**Use of Public or Private Hospitals**

**§17.52 Hospital care and medical services in non-VA facilities.**

\(a\) 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 through
f, 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(j). (Authority: 38 U.S.C. 1703, 3104; sec. 101,
> Pub. L. 96-466; sec. 19012, Pub. L. 99-272)

\(2\) 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 received VA inpatient care for treatment of
nonservice-connected conditions for which treatment was begun during the
period of inpatient care. The treatment period (to include care
furnished in both facilities of VA and non-VA facilities or any
combination of such modes of care) may not continue for a period
exceeding 12 months following discharge from the hospital except when it
is determined that a longer period is required by virtue of the
disabilities being treated, 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 VA (or, in
areas where no such physician is available, by a physician carrying out
such function under a contract or fee arrangement), that the medical
condition of such veteran precludes appropriate treatment in VA
facilities; (Authority: 38 U.S.C. 1703; sec. 19012, Pub. L. 99-272)

\(3\) Hospital care or medical services for the treatment of medical
emergencies which pose a serious threat to the life or health of a
veteran receiving hospital care or medical services in a facility over
which the Secretary has direct jurisdiction or government facility with
which the Secretary contracts, and for which the facility is not staffed
or equipped to perform. and transfer to a public or private hospital
which has the necessary staff or equipment is the only feasible means of
providing the necessary treatment, until such time following the
furnishing of care in the non-VA facility as the veteran can be safely
transferred to a VA facility; (Authority: 38 U.S.C. 1703; sec. 19012,
Pub. L. 99-272)

\(4\) Hospital care for women veterans; (Authority: 38 U.S.C. 1703; sec.
19012, Pub. L. 99-272)

\(5\) Through September 30, 1988, hospital care or medical services that
will obviate the need for hospital admission for veterans in the
Commonwealth of Puerto Rico, except that the dollar expenditure in
Fiscal year 1986 cannot exceed 85% of the Fiscal year 1985 obligations,
in Fiscal year 1987 the dollar expenditure cannot exceed 50% of the
Fiscal year 1985 obligations and in Fiscal year 1988 the dollar
expenditure cannot exceed 25% of the Fiscal year 1985 obligations.
(Authority: 38 U.S.C. 1703; sec. 102, Pub. L. 99-166; sec. 19012, Pub.
L. 99-272)

\(6\) Hospital care or medical services that will obviate the need for
hospital admission for veterans in Alaska, Hawaii, Virgin Islands and
other territories of the United States except that the annually
determined hospital patient load and incidence of the furnishing of
medical services to veterans hospitalized or treated at the expense of
VA in government and non-VA facilities in each such State or territory
shall be consistent with the patient load or incidence of the provision
of medical services for veterans hospitalized or treated by VA within
the 48 contiguous States. (Authority: 38 U.S.C. 1703; sec. 19012, Pub.
L. 99-272)

\(7\) Outpatient dental services and treatment, and related dental
appliances, for a veteran who is a former prisoner of war and was
detained or interned for a period of not less that 181 days. (Authority:
38 U.S.C. 1703; sec. 19012, Pub. L. 99-272)

\(8\) Hospital care or medical services for the treatment of medical
emergencies which pose a serious threat to the life or health of a
veteran which developed during authorized travel to the hospital, or
during authorized travel after hospital discharge preventing completion
of travel to the originally designated point of return (and this will
encompass any other medical services necessitated by the emergency,
including extra ambulance or other transportation which may also be
furnished at VA expense. (Authority: 38 U.S.C. 1701(5))

\(9\) Diagnostic services necessary for determination of eligibility
for, or of the appropriate course of treatment in connection with,
furnishing medical services at independent VA outpatient clinics to
obviate the need for hospital admission. (Authority: 38 U.S.C. 1703;
sec. 19012, Pub. L. 99-272)

\(10\) For any disability of a veteran receiving VA contract nursing
home care. The veteran is receiving contract nursing home care and
requires emergency treatment in non-VA facilities. (Authority: 38 U.S.C.
1703(a))

\(11\) For completion of evaluation for observation and examination
(O&E) purposes, clinic directors or their designees will authorize
necessary diagnostic services at non-VA facilities (on an inpatient or
outpatient basis) in order to complete requests from VA Regional Offices
for O&E of a person to determine eligibility for VA benefits or
services.

\(b\) The Under Secretary for Health shall only furnish care and
treatment under paragraph (a) of this section to veterans described in
§17.47(d).

\(1\) 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 §17.47(a) and (c), and

\(2\) If the veteran agrees to pay the United States an amount as
determined in §17.48(e). (Authority: 38 U.S.C. 1703, 1710 and 1712; sec.
19011-19012, Pub. L. 99-272)

\[51 FR 25066, July 10, 1986, as amended at 53 FR 32391, Aug. 25, 1988;
54 FR 53057, Dec. 27, 1989; 58 FR 32446, June 10, 1993. Redesignated and
amended at 61 FR 21965, 21966, May 13, 1996; 62 FR 17072, Apr. 9, 1997\]