[Federal Register Volume 76, Number 245 (Wednesday, December 21, 2011)]
[Rules and Regulations]
[Pages 79067-79072]
From the Federal Register Online via the Government Publishing Office [www.gpo.gov]
[FR Doc No: 2011-32413]
=======================================================================
-----------------------------------------------------------------------
DEPARTMENT OF VETERANS AFFAIRS
38 CFR Part 17
RIN 2900-AN49
Payment or Reimbursement for Emergency Treatment Furnished by
Non-VA Providers in Non-VA Facilities to Certain Veterans With Service-
Connected or Nonservice-Connected Disabilities
AGENCY: Department of Veterans Affairs.
ACTION: Final rule.
-----------------------------------------------------------------------
SUMMARY: This document amends the Department of Veterans Affairs (VA)
medical regulations concerning emergency hospital care and medical
services provided to eligible veterans at non-VA facilities. The
amendments are required by section 402 of the Veterans' Mental Health
and Other Care Improvements Act of 2008. Among other things, the
amendments authorize VA to pay for emergency treatment provided to a
veteran at a non-VA facility up to the time the veteran can be safely
transferred to a VA or other Federal facility and such facility is
capable of accepting the transfer, or until such transfer was actually
accepted, so long as the non-VA facility made and documented reasonable
attempts to transfer the veteran to a VA or other Federal facility.
DATES: Effective Date: This final rule is effective January 20, 2012.
[[Page 79068]]
FOR FURTHER INFORMATION CONTACT: Lisa Brown, Chief Policy Management
Department, Department of Veterans Affairs, 3773 Cherry Creek North
Drive, Suite 450, Denver, CO 80209, (303) 331-7829. (This is not a
toll-free number.)
SUPPLEMENTARY INFORMATION: Sections 1725 and 1728 of title 38, United
States Code, authorize the Secretary of Veterans Affairs to reimburse
eligible veterans for costs related to non-VA emergency treatment
furnished at non-VA facilities, or to pay providers directly for such
costs. Specifically, section 1725 authorizes reimbursement for
emergency treatment for eligible veterans with nonservice-connected
conditions, and section 1728 authorizes reimbursement for emergency
treatment for eligible veterans with service-connected conditions.
These statutory provisions are implemented at 38 CFR 17.1000 through
17.1008 for eligible veterans with nonservice-connected conditions, and
at 38 CFR 17.120 and 17.121 for eligible veterans with service-
connected conditions.
As explained in a notice of proposed rulemaking published on June
11, 2010 (75 FR 33216), prior to recent amendments to the law, VA was
not authorized to reimburse or pay for treatment provided after ``the
veteran c[ould] be transferred safely to a [VA] facility or other
Federal facility'' under 38 U.S.C. 1725(f)(1)(C) (2007). Thus, under 38
U.S.C. 1725 and pursuant to regulations implementing 38 U.S.C. 1728, VA
was unable to provide payment to the veteran or medical provider for
services rendered beyond the point the veteran was determined to be
stable enough for transfer, even if no VA or other Federal facility
could immediately accept the transfer and the veteran required
continued, non-emergency treatment.
On October 10, 2008, the Veterans' Mental Health and Other Care
Improvements Act of 2008, Public Law 110-387, was enacted, and it made
several amendments to our authority to reimburse for the cost of non-VA
emergency care.
Section 402 of Public Law 110-387 amended the definition of
``emergency treatment'' in section1725(f)(1), extending VA's payment
authority until ``such time as the veteran can be transferred safely to
a [VA] facility or other Federal facility and such facility is capable
of accepting such transfer,'' or until such transfer was accepted, so
long as the non-VA facility ``made and documented reasonable attempts
to transfer the veteran to a [VA] facility or other Federal facility.''
This amendment extended our authority to pay for treatment post-
stabilization.
