(iv) 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. 603, 1504; 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. 603; 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 furnish

ing of care in the non-VA facility as the veteran can be safely transferred to a VA facility;

(Authority: 38 U.S.C. 603; sec. 19012, Pub. L. 99-272)

(4) Hospital care for women veterans;

(Authority: 38 U.S.C. 603; 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. 603; 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. 603; 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. 603; 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. 601(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. 603; 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. 603(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 Chief Medical Director 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. 603, 610 and 612; 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]

§ 17.50c Limitations on use of public or private hospitals.

The admission of any patient to a private or public hospital at Department of Veterans Affairs expense will only be authorized if a Department of Veterans Affairs medical center or other Federal facility to which the patient would otherwise be eligible for admission is not feasibly available. A Department of Veterans Affairs facility may be considered as not feasibly available when the urgency of the applicant's medical condition, the relative distance of the travel involved, or the nature of the treatment required makes it necessary or economically advisable to use public or private facilities. In those instances where care in public or private hospitals at Department of Veterans Affairs expense is authorized because a Department of Veterans Affairs or other Federal facility was not feasibly available, as defined in this section, the authorization will be continued after admission only for the period of time required to stabilize or improve the patient's condition to the extent that further care is no longer required to satisfy the purpose for which it was initiated.

[39 FR 17223, May 14, 1974, as amended at 47 FR 58248, Dec. 30, 1982]

§ 17.50d Necessity for prior authorization.

(a) The admission of a veteran to a non-Department of Veterans Affairs hospital at Department of Veterans Affairs expense must be authorized in advance. In the case of an emergency which existed at the time of admission, an authorization may be deemed a prior authorization if an application, whether formal or informal, by telephone, telegraph or other communication, made by the veteran or by others in his or her behalf is dispatched to the Department of Veterans Affairs (1) for veterans in the 48 contiguous States and Puerto Rico, within 72 hours after the hour of admission, including in the computation of time Saturday, Sunday and holidays, or (2) for veterans in a noncontiguous State, territory or possession of the United States (not including Puerto Rico) if facilities for dispatch of application as described in this section are not avail

able within the 72-hour period, provided the application was filed within 72 hours after facilities became available.

(b) When an application for admission by a veteran in one of the 48 contiguous States in the United States or in Puerto Rico has been made more than 72 hours after admission, or more than 72 hours after facilities are available in a noncontiguous State, territory of possession of the United States, authorization for continued care at Department of Veterans Affairs expense shall be effective as of the postmark or dispatch date of the application, or the date of any telephone call constituting an informal application.

[42 FR 55212, Oct. 14, 1977]

§ 17.50e Use of hospitals under sharing agreements.

Hospital care in a Federal, State or local, public or private hospital facility may be authorized for any veteran entitled to hospital care under § 17.47 when such care requires the use of a specialized medical resource made available by that facility pursuant to an agreement for sharing specialized medical resources.

(Authority: 38 U.S.C. 624)

[47 FR 58248, Dec. 30, 1982]

§ 17.50f Payment for authorized public or private hospital care.

Payment for public or private hospital care authorized under § 17.50b shall not be in excess of the rates the hospital customarily charges the general public for similar services in the community. Payment for ancillary services, supplies, or equipment will be made only to the extent the charges are reasonable and necessary. In the case of services which are out of the ordinary or of an unusual nature, payment will only be made upon a determination by the Department of Veterans Affairs that the services were, in fact, necessary and the charges reasonable. In the case of a hospital under contract with the Department of Veterans Affairs, all services and supplies will be paid at rates in accordance with the terms of the contract.

[33 FR 19011, Dec. 20, 1968]

USE OF COMMUNITY NURSING HOME CARE FACILITIES

§ 17.51 Use of community nursing homes. (a) Nursing home care in a contract public or private nursing home facility may be authorized for the following:

(1) Subject to the limitations of paragraph (a)(5) of this section, any veteran eligible for hospital, nursing home, or domiciliary care under § 17.47 who has attained the maximum benefit from such care and for whom a protracted period of nursing home care will be required.

