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[Senate Report 110-263]
[From the U.S. Government Publishing Office]

                                                       Calendar No. 579
110th Congress                                                   Report
                                 SENATE
 2d Session                                                     110-263

======================================================================

 
              VETERANS EMERGENCY CARE FAIRNESS ACT OF 2007

                                _______
                                

               February 25, 2008.--Ordered to be printed

                                _______
                                

   Mr. Akaka, from the Committee on Veterans' Affairs, submitted the 
                               following

                              R E P O R T

                         [To accompany S. 2142]

    The Committee on Veterans' Affairs (hereinafter, ``the 
Committee''), to which was referred the bill (S. 2142) to amend 
title 38, United States Code, to require the Secretary of 
Veterans Affairs to reimburse veterans receiving emergency 
treatment in non-Department of Veterans Affairs facilities for 
such treatment until such veterans are transferred to 
Department facilities, and for other purposes, having 
considered an amended version of the same, reports favorably 
thereon, and recommends that the bill, as amended, do pass.

                              Introduction

    On October 4, 2007, Committee member Senator Sherrod Brown 
introduced S. 2142, the proposed ``Veterans Emergency Care 
Fairness Act of 2008.'' On October 24, 2007, the Committee held 
a hearing on pending veterans' health legislation at which 
testimony on an amended version of S. 2142, among other bills, 
was offered by: Michael J. Kussman, MD, MS, MACP, the 
Department of Veterans Affairs' Under Secretary for Health; 
Carl Blake, National Legislative Director, Paralyzed Veterans 
of America; and Joy J. Ilem, Assistant National Legislative 
Director, Disabled American Veterans. The witnesses expressed 
support for S. 2142 on behalf of their respective 
organizations. VA supported the legislation, and Under 
Secretary Kussman indicated that VA was also working on 
improving the reimbursement process for veterans receiving 
emergency care at non-VA facilities.

                           Committee Meeting

    After carefully reviewing the testimony from the foregoing 
hearing, the Committee met in open session on November 14, 
2007, to consider, among other legislation, an amended version 
of S. 2142. The Committee agreed by voice vote to report 
favorably S. 2142, as amended, to the Senate.

                     Summary of S. 2142 as Reported

    S. 2142, as reported (hereinafter, ``the Committee bill''), 
would amend sections 1725 and 1728 of title 38, United States 
Code, to make reimbursement for emergency care received at non-
VA facilities mandatory for eligible veterans.
    Section 2(a) would make the reimbursement of veterans for 
emergency care received at non-VA facilities mandatory by 
amending section 1725 of title 38. The amended text would also 
clarify when VA's obligation to reimburse ends by more clearly 
defining the conditions for transfers and patient 
stabilization.
    Section 2(b) would amend section 1728 of title 38 to 
conform to section 1725 by making the provision mandatory. To 
ensure consistency, ``care and services'' would be replaced by 
``emergency treatment.'' A new subsection, subsection (c), 
would also be added in order to use a consistent definition of 
``emergency treatment,'' as defined in proposed new section 
1725(f)(1).

                       Background and Discussion

    The Committee bill was developed in response to the need 
for clearer procedures for reimbursement by VA when veterans 
receive emergency care at non-VA facilities.
    Under current law, section 1728 of title 38 authorizes the 
Secretary to pay the expenses incurred by a veteran for 
emergency treatment services when delay of such services would 
have been hazardous to the life or health of the veteran; 
treatment of a service-connected disability; treatment of a 
non-service-connected disability aggravating a service-
connected disability; treatment of any disability of a veteran 
with a permanent and total disability; or for a covered 
vocational rehabilitation purpose. Expenses incurred after the 
medical emergency has ended, and after the point in time when 
the veteran may be transferred safely to VA or another Federal 
facility, may not be reimbursed. Pursuant to current section 
1725, the Secretary may also reimburse a veteran for expenses 
incurred for emergency treatment provided at a non-VA facility 
for a non-service connected disability.
    VA's interpretation of the existing authority for emergency 
care reimbursement has created difficulties for veterans and 
non-VA hospitals seeking reimbursement. A November 16, 2005, VA 
Office of General Counsel memorandum supported a narrow 
interpretation of the statutory authorities, particularly in 
the context of an emergency that has terminated, thereby ending 
the obligation to pay. VA's interpretation has tended to favor 
the denial of reimbursement claims for continuing care where a 
transfer attempt is made but VA does not have a bed available. 
The problems with securing reimbursement can make transfers to 
alternative (and potentially more suitable) facilities for 
treatment difficult when VA does not have a bed available.
    During a Committee field hearing in New Philadelphia, Ohio, 
on May 29, 2007, chaired by Senator Brown, problems with the 
current procedures were highlighted. Specifically, community 
hospitals in Ohio reported encountering difficulty transferring 
veterans to an appropriate VA Medical Center and subsequently 
obtaining reimbursement following emergency care at these 
facilities. Terry M. Carson, Chief Executive Officer of 
Harrison Community Hospital, addressed the issue, testifying:

          The problem that we experience has to do with 
        treating initial emergency/urgent situations and having 
        little success in being able to transfer veterans to 
        the appropriate Veterans' Hospital Center. Often, we 
        wait days to receive transfer approval, and it is not 
        uncommon for those approvals to be withdrawn during the 
        actual transfer, and change of direction mid-stream.

    This testimony highlights the difficulties arising from the 
current system, which reflects the ambiguities and uncertainty 
of the existing statutory authorities.
    Delays in the transfer from community to VA facilities can 
jeopardize veterans' health, and place hospitals in the 
position of being forced to proceed with treatments that would 
otherwise have been provided by VA. By delaying or refusing the 
acceptance of veteran transfers, VA adds unnecessary complexity 
to the reimbursement process. The net result is difficulty for 
veterans and the hospitals in receiving reimbursement for care.

                             Committee Bill

    Section 2(a) of the Committee bill would amend section 1725 
of title 38 in subsections (a)(1) and (f)(1). Subsection (a)(1) 
would be amended by replacing ``may reimburse'' with ``shall 
reimburse.'' This change would make reimbursement for emergency 
care received at non-VA facilities mandatory for eligible 
veterans, rather than at the discretion of the Secretary.
    Subsection (f)(1) would be amended to provide greater 
specificity regarding the termination of VA's obligation to 
reimburse. The ambiguities that have driven the restriction of 
VA's obligation to pay would be eliminated through the more 
specific language proposed by the Committee bill, which would 
specify that VA's obligation to reimburse terminates when the 
veteran may be transferred safely from the private facility to 
a VA hospital and the VA facility is capable of accepting the 
transfer. Alternatively, if VA does not initially have a bed 
available, VA's obligation to reimburse will terminate only 
after the veteran is actually transferred to a VA or other 
Federal facility, so long as the private facility made and 
documented reasonable efforts to transfer the veteran when he 
or she was first able to be transferred safely.
    Section 2(b) of the Committee bill would amend section 1728 
of title 38 so as to make that section, which relates to 
reimbursement for the emergency treatment of service-connected 
conditions, consistent with section 1725, as amended by section 
2(a) of the Committee bill. Thus, reimbursement would also be 
made mandatory under Section 1728. The existing criteria, 
defining veteran eligibility for reimbursement for emergency 
care services, would be carried over in the revised statutory 
language.
    In addition, section 2(b) would further amend section 1728 
so as to strike the phrase ``care and services'' in current 
subsection (b) of section 1728, and replace that phrase with 
``emergency treatment.'' This proposed change is designed to 
promote consistency between section 1725 and 1728 of title 38. 
This goal of consistency is further reflected in the Committee 
bill's proposed addition of subsection (c) to section 1728, to 
adopt the same definition of ``emergency treatment'' that would 
be established in section 1725(f)(1) of the Committee bill.