Section 402(a)(1) amended section 1725(a)(1) by striking the term
``may reimburse'' and inserting ``shall reimburse'' in its place. This
amendment requires VA to reimburse the covered costs for emergency care
received at non-VA facilities for eligible veterans, rather than
leaving the decision to make such reimbursement at the discretion of
the Secretary.
Section 402(b) of Public Law 110-387 amended 38 U.S.C. 1728. First,
section 402(b)(1) authorized VA to reimburse or pay for ``customary and
usual charges of emergency treatment'' when a veteran makes payment
directly to a non-VA provider of emergency care. The statute had
previously authorized reimbursement for ``the reasonable value of such
care or services.'' This amendment relates to the amount of payment and
is the subject of another rulemaking, RIN 2900-AN37, ``Payment for
Inpatient and Outpatient Health Care Professional Services at Non-
Departmental Facilities and Other Medical Charges Associated with Non-
VA Outpatient Care''. 75 FR 7218 (Feb. 18, 2010).
Second, section 402(b)(3) made the definition of ``emergency
treatment'' in section 1725(f)(1) applicable to section 1728. As
described above, that definition of emergency treatment now includes
care or services furnished until ``such time as the veteran can be
transferred safely to a [VA] facility or other Federal facility and
such facility is capable of accepting such transfer,'' or until such
transfer was accepted, so long as the non-VA facility ``made and
documented reasonable attempts to transfer the veteran to a [VA]
facility or other Federal facility.''
In the proposed rule published on June 11, 2010 (75 FR 33216), we
proposed to amend the following VA regulations to comply with the
amendments made to 38 U.S.C. 1725 and 1728, and make technical changes
such as correcting grammatical errors and updating obsolete regulatory
citations: 38 CFR 17.120, 17.121, 17.1002, 17.1005, 17.1006, and
17.1008.
We received four comments on the proposed rule. One commenter fully
supported the rule because it will improve veterans' ability to obtain
emergency care from non-VA facilities. The remainder of the comments
are addressed below.
One commenter was concerned with our decision in Sec. Sec.
17.121(a) and 17.1006 to assign a ``designated VA clinician'' with the
task of determining whether treatment should be reimbursed,
specifically asserting that VA should place this responsibility in more
highly skilled and trained employees. We disagree with this comment,
and make no changes to the rule, because this portion of the rule
simply adopts customary practice as implemented in the health care
industry. The common industry practice is to utilize the services of
health care professionals, such as nurses, for purposes of clinical
review. Further, we believe that this designation of responsibility
will promote greater efficiency in the use of VA physician services. VA
employs highly trained clinical staff that is capable of making a
clinical determination as to whether emergency care meets the
requirements set forth under this rule, and whether a veteran can be
safely transferred from the non-VA facility.
We received three comments related to the transfer of veterans from
non-VA hospitals. The commenters questioned whether VA was giving
enough deference to the treating physician at the non-VA facility to
determine when the veteran is stable enough to be transferred to a VA
facility. A veteran may not be transferred from a non-VA facility to a
VA facility before such veteran has first been released by the
physician of the treating facility, and only after such physician
determines the veteran has been stabilized. We note that this rule
governs the payment for emergency services only, and VA's review of an
episode of care for the purposes of determining eligibility for payment
is retroactive, meaning the emergency care has already been provided.
In reviewing the episode of care for payment purposes, VA will consider
the treating physician's assessment of when the veteran returned to a
stable condition and could have been transferred to a VA or other
Federal facility. Although the procedure for transferring a VA-enrolled
patient from a non-VA facility to a VA facility is not governed by this
rule, we note that VA's practice is to work with the treating non-VA
clinicians to determine when transfer would be safe. If the veteran's
stability for transfer is questionable, the designated VA clinician
will consult with the attending non-VA physician to determine whether
transfer is in the best interest of the veteran. At no time during an
episode of care will VA challenge the discretion of the treating non-VA
physician with regard to whether an emergency situation has ended. We
make no changes based on these comments.