(Authority: 38 U.S.C. 610, 620; sec. 19011, Pub. L. 99-272)

(2) Any person who has been furnished care in any hospital of any of the Armed Forces, who the appropriate Secretary concerned has determined has received maximum hospital benefits but requires a protracted period of nursing home care, and who upon discharge therefrom will become a veteran.

(Authority: 38 U.S.C. 620)

(3) Any veteran who requires nursing home care for a service-connected disability without first requiring a period of hospitalization. Admission may be authorized upon a determination of need therefore by a physician employed by VA or, in areas where no such physician is available, by carrying out such function under contract or fee arrangement.

(Authority: 38 U.S.C. 620; sec. 108, Pub. L. 99-166)

(4) Any veteran who has been discharged from a hospital under the direct jurisdiction of VA and is currently receiving VA hospital based home health services.

(Authority: Pub. L. 99-166)

(Authority: 38 U.S.C. 620; sec. 108, Pub. L. 99-166)

(5) 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), the Chief Medical Director may furnish care under this paragraph to any veteran described in § 17.47(d) if the vet

eran agrees to pay the United States an amount as determined in § 17.48(e).

(Authority: 38 U.S.C. 610, 620; sec. 19011, Pub. L. 99-272)

(b) Such nursing home care will be subject to the following restrictions:

(1) Any veteran eligible under paragraph (a)(1) of this section shall be transferred to the nursing home care facility from a hospital, nursing home or domiciliary under the direct jurisdiction of VA, except as provided for in § 17.51b.

(2) The nursing home care facility is determined to meet the physical and professional standards prescribed by the Chief Medical Director, and

(3) The cost of the nursing home care will not exceed 45 percent of the cost of care furnished by VA in a general medical center an determined annually. However, the Secretary upon the recommendation of the Chief Medical Director may approve a higher rate not to exceed 50 percent of the cost of such care.

(4) Except as provided for in § 17.51a, nursing home care will not be for more than 6 months in the aggregate in connection with any one transfer, except in the case of a veteran who requires nursing home care for a service-connected disability. In such case entitlement to nursing home care under this paragraph is not subject to any time limitation.

(5) The standards prescribed by the Chief Medical Director and any report of inspection of institutions furnishing nursing home care to veterans shall, to the extent possible, be made available to all Federal, State, and local agencies charged with the responsibility of licensing or otherwise regulating or inspecting such institutions.

(Authority: 38 U.S.C. 620(b)) [51 FR 25067, July 10, 1986]

§ 17.51a Extensions of community nursing home care beyond six months.

Directors of health care facilities may authorize, for any veteran whose hospitalization was not primarily for a service-connected disability, an extension of nursing care in a public or private nursing home care facility at VA expense beyond six months when the

need for nursing home care continues to exist and

(a) Arrangements for payment of such care through a public assistance program (such as Medicaid) for which the veteran has applied, have been delayed due to unforeseen eligibility problems which can reasonably be expected to be resolved within the extension period, or

(b) The veteran has made specific arrangements for private payment for such care, and

(1) Such arrangements cannot be effectuated as planned because of unforseen, unavoidable difficulties, such as a temporary obstacle to liquidation of property, and

(2) Such difficulties can reasonably be expected to be resolved within the extension period; or

(c) The veteran is terminally ill and life expectancy has been medically determined to be less than six months.

(d) In no case may an extension under paragraph (a) or (b) of this section exceed 45 days.

(Authority: 38 U.S.C. 210 (c)(1); 620(a)) [53 FR 13121, Apr. 21, 1988]

§ 17.51b Transfers from facilities for nursing home care in Alaska and Hawaii. Transfer of any veteran hospitalized in a non-VA hospital facility or receiving domiciliary care at VA expense to a community nursing home facility in Alaska or Hawaii may be authorized subject to the provisions of § 17.51, except paragraph (b)(1).