                      Committee Bill Cost Estimate

    In compliance with paragraph 11(a) of rule XXVI of the 
Standing Rules of the Senate, the Committee, based on 
information supplied by the CBO, estimates that enactment of 
the Committee bill would increase spending by $20 million in 
2008 and by $323 million over the 2009-2013 period. Enactment 
of the Committee bill would not affect direct spending or 
receipts, and would not affect the budget of state, local or 
tribal governments.
    The cost estimate provided by CBO, setting forth a detailed 
breakdown of costs, follows:

                               Congressional Budget Office,
                                  Washington, DC, January 16, 2008.
Hon. Daniel K. Akaka,
Chairman, Committee on Veterans' Affairs,
U.S. Senate, Washington, DC.
    Dear Mr. Chairman: The Congressional Budget Office has 
prepared the enclosed cost estimate for S. 2142, the Veterans 
Emergency Care Fairness Act of 2007.
    If you wish further details on this estimate, we will be 
pleased to provide them. The CBO staff contact is Sunita 
D'Monte.
            Sincerely,
                                           Peter R. Orszag,
                                                          Director.
    Enclosure.
    Summary: S. 2142 would require the Department of Veterans 
Affairs (VA) to pay for the emergency care certain veterans 
receive at non-VA medical facilities, or to reimburse veterans 
if they have paid for that care. CBO estimates that 
implementing S. 2142 would cost $20 million in 2008 and an 
additional $323 million over the 2009-2013 period, assuming 
appropriation of the estimated amounts. Enacting the bill would 
not affect direct spending or revenues.
    S. 2142 contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA) 
and would impose no costs on state, local, or tribal 
governments.
    Estimated cost to the Federal Government: The estimated 
budgetary impact of S. 2142 is shown in the following table. 
The costs of this legislation fall within budget function 700 
(veterans benefits and services).

----------------------------------------------------------------------------------------------------------------
                                                                     By fiscal year, in millions of dollars--
                                                                 -----------------------------------------------
                                                                   2008    2009    2010    2011    2012    2013
----------------------------------------------------------------------------------------------------------------
                                  CHANGES IN SPENDING SUBJECT TO APPROPRIATION

Estimated Authorization Level...................................      22      52      58      65      73      82
Estimated Outlays...............................................      20      49      57      64      72      81
----------------------------------------------------------------------------------------------------------------

    Basis of estimate: For this estimate, CBO assumes that the 
legislation will be enacted around the middle of fiscal year 
2008, that the estimated amounts will be appropriated each 
year, and that outlays will follow historical spending patterns 
for the VA medical services program.
    Under two different sections of law, VA currently has the 
authority to reimburse certain veterans or to pay for emergency 
care provided at non-VA facilities. S. 2142 would amend and 
enhance those authorities. Based on information from VA, CBO 
estimates that by requiring VA to pay for longer (on average) 
lengths of stay in private medical facilities, the bill would 
cost $20 million in 2008 and another $323 million over the 
2009-2013 period, assuming appropriation of the estimated 
amounts.

Reimbursements under current law

    Under 38 U.S.C. 1725, VA may reimburse veterans or pay for 
emergency treatment of a nonservice-connected condition, if VA 
is the payer of last resort. Under this section of law, 
emergency treatment is defined as care or services provided for 
a medical emergency where a prudent layperson could reasonably 
expect that a delay in seeking medical attention would be 
hazardous to life or health. According to VA data on payments 
made under 38 U.S.C. 1725, VA paid a total of $123 million in 
2006--$103 million for inpatient treatment provided to about 
18,200 veterans ($1,200 per day, for an average length of stay 
of 4.7 days) and $20 million for ancillary care.
    Under 38 U.S.C. 1728, VA may reimburse certain veterans 
with service-connected conditions or those who are covered for 
purposes of a vocational rehabilitation program if medical 
professionals determine that a medical emergency exists. Data 
from VA on payments made under 38 U.S.C. 1728 indicate that in 
2006 VA paid $83 million for treatment provided to 7,800 
veterans ($1,900 per day, for an average length of stay of 5.6 
days).
    Under both sections of current law, VA can make payments 
only until the veteran's condition has stabilized and he or she 
can be transferred safely to a VA or other federal facility, 
regardless of whether any such facility is actually available 
to accept such a transfer.

