Code of Federal Regulations (Last Updated: November 8, 2024) |
Title 38 - Pensions, Bonuses, and Veterans' Relief |
Chapter I - Department of Veterans Affairs |
Part 17 - Medical |
Payment or Reimbursement for Emergency Services for Nonservice-Connected Conditions in Non-VA Facilities |
§ 17.1003 - Emergency transportation.
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§ 17.1003 Emergency transportation.
Notwithstanding the provisions of § 17.1002, payment or reimbursement under 38 U.S.C. 1725 for ambulance services, including air ambulance services, may be made for transporting a veteran to a facility only if the following conditions are met:
(a) Payment or reimbursement is authorized under 38 U.S.C. 1725 for emergency treatment provided at a non-VA facility, or payment or reimbursement would have been authorized under 38 U.S.C. 1725 for emergency treatment had:
(1) The veteran's personal liability for the emergency treatment not been fully extinguished by payment by a third party, including under a health-plan contract, or by VA; or
(2) Death had not occurred before emergency treatment could be provided;
(b) The veteran is financially liable to the provider of the emergency transportation;
(c) The veteran does not have coverage under a health-plan contract that would fully extinguish the medical liability for the emergency transportation (this condition is not met if the veteran has coverage under a health-plan contract but payment is barred because of a failure by the veteran or the provider to comply with the provisions of that health-plan contract);
(d) If the condition for which the emergency transportation was furnished was caused by an accident or work-related injury, the claimant has exhausted without success all claims and remedies reasonably available to the veteran or provider against a third party for payment of such transportation; and the veteran has no contractual or legal recourse against a third party that could reasonably be pursued for the purpose of fully extinguishing the veteran's liability to the provider; and
(e) If the veteran is not eligible for reimbursement for any emergency treatment expenses under 38 U.S.C. 1728.
[66 FR 36470, July 12, 2001, as amended at 83 FR 979, Jan. 9, 2018; 88 FR 10841, Feb. 22, 2023]