, May 13, 1996, as amended at 87 FR 43748, July 22, 2022] | (a) This section applies only to legacy claims. (b) When any claim for payment or reimbursement of expenses of medical care or services rendered in non-Department of Veterans Affairs facilities or from non-Department of Veterans Affairs resources has been disallowed, the claimant shall be notified of the reasons for the disallowance and of the right to initiate an appeal to the Board of Veterans Appeals by filing a Notice of Disagreement, and shall be furnished such other notices or statements as are required by part 19 of this chapter, governing appeals. | ||||||
| 38:38:1.0.1.1.19.0.192.91 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.133 Procedures. | VA | [64 FR 44660, Aug. 17, 1999, as amended at 87 FR 43748, July 22, 2022] | (a) Scope. This section sets forth reconsideration procedures regarding claims for benefits administered by the Veterans Health Administration (VHA). This section applies only to legacy claims. (b) Process. An individual who disagrees with the initial decision denying the claim in whole or in part may obtain reconsideration under this section by submitting a reconsideration request in writing to the Director of the healthcare facility of jurisdiction within one year of the date of the initial decision. The reconsideration decision will be made by the immediate supervisor of the initial VA decision-maker. The request must state why it is concluded that the decision is in error and must include any new and relevant information not previously considered. Any request for reconsideration that does not identify the reason for the dispute will be returned to the sender without further consideration. The request for reconsideration may include a request for a meeting with the immediate supervisor of the initial VA decision-maker, the claimant, and the claimant's representative (if the claimant wishes to have a representative present). Such a meeting shall only be for the purpose of discussing the issues and shall not include formal procedures (e.g., presentation, cross-examination of witnesses, etc.). The meeting will be taped and transcribed by VA if requested by the claimant and a copy of the transcription shall be provided to the claimant. After reviewing the matter, the immediate supervisor of the initial VA decision-maker shall issue a written decision that affirms, reverses, or modifies the initial decision. The final decision of the immediate supervisor of the initial VA decision-maker will inform the claimant of further appellate rights for an appeal to the Board of Veterans' Appeals. | ||||||
| 38:38:1.0.1.1.19.0.193.92 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.142 Authority to approve sharing agreements, contracts for scarce medical specialist services and contracts for other medical services. | VA | [45 FR 6938, Jan. 31, 1980. Redesignated at 61 FR 21966, May 13, 1996, as amended at 62 FR 17072, Apr. 9, 1997; 79 FR 54616, Sept. 12, 2014] | The Under Secretary for Health is delegated authority to enter into (a) Sharing agreements authorized under 38 U.S.C. 8153 and § 17.240; (b) Contracts with schools and colleges of medicine, osteopathy, dentistry, podiatry, optometry, and nursing, clinics, and any other group or individual capable of furnishing such services to provide scarce medical specialist services at Department of Veterans Affairs health care facilities (including, but not limited to, services of physicians, dentists, podiatrists, optometrists, nurses, physicians' assistants, expanded function dental auxiliaries, technicians, and other medical support personnel); and (c) When a sharing agreement or contract for scarce medical specialist services is not warranted, contracts authorized under the provisions of 38 U.S.C. 8153 for medical and ancillary services. The authority under this section generally will be exercised by approval of proposed contracts or agreements negotiated at the health care facility level. Such approval, however, will not be necessary in the case of any purchase order or individual authorization for which authority has been delegated in 48 CFR 801.670-3. All such contracts and agreements will be negotiated pursuant to 48 CFR chapters 1 and 8. | ||||||
| 38:38:1.0.1.1.19.0.194.93 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.148 Service dogs. | VA | [77 FR 54381, Sept. 5, 2012] | (a) Definitions. For the purposes of this section: Service dogs are guide or service dogs prescribed for a disabled veteran under this section. (b) Clinical requirements. VA will provide benefits under this section to a veteran with a service dog only if: (1) The veteran is diagnosed as having a visual, hearing, or substantial mobility impairment; and (2) The VA clinical team that is treating the veteran for such impairment determines based upon medical judgment that it is optimal for the veteran to manage the impairment and live independently through the assistance of a trained service dog. Note: If other means (such as technological devices or rehabilitative therapy) will provide the same level of independence, then VA will not authorize benefits under this section. (3) For the purposes of this section, substantial mobility impairment means a spinal cord injury or dysfunction or other chronic impairment that substantially limits mobility. A chronic impairment that substantially limits mobility includes but is not limited to a traumatic brain injury that compromises a veteran's ability to make appropriate decisions based on environmental cues ( i.e. , traffic lights or dangerous obstacles) or a seizure disorder that causes a veteran to become immobile during and after a seizure event. (c) Recognized service dogs. VA will recognize, for the purpose of paying benefits under this section, the following service dogs: (1) The dog and veteran must have successfully completed a training program offered by an organization accredited by Assistance Dogs International or the International Guide Dog Federation, or both (for dogs that perform both service- and guide-dog assistance). The veteran must provide to VA a certificate showing successful completion issued by the accredited organization that provided such program. (2) Dogs obtained before September 5, 2012 will be recognized if a guide or service dog training organization in existence before September 5, 2012 certifies that the veteran and dog, as a tea… | ||||||