Additional reimbursements under S. 2142

    S. 2142 would amend those authorities by establishing the 
prudent layperson definition of emergency treatment for both 
sections of law and requiring VA to pay for treatment until the 
veteran is transferred to a VA or other federal facility, or 
the veteran is otherwise discharged from the hospital. Under 
the bill, some veterans who incur medical costs after they are 
deemed to be stable but before they are transferred to a VA or 
other federal facility would now be eligible for additional 
payments from VA.
    Data from the 2005 National Hospital Discharge Survey 
indicate that male patients over age 45 who were admitted 
through the emergency department stayed in the hospital for an 
average of 5.4 days. CBO estimates that under the bill, the 
average length of stay for which veterans would be reimbursed 
would rise from 4.7 days to 5.4 days, and VA's costs under 38 
U.S.C. 1725 would increase by $10 million in 2008 and by an 
average of $30 million a year over the 2009-2013 period, 
assuming appropriation of the estimated amounts. (Costs rise 
sharply starting in 2009, because CBO assumes the bill would be 
enacted in mid-2008.)
    Based on information from VA, CBO estimates that under S. 
2142, veterans who are eligible for reimbursement under 38 
U.S.C. 1728--primarily veterans with service-connected 
disabilities--would be reimbursed for hospital stays averaging 
6.6 days. CBO also expects that by establishing a prudent 
layperson definition of medical emergencies, the bill would 
increase the number of eligible veterans by 5 percent each 
year. Thus, CBO estimates that under the bill, costs under 38 
U.S.C. 1728 would rise by $10 million in 2008 and by an average 
of $35 million a year over the 2009-2013 period, assuming 
appropriation of the estimated amounts.
    Intergovernmental and private-sector impact: S. 2142 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would impose no costs on state, local, or 
tribal governments.
    Estimate prepared by: Federal costs: Sunita D'Monte; Impact 
on state, local, and tribal governments: Lisa Ramirez-Branum; 
Impact on the private sector: Victoria Liu.
    Estimate approved by: Theresa Gullo, Deputy Assistant 
Director for Budget Analysis.

                      Regulatory Impact Statement

    In compliance with paragraph 11(b) of rule XXVI of the 
Standing Rules of the Senate, the Committee has made an 
evaluation of the regulatory impact that would be incurred in 
carrying out the Committee bill. The Committee finds that the 
Committee bill would not entail any regulation of individuals 
or businesses or result in any impact on the personal privacy 
of any individuals and that the paperwork resulting from 
enactment would be minimal.

                 Tabulation of Votes Cast in Committee

    In compliance with paragraph 7 of rule XXVI of the Standing 
Rules of the Senate, the following is a tabulation of votes 
cast in person or by proxy by members of the Committee at its 
November 14, 2007, meeting. On that date, the Committee, by 
voice vote, ordered S. 2142, as amended, reported favorably to 
the Senate.

                             Agency Report

    On October 24, 2007, Michael J. Kussman, MD, MS, MACP, the 
Department of Veterans Affairs Under Secretary for Health, 
appeared before the Committee and submitted testimony on, among 
other things, the Veterans Emergency Care Fairness Act of 2007. 
Excerpts of this statement are reprinted below:

              Statement of the Views of the Administration

 Michael J. Kussman, MD, MS, MACP, Under Secretary for Health for the 
                     Department of Veterans Affairs

    Good morning Mr. Chairman and Members of the Committee:
    Thank you for inviting me here today to present the 
Administration's views on several bills that would affect 
Department of Veterans Affairs (VA) programs that provide 
veterans benefits and services. With me today is Walter A. 
Hall, Assistant General Counsel. I will address the five bills 
on today's agenda and then I would be happy to answer any 
questions you and the Committee members may have.