(Authority: 38 U.S.C. 612A, Pub. L. 99-166) [51 FR 25067, July 10, 1986]

ADULT DAY HEALTH CARE

SOURCE: 52 FR 13441, Apr. 23, 1987, unless otherwise noted.

§ 17.51c Definition of adult day health care program.

The adult day health care program is a therapeutic day care program which provides medical and rehabilitation services to disabled veterans in a congregate setting. The Veterans' Health Care Amendments of 1983, Pub. L. 98-160, authorizes VA to furnish this program until September 30, 1988.

(Authority: 38 U.S.C. 529(f)(1)(A))

§ 17.51d Adult day health care in Department of Veterans Affairs facilities.

(a) VA facilities may provide adult day health care to:

(1) Any veteran who has a serviceconnected disability rated at 50 percent or more who is determined by VA to be in need of such care.

(2) Any veteran who has been furnished care in a hospital under the direct jurisdiction of the Secretary or any veteran who has been furnished care by the Secretary in a hospital in Alaska or Hawaii if VA determines that the veteran has received maximum benefits for such care in such hospital, but will require a protracted period of adult day health care which can be furnished in an institution furnishing adult day health care.

(3) Any person (i) who has been furnished care in any hospital of any of the Armed Forces, (ii) who the appropriate Secretary concerned and VA have determined has received maximum hospital benefits but requires a protracted period of adult day health care, and (iii) who upon discharge from the armed forces will become a veteran.

(b) Adult day health care furnished in VA facilities shall not include travel and incidental expenses (or transportation in lieu thereof) except as authorized by § 17.100.

(Authority: 38 U.S.C. 620(f)(1)(A)(i))

§ 17.51e Adult day health care in private facilities.

Veterans eligible under § 17.51d for adult day health care may be transferred to any public or private institution not under the jurisdiction of the Secretary which furnishes adult day health care for such care at VA expense if:

(a) The cost of adult day health care in such institution will not exceed 45 percent of the cost of care furnished by VA in a general hospital under the direct and exclusive jurisdiction of the Secretary, as such cost may be determined annually by the Secretary, or not to exceed 50 percent of such cost where determined necessary by the Secretary, upon the recommendation

of the Chief Medical Director, to provide adequate care;

(b) A contract between the institution and VA is awarded in accordance with Federal and VA acquisition law and regulations;

(c) A VA inspection finds that the institution meets the following standards:

(1) The institution shall meet all Federal, State and local laws, regulations, and codes pertaining to health and safety such as provisions regulating:

(i) Construction, maintenance, and equipment;

(ii) Sanitation;

(iii) Buying, dispensing, safeguarding, administering, and disposing of medications and controlled substances.

(2) The institution shall meet the applicable provisions of the National Fire Protection Association's Life Safety Code, entitled NFPA 101 Life Safety Code 1985, dated February 7, 1985, (which is incorporated by reference). Incorporation of the 1985 edition of the Life Safety Code was approved by the Director of the Federal Register in accordance with 5 U.S.C. 552(a) and 1 CFR Part 51. The code is available for inspection at the Office of the Federal Register Information Center, Room 8301, 1110 L Street, NW, Washington, DC. Copies may be obtained from: National Fire Protection Association, Battery March Park, Quincy, MA 02269. If any changes in this code are also to be incorporated by reference, a notice to that effect will be published in the FEDERAL REGISTER. The institution shall provide sufficient staff to assist patients in the event of fire or other emergency.

(3) The institution shall have the capability (including sufficient qualified staff) to provide:

(i) Medical services including a medical director at least on a consulting basis and the provision of direct patient care;

(ii) Services of a registered nurse; (iii) Social services provided by a qualified social worker;

(iv) Rehabilitation services including occupational and physical therapy;

(v) Assistance for daily living including bathing, feeding, toileting, ambulation, and transferring;