| 38:38:1.0.1.1.19.0.194.94 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.149 Sensori-neural aids. | VA | [62 FR 30242, June 3, 1997, as amended at 69 FR 33575, June 16, 2004] | (a) Notwithstanding any other provision of this part, VA will furnish needed sensori-neural aids ( i.e. , eyeglasses, contact lenses, hearing aids) only to veterans otherwise receiving VA care or services and only as provided in this section. (b) VA will furnish needed sensori-neural aids ( i.e. , eyeglasses, contact lenses, hearing aids) to the following veterans: (1) Those with a compensable service-connected disability; (2) Those who are former prisoners of war; (3) Those awarded a Purple Heart; (4) Those in receipt of benefits under 38 U.S.C. 1151; (5) Those in receipt of increased pension based on the need for regular aid and attendance or by reason of being permanently housebound; (6) Those who have a visual or hearing impairment that resulted from the existence of another medical condition for which the veteran is receiving VA care, or which resulted from treatment of that medical condition; (7) Those with a significant functional or cognitive impairment evidenced by deficiencies in activities of daily living, but not including normally occurring visual or hearing impairments; and (8) Those visually or hearing impaired so severely that the provision of sensori-neural aids is necessary to permit active participation in their own medical treatment. (c) VA will furnish needed hearing aids to those veterans who have service-connected hearing disabilities rated 0 percent if there is organic conductive, mixed, or sensory hearing impairment, and loss of pure tone hearing sensitivity in the low, mid, or high-frequency range or a combination of frequency ranges which contribute to a loss of communication ability; however, hearing aids are to be provided only as needed for the service-connected hearing disability. | ||||||
| 38:38:1.0.1.1.19.0.194.95 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.150 [Reserved] | VA | ||||||||
| 38:38:1.0.1.1.19.0.194.96 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.151 Invalid lifts for recipients of aid and attendance allowance or special monthly compensation. | VA | [33 FR 12315, Aug. 31, 1968, as amended at 36 FR 3117, Feb. 13, 1971; 54 FR 34983, Aug. 23, 1989. Redesignated at 61 FR 21966, May 13, 1996] | An invalid lift may be furnished if: (a) The applicant is a veteran who is receiving (1) special monthly compensation (including special monthly compensation based on the need for aid and attendance) under the provisions of 38 U.S.C. 1114(r), or (2) comparable compensation benefits at the rates prescribed under 38 U.S.C. 1134, or (3) increased pension based on the need for aid and attendance or a greater compensation benefit rather than aid and attendance pension to which he or she has been adjudicated to be presently eligible; and (b) The veteran has loss, or loss of use, of both lower extremities and at least one upper extremity (loss of use may result from paralysis or other impairment to muscle power and includes all cases in which the veteran cannot use his or her extremities or is medically prohibited from doing so because of a serious disease or disability); and (c) The veteran has been medically determined incapable of moving himself or herself from his or her bed to a wheelchair, or from his or her wheelchair to his or her bed, without the aid of an attendant, because of the disability involving the use of his or her extremities; and (d) An invalid lift would be a feasible means by which the veteran could accomplish the necessary maneuvers between bed and wheelchair, and is medically determined necessary. | ||||||
| 38:38:1.0.1.1.19.0.194.97 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.152 Devices to assist in overcoming the handicap of deafness. | VA | [53 FR 46607, Nov. 18, 1988. Redesignated at 61 FR 21966, May 13, 1996; 79 FR 54616, Sept. 12, 2014] | Devices for assisting in overcoming the handicap of deafness (including telecaptioning television decoders) may be furnished to any veteran who is profoundly deaf (rated 80% or more disabled for hearing impairment by the Department of Veterans Affairs) and is entitled to compensation on account of such hearing impairment. | ||||||
| 38:38:1.0.1.1.19.0.194.98 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.153 [Reserved] | VA | ||||||||
| 38:38:1.0.1.1.19.0.194.99 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.154 Equipment for blind veterans. | VA | [77 FR 54382, Sept. 5, 2012] | VA may furnish mechanical and/or electronic equipment considered necessary as aids to overcoming the handicap of blindness to blind veterans entitled to disability compensation for a service-connected disability. | ||||||
| 38:38:1.0.1.1.19.0.195.100 | 38 | Pensions, Bonuses, and Veterans' Relief | I | 17 | PART 17—MEDICAL | § 17.155 Minimum standards of safety and quality for automotive adaptive equipment. | VA | [40 FR 8819, Mar. 3, 1975. Redesignated at 61 FR 21966, May 13, 1996, as amended at 62 FR 17072, Apr. 9, 1997] | (a) The Under Secretary for Health or designee is authorized to develop and establish minimum standards of safety and quality for adaptive equipment provided under 38 U.S.C. chapter 39. (b) In the performance of this function, the following considerations will apply: (1) Minimum standards of safety and quality will be developed and promulgated for basic adaptive equipment specifically designed to facilitate operation and use of standard passenger motor vehicles by persons who have specified types of disablement and for the installation of such equipment. (2) In those instances where custombuilt adaptive equipment is designed and installed to meet the peculiar needs of uniquely disabled persons and where the incidence of probable usage is not such as to justify development of formal standards, such equipment will be inspected and, if in order, approved for use by a qualified designee of the Under Secretary for Health. (3) Adaptive equipment, available to the general public, which is manufactured under standards of safety imposed by a Federal agency having authority to establish the same, shall be deemed to meet required standards for use as adaptive equipment. These include such items as automatic transmissions, power brakes, power steering and other automotive options. (c) For those items where specific Department of Veterans Affairs standards of safety and quality have not as yet been developed, or where such standards are otherwise provided as with custom-designed or factory option items, authorization of suitable adaptive equipment will not be delayed. Approval of such adaptive equipment, however, shall be subject to the judgment of designated certifying officials that it meets implicit standards of safety and quality adopted by the industry or as later developed by the Department of Veterans Affairs. |
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