        S. 2142 ``VETERANS EMERGENCY CARE FAIRNESS ACT OF 2007''

    S. 2142 would make mandatory, standardize, and enhance the 
two existing authorities the Secretary has to pay for expenses 
incurred in connection with a veteran's receipt of emergency 
treatment in a non-VA facility. The two authorities under which 
the Secretary may currently pay these claims are discretionary 
in nature (``may reimburse'' as opposed to ``shall reimburse'') 
and cover different veteran populations and use different 
standards to define a medical emergency.
    As background, the Secretary is authorized to pay the 
reasonable expenses incurred by a veteran for non-VA emergency 
treatment of a service-connected disability, a non-service-
connected disability aggravating a service-connected 
disability, any disability of a veteran with a permanent and 
total disability, or for a covered vocational rehabilitation 
purpose. In these claims, VA medical professionals must 
determine whether a medical emergency existed (i.e., if there 
was an actual emergency of such nature that delay in obtaining 
treatment would have been hazardous to life or health). 
Expenses incurred after the medical emergency has ended, that 
is, after the point in time the veteran could have been 
transferred safely to VA or another Federal facility, may not 
be reimbursed.
    The Secretary may also reimburse or pay a veteran for 
expenses incurred for non-VA emergency treatment of a non-
service connected disability. In these claims, the law requires 
use of a prudent layperson standard to determine the need for 
the non-VA emergency treatment. Thus, if it turns out that the 
veteran's condition was not an actual medical emergency, VA can 
still pay the expenses if a prudent layperson would have 
thought it reasonable for the veteran to seek immediate medical 
treatment. This happens, for instance, when a veteran goes to 
the nearest emergency room because of the belief he or she is 
having a heart attack but turns out only to have a severe case 
of heartburn. Similar to claims for service-connected 
conditions, the Secretary is only authorized to pay for the 
emergency treatment expenses, and the emergency ends at the 
point the veteran can be transferred safely to a VA facility or 
other Federal facility.
    S. 2142 would amend both existing authorities by requiring 
the Secretary to pay the expenses of any veteran who meets 
eligibility criteria. It would also standardize these programs 
by applying the prudent layperson definition of ``emergency 
treatment'' in both situations. And most importantly it would 
define ``emergency treatment'' as continuing until (1) the 
point in time the veteran can be transferred safely to a VA or 
other Federal facility, or (2) such time as a VA facility or 
other Federal facility agrees to accept such transfer if, at 
the time the veteran could have been transferred safely, the 
non-VA provider makes and documents reasonable attempts to 
transfer the veteran to a VA facility or other Federal 
facility.
    VA strongly supports S. 2142; effective emergency room 
reimbursement has been an issue of concern to the Department. 
In fact, VA is in the process of drafting regulations to 
address these concerns within the authority it has under 
current law.
    It is VA's expectation that facilities aggressively work to 
accept the transfer of a veteran in these situations. We are 
aware, however, that there have been cases where VA has been 
unable to find a facility that had the bed, capability, staff, 
or resources needed to furnish the care required by the 
veteran. In those cases, which we believe are the exception and 
not the norm, the non-VA providers ultimately billed the 
veterans for those expenses. This can impose a serious monetary 
hardship for our beneficiaries.
    S. 2142 would properly put the financial onus on the 
Department to provide appropriate care either in the VA or 
Federal system or at the non-VA facility. Enrolled veterans are 
eligible for needed hospital or medical care. Good medical 
practice demands we furnish such care in a manner that advances 
a seamless continuum of care and reduces fragmentation of such 
care. Clearly these goals are best achieved by bringing the 
veteran into the VA health care system as soon as possible. In 
those rare cases where VA cannot immediately agree to accept 
the patient transfer, it would be entirely appropriate for VA 
to be responsible for the expenses related to the veteran's 
needed continued hospital care in the private facility until 
the point VA can take over.
    When VA initiated drafting regulations for this program 
choice, it determined funds were available within the FY2008 
President's Budget level for this expanded benefit.
    As a final and more technical matter, I would like to 
clarify that if a veteran currently meets the eligibility 
criteria on which his or her claim is based, VA invariably pays 
the claim. Thus, changing the Secretary's authority from 
``may'' to ``shall'' for purposes of both types of claims would 
have no practical effect. Nevertheless, we do not object to 
such a change.

           *       *       *       *       *       *       *

    Changes in Existing Law Made by the Committee Bill, as Reported

    In compliance with rule XXVI paragraph 12 of the Standing 
Rules of the Senate, changes in existing law made by the 
Committee bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

                      TITLE 38, UNITED STATES CODE

                       PART II--GENERAL BENEFITS

CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE

           *       *       *       *       *       *       *

   Subchapter III--Miscellaneous Provisions Relating to Hospital and 
Nursing Home Care and Medical Treatment of Veterans

           *       *       *       *       *       *       *

Sec. 1725. Reimbursement for emergency treatment

    (a) General Authority.--
          (1) Subject to subsections (c) and (d), the Secretary 
        [may reimburse] shall reimburse a veteran described in 
        subsection (b) for the reasonable value of emergency 
        treatment furnished the veteran in a non-Department 
        facility.