One commenter read the refusal of transfer provisions at proposed
Sec. 17.121(c) and Sec. 17.1005(d) to exclude payment for non-
emergency care
[[Page 79069]]
provided up until the point that transfer was available but refused by
the veteran. Under the applicable law, VA is authorized to provide
reimbursement for emergency care only ``until * * * such time as the
veteran can be transferred'' to a VA or other Federal facility. 38
U.S.C. 1725(f)(1)(C). See also 38 U.S.C. 1728(c) (adopting the meaning
of ``emergency treatment'' provided in section 1725(f)(1)). VA intended
that the proposed rule provide that the episode of care will be
considered for payment up to the point in time where VA was able to
accept transfer but the veteran refused or opted not to be transferred
to the VA facility. Because the language in the proposed rule did not
accurately express this statutory authorization and VA's intent, we
have revised the language in both Sec. 17.121(c) and Sec. 17.1005(d).
Specifically, in Sec. 17.121(c), we have removed the language
referring to the point of ``stabilization'' and replaced it with
language referring to the point of ``refusal of transfer by the
veteran.'' We make the same change in Sec. 17.1005(d).
One commenter suggested that VA should provide payment for
ancillary and pharmaceutical treatment in connection with the veteran's
emergency care. To the extent the commenter wishes VA to reimburse
veterans for the cost of such treatment provided during an episode of
emergency care (prior to stabilization and a transfer determination),
such treatment is in fact reimbursable as emergency care under this
regulation--even if the emergency treatment includes the direct
provision by the non-VA facility of a short course of medications
needed to enable the discharge or transfer of the veteran. To the
extent the commenter wishes VA to pay for medications provided after
the episode of emergency care, this is beyond the scope of this
rulemaking.
In light of the potential for confusion as to what constitutes
emergency treatment under the regulation, we have added to Sec.
17.120(b) and Sec. 17.1002 clarification that emergency treatment
includes ``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 the patient for use after the emergency
condition is stabilized and the patient is discharged))''. This
reflects our original intent, but should reduce or eliminate some of
the concerns raised by the commenter.
We propose to clarify the term ``Federal facility'' in additional
subsections of the regulations implementing 38 U.S.C. 1725 and 38
U.S.C. 1728. The term ``Federal facility'' is used in the definition of
``emergency treatment'' in subparagraph (C) of section 1725(f)(1) in
the context of veterans being stable enough after an emergency to be
transferred to a VA or other Federal facility and the availability of
such facilities. 38 U.S.C. 1725(f)(1)(C). As identified in the notice
of proposed rulemaking published on June 11, 2010 (75 FR 33216), the
term ``Federal facility'' as it is used in 38 U.S.C. 1725(f)(1)(C) is
clarified in this rulemaking in 38 CFR 17.121 and 17.1005 to mean
``Federal facility that VA has an agreement with to furnish health care
services for veterans''. Practically, VA considers that ``emergency
treatment'' should be considered to continue until transfer is possible
and accepted to a VA facility or Federal facility with which VA has an
agreement, because determining availability of or eligibly for other
Federal facilities will typically not be feasible.
The term ``Federal facilities'' is also used in the definition of
``emergency treatment'' in subparagraph (A) of 38 U.S.C. 1725(f)(1), to
specify that ``emergency treatment'' under sections 1728 and 1725
means, in pertinent part, ``medical care or services furnished, in the
judgment of the Secretary--(A) when Department or other Federal
facilities are not feasibly available and an attempt to use them
beforehand would not be reasonable''. See definition of ``emergency
treatment'' at 38 U.S.C. 1725(f)(1)(A) and 38 U.S.C. 1728(c)
referencing such definition. Current regulations implementing sections
1728 and 1725 reiterate this requirement, explaining that payment or
reimbursement may only be made if a VA or other Federal facility was
not feasibly available, and an attempt to use them beforehand would not
have been reasonable. See 38 CFR 17.1002(c) and 38 CFR 17.120(c). We
propose to clarify the term ``Federal facilities'' as it is used in
subparagraph (A) of section 1725(f)(1), just as we have done as it is
used in subparagraph (C) of section 1725(f)(1), to mean only those
Federal facilities ``that VA has an agreement with to furnish health
care services for veterans.'' We make this change to allow for VA
reimbursement of care provided in Federal facilities with which VA does
not have an agreement and where the veteran would be personally liable
for payment. Without this qualification, it may not be clear that VA
can pay for or reimburse a veteran who obtains emergency care in a
Federal facility with which VA does not have an agreement and which
holds the veteran personally financially liable for the costs of the
care.
