Source: https://www.federalregister.gov/documents/2011/12/21/2011-32413/payment-or-reimbursement-for-emergency-treatment-furnished-by-non-va-providers-in-non-va-facilities
Timestamp: 2018-07-16 11:33:09
Document Index: 707429892

Matched Legal Cases: ['§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917', '§\u200917']

A Rule by the Veterans Affairs Department on 12/21/2011
79067-79072 (6 pages)
2011-32413
https://www.federalregister.gov/d/2011-32413 https://www.federalregister.gov/d/2011-32413
This PDF is the current document as it appeared on Public Inspection on 12/16/2011 at 01:55 pm.
Start Further Info Start Printed Page 79068
One commenter was concerned with our decision in §§ 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.
One commenter read the refusal of transfer provisions at proposed § 17.121(c) and § 17.1005(d) to exclude payment for non-emergency care Start Printed Page 79069provided 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 § 17.121(c) and § 17.1005(d). Specifically, in § 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 § 17.1005(d).
In light of the potential for confusion as to what constitutes emergency treatment under the regulation, we have added to § 17.120(b) and § 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.
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 § 17.120(c), “Federal facility” in § 17.1001(d), and “Federal facility/provider” in § 17.1002(c). We note the reference to “other Federal facility” in § 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.Start Printed Page 79070
e. In paragraph (a)(4), removing “§ 17.48(j); and” and adding, in its place, “§ 17.47(i)(2);”.
(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 Start Printed Page 79071pain) 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,
4. Revise paragraph (d) of § 17.1001 to read as follows:
5. Amend § 17.1002 by:
6. In § 17.1005, revise paragraph (b) and add paragraphs (c) and (d) as follows:
(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. Start Printed 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.
7. Amend § 17.1006 by removing “Fee Service Review Physician or equivalent officer” and adding, in its place, “designated VA clinician”.
8. Amend § 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 § 17.1005(c) of this part”.