           *       *       *       *       *       *       *

    (f) Definitions.--For purposes of this section:
          (1) The term ``emergency treatment'' means 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;
                  (B) when such care or services are rendered 
                in a medical emergency of such nature that a 
                prudent layperson reasonably expects that delay 
                in seeking immediate medical attention would be 
                hazardous to life or health; and
                  [(C) until such time as the veteran can be 
                transferred safely to a Department facility or 
                other Federal facility.]
                  (C) until--
                          (i) such time as the veteran can be 
                        transferred safely to a Department 
                        facility or other Federal facility and 
                        such facility is capable of accepting 
                        such transfer; or
                          (ii) such time as a Department 
                        facility or other Federal facility 
                        accepts such transfer if--
                                  (I) at the time the veteran 
                                could have been transferred 
                                safely to a Department facility 
                                or other Federal facility, no 
                                Department facility or other 
                                Federal facility agreed to 
                                accept such transfer; and
                                  (II) the non-Department 
                                facility in which such medical 
                                care or services was furnished 
                                made and documented reasonable 
                                attempts to transfer the 
                                veteran to a Department 
                                facility or other Federal 
                                facility.

           *       *       *       *       *       *       *

Sec. 1728. Reimbursement of certain medical expenses

    [(a) The Secretary may, under such regulations as the 
Secretary shall prescribe, reimburse veterans entitled to 
hospital care or medical services under this chapter for the 
reasonable value of such care or services (including travel and 
incidental expenses under the terms and conditions set forth in 
section 111 of this title), for which such veterans have made 
payment, from sources other than the Department, where--
          [(1) such care or services were rendered in a medical 
        emergency of such nature that delay would have been 
        hazardous to life or health;
          [(2) such care or services were rendered to a veteran 
        in need thereof
                  [(A) for an adjudicated service-connected 
                disability,
                  [(B) for a non-service-connected disability 
                associated with and held to be aggravating a 
                service-connected disability,
                  [(C) for any disability of a veteran who has 
                a total disability permanent in nature from a 
                service-connected disability, or
                  [(D) for any illness, injury, or dental 
                condition in the case of a veteran who
                          [(i) is a participant in a vocational 
                        rehabilitation program (as defined in 
                        section 3101 (9) of this title), and
                          [(ii) is medically determined to have 
                        been in need of care or treatment to 
                        make possible such veteran's entrance 
                        into a course of training, or prevent 
                        interruption of a course of training, 
                        or hasten the return to a course of 
                        training which was interrupted because 
                        of such illness, injury, or dental 
                        condition; and
          [(3) Department or other Federal facilities were not 
        feasibly available, and an attempt to use them 
        beforehand would not have been reasonable, sound, wise, 
        or practical.]
    (a) The Secretary shall, under such regulations as the 
Secretary prescribes, reimburse veterans eligible for hospital 
care or medical services under this chapter for the customary 
and usual charges of emergency treatment (including travel and 
incidental expenses under the terms and conditions set forth in 
section 111 of this title) for which such veterans have made 
payment, from sources other than the Department, where such 
emergency treatment was rendered to such veterans in need 
thereof for any of the following:
          (1) An adjudicated service-connected disability.
          (2) A non-service-connected disability associated 
        with and held to be aggravating a service-connected 
        disability.
          (3) Any disability of a veteran if the veteran has a 
        total disability permanent in nature from a service-
        connected disability.
          (4) Any illness, injury, or dental condition of a 
        veteran who--
                  (A) is a participant in a vocational 
                rehabilitation program (as defined in section 
                3101(9) of this title); and
                  (B) is medically determined to have been in 
                need of care or treatment to make possible the 
                veteran's entrance into a course of training, 
                or prevent interruption of a course of 
                training, or hasten the return to a course of 
                training which was interrupted because of such 
                illness, injury, or dental condition.
    (b) In any case where reimbursement would be in order under 
subsection (a) of this section, the Secretary may, in lieu of 
reimbursing such veteran, make payment of the reasonable value 
of [care or services] emergency treatment directly--
          (1) to the hospital or other health facility 
        furnishing the [care or services] emergency treatment; 
        or
          (2) to the person or organization making such 
        expenditure on behalf of such veteran.
    (c) In this section, the term `emergency treatment' has the 
meaning given such term in section 1725(f)(1) of this title.

           *       *       *       *       *       *       *

                                  
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