Congress did not define ``Federal facility'' (or ``Federal
facilities'') in 38 U.S.C. 1728 or 1725, which provide VA's authority
to make payment or provide reimbursement for emergency treatment from
non-VA providers. As indicated, we propose to interpret ``Federal
facility'' (and ``Federal facilities'') to mean facilities that VA has
an agreement with to furnish health care services for veterans. From a
practical standpoint, this interpretation makes sense because VA would
generally have no way of knowing whether other Federal resources are
available at any one time without such agreement. Without knowing of
the availability of such Federal facilities, it is the Secretary's
judgment that those facilities cannot be considered reasonable or
feasible in the context of a medical emergency. This interpretation is
also consistent with the intent of the statute, which is to cover the
costs of care for veterans when such care must be provided outside of
the VA setting. If the veteran who has an accident on a military
installation is personally financially liable for that care, the intent
of the statute was to relieve that burden. We note, however, that we do
not interpret the statute as requiring VA to reimburse a Federal
facility when the veteran receiving care would not otherwise be
financially liable.
Finally, although we have added this clarifying language, we note
that this is not a change in VA's interpretation of the statute because
VA currently interprets the statute in this way. These regulatory
amendments merely codify VA's current interpretation for legal notice
purposes. We, therefore, add the clarifying language ``that VA has an
agreement with to furnish health care services for veterans'' after the
term ``Federal facilities'' in Sec. 17.120(c), ``Federal facility'' in
Sec. 17.1001(d), and ``Federal facility/provider'' in Sec.
17.1002(c). We note the reference to ``other Federal facility'' in
Sec. 17.1001(d) pertains to the veteran's stability for transfer to a
VA or other Federal facility, not other Federal facilities being
unavailable at the time of the emergency, but was not noted for
amendment in the notice of proposed rulemaking published on June 11,
2010 (75 FR 33216). The change reflects VA's existing interpretation of
the statute.
For the reasons set forth in the supplementary information to the
notice of proposed rulemaking and in this notice, VA is adopting the
proposed rule as a final rule with the changes discussed above.
[[Page 79070]]
Effect of Rulemaking
The Code of Federal Regulations, as revised by this notice,
represents the exclusive legal authority on this subject. No contrary
rules or procedures are authorized. All VA guidance must be read to
conform with this rulemaking if possible or, if not possible, such
guidance is superseded by this rulemaking.
Unfunded Mandates
The Unfunded Mandates Reform Act of 1995 requires, at 2 U.S.C.
1532, that agencies prepare an assessment of anticipated costs and
benefits before issuing any rule that may result in an expenditure by
State, local, and tribal governments, in the aggregate, or by the
private sector, of $100 million or more (adjusted annually for
inflation) in any one year. This rule would have no such effect on
State, local, and tribal governments, or on the private sector.
Paperwork Reduction Act
This action contains no provisions constituting a collection of
information under the Paperwork Reduction Act (44 U.S.C. 3501 et seq.).
Executive Orders 12866 and 13563
Executive Orders 12866 and 13563 direct agencies to assess all
costs and benefits of available regulatory alternatives and, when
regulation is necessary, to select regulatory approaches that maximize
net benefits (including potential economic, environmental, public
health and safety, and other advantages; distributive impacts; and
equity). Executive Order 13563 (Improving Regulation and Regulatory
Review) emphasizes the importance of quantifying both costs and
benefits, reducing costs, harmonizing rules, and promoting flexibility.
Executive Order 12866 (Regulatory Planning and Review) defines
``significant regulatory action,'' requiring review by the Office of
Management and Budget (OMB) unless OMB waives such review, as any
regulatory action that is likely to result in a rule that may: (1) Have
an annual effect on the economy of $100 million or more or adversely
affect in a material way the economy, a sector of the economy,
productivity, competition, jobs, the environment, public health or
safety, or State, local or tribal governments or communities; (2)
create a serious inconsistency or otherwise interfere with an action
taken or planned by another agency; (3) materially alter the budgetary
impact of entitlements, grants, user fees, or loan programs or the
rights and obligations of recipients thereof; or (4) raise novel legal
or policy issues arising out of legal mandates, the President's
priorities, or the principles set forth in the Executive Order.
The economic, interagency, budgetary, legal, and policy
implications of this rule have been examined and it has been determined
not to be a significant regulatory action under the Executive Order
12866.
Regulatory Flexibility Act
The Secretary hereby certifies that this rule would not have a
significant economic impact on a substantial number of small entities
as they are defined in the Regulatory Flexibility Act, 5 U.S.C. 601 et
seq. This rule will not cause a significant economic impact on health
care providers, suppliers, or entities since only a small portion of
the business of such entities concerns VA beneficiaries. Therefore,
pursuant to 5 U.S.C. 605(b), this amendment is exempt from the initial
and final regulatory flexibility analysis requirements of sections 603
and 604.
Catalog of Federal Domestic Assistance Numbers
The Catalog of Federal Domestic Assistance numbers and titles for
the programs affected by this document are 64.009, Veterans Medical
Care Benefits; 64.010, Veterans Nursing Home Care; and 64.011, Veterans
Dental Care.
Signing Authority
The Secretary of Veterans Affairs, or designee, approved this
document and authorized the undersigned to sign and submit the document
to the Office of the Federal Register for publication electronically as
an official document of the Department of Veterans Affairs. John R.
Gingrich, Chief of Staff, Department of Veterans Affairs, approved this
document on November 14, 2011, for publication.
List of Subjects in 38 CFR Part 17
Administrative practice and procedure, Alcohol abuse, Alcoholism,
Claims, Day care, Dental health, Drug abuse, Foreign relations,
Government contracts, Grant programs--health, Grant programs--Veterans,
Health care, Health facilities, Health professions, Health records,
Homeless, Medical and dental schools, Medical devices, Medical
research, Mental health programs, Nursing homes, Philippines, Reporting
and recordkeeping requirements, Scholarships and fellowships, Travel
and transportation expenses, Veterans.
Dated: December 14, 2011.
Robert C. McFetridge,
Director of Regulation Policy and Management, Office of the General
Counsel, Department of Veterans Affairs.
For the reasons set forth in the preamble, 38 CFR part 17 is
amended as follows:
PART 17--MEDICAL
0
1. The authority citation for part 17 continues to read as follows:
Authority: 38 U.S.C. 501, and as noted in specific sections.
0
2. Amend Sec. 17.120 by:
0
a. Revising the section heading.
0
b. In the introductory text, removing ``care'' and adding, in its
place, ``emergency treatment'', removing ``medical services'' and
adding, in its place, ``emergency treatment'', and removing ``may be
paid'' and adding, in its place, ``will be paid''.
0
c. Revising paragraph (a) introductory text.
0
d. In paragraph (a)(3), removing ``United State'' and adding, in its
place, ``United States'' and adding the word ``or'' at the end of
paragraph (a)(3).
0
e. In paragraph (a)(4), removing ``Sec. 17.48(j); and'' and adding, in
its place, ``Sec. 17.47(i)(2);''.
0
f. Revising paragraph (b).
0
g. Revising paragraph (c).
The revisions read as follows:
Sec. 17.120 Payment or reimbursement for emergency treatment
furnished by non-VA providers to certain veterans with service-
connected disabilities.
* * * * *
(a) For veterans with service connected disabilities. Emergency
treatment not previously authorized was rendered to a veteran in need
of such emergency treatment:
* * * * *
(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 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 severity (including severe
[[Page 79071]]
pain) that a prudent layperson who possesses an average knowledge of
health and medicine could reasonably expect the absence of immediate
medical attention to result in placing the health of the individual in
serious jeopardy, serious impairment to bodily functions, or serious
dysfunction of any bodily organ or part. And,
(c) When Federal facilities are unavailable. VA or other Federal
facilities that VA has an agreement with to furnish health care
services for veterans were not feasibly available, and an attempt to
use them beforehand or obtain prior VA authorization for the services
required would not have been reasonable, sound, wise, or practicable,
or treatment had been or would have been refused.
0
3. Section 17.121 is revised to read as follows:
Sec. 17.121 Limitations on payment or reimbursement of the costs of
emergency treatment not previously authorized.
(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 an
available VA facility (or other Federal facility that VA has an
agreement with to furnish health care services for veterans), VA will
make payment or reimbursement only for the expenses related to the
initial evaluation and the emergency treatment furnished to the veteran
up to the point of refusal of transfer by the veteran.
(Authority: 38 U.S.C. 1724, 1728, 7304)
0
4. Revise paragraph (d) of Sec. 17.1001 to read as follows:
Sec. 17.1001 Definitions.
* * * * *
(d) The term stabilized means that no material deterioration of the
emergency medical condition is likely, within reasonable medical
probability, to occur if the veteran is discharged or transferred to a
VA or other Federal facility that VA has an agreement with to furnish
health care services for veterans.
* * * * *
0
5. Amend Sec. 17.1002 by:
0
a. Revising the introductory text.
0
b. Revising paragraph (c).
0
c. Removing paragraph (d).
0
d. Redesignating paragraphs (e) through (i) as new paragraphs (d)
through (h) respectively.
The revision reads as follows:
Sec. 17.1002 Substantive conditions for payment or reimbursement.
Payment or reimbursement under 38 U.S.C. 1725 for emergency
treatment (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 the patient for use after the
emergency condition is stabilized and the patient is discharged)) will
be made only if all of the following conditions are met:
* * * * *
(c) A VA or other Federal facility/provider that VA has an
agreement with to furnish health care services for veterans was not
feasibly available and an attempt to use them beforehand would not have
been considered reasonable by a prudent layperson (as an example, these
conditions would be met by evidence establishing that a veteran was
brought to a hospital in an ambulance and the ambulance personnel
determined the nearest available appropriate level of care was at a
non-VA medical center);
* * * * *
0
6. In Sec. 17.1005, revise paragraph (b) and add paragraphs (c) and
(d) as follows:
Sec. 17.1005 Payment limitations.
* * * * *
(b) Except as provided in paragraph (c) 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, a
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.
(c) Claims for payment or reimbursement of the costs of emergency
treatment not previously authorized may be approved for continued, non-
emergency treatment, only 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 VA (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.
[[Page 79072]]
(d) If a stabilized veteran who requires continued non-emergency
treatment refuses to be transferred to an available VA facility (or
other Federal facility that VA has an agreement with to furnish health
care services for veterans), VA will make payment or reimbursement only
for the expenses related to the initial evaluation and the emergency
treatment furnished to the veteran up to the point of refusal of
transfer by the veteran.
* * * * *
Sec. 17.1006 [Amended]
0
7. Amend Sec. 17.1006 by removing ``Fee Service Review Physician or
equivalent officer'' and adding, in its place, ``designated VA
clinician''.
Sec. 17.1008 [Amended]
0
8. Amend Sec. 17.1008 by removing ``treatment'' in both places it
appears, and adding, in each place, ``treatment and any non-emergency
treatment that is authorized under Sec. 17.1005(c) of this part''.
[FR Doc. 2011-32413 Filed 12-16-11; 8:45 am]
BILLING CODE 8302-01-P