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I hereby certify that this claim meets all of the conditions for payment
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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 extinguishing, in whole or in part, the
veteran's liability to the provider.
(Authority: 38 U.S.C. 1725)
Signature
38 CFR 17.1002 Substantive conditions for payment or reimbursement.
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Payment or reimbursement under 38 U.S.C. 1725 for emergency
services may be made only if all of the following conditions are met:
(a) The emergency services were provided in a hospital emergency
department or a similar facility held out as providing emergency care
by VA for emergency medical services under 38 CFR 17.1002 and 17.1003.
to the public;
(b) The claim for payment or reimbursement for the initial
evaluation and treatment is for a condition of such a 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 would be met if there were an emergency medical
condition manifesting itself by acute symptoms of sufficient severity
(including severe pain) 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
I am aware that 38 CFR U.S.C. 6102(b) provides that one who obtains
of the individual in serious jeopardy, serious impairment to bodily
functions, or serious dysfunction of any bodily organ or part);
(c) A VA or other Federal facility/provider was not feasibly
available and an attempt to use them beforehand would not have been
considered reasonable by a prudent layperson (as an example, these
conditions would be met by evidence establishing that a veteran was
brought to a hospital in an ambulance and the ambulance personnel
determined that the nearest available appropriate level of care was at
a non-VA medical center);
(d) The claim for payment or reimbursement for any medical care
payment without being entitled to it and with intent to defraud the
beyond the initial emergency evaluation and treatment is for a
continued medical emergency of such a nature that the veteran could not
have been safely transferred to a VA or other Federal facility (the
medical emergency lasts only until the time the veteran becomes
stabilized);
(e) At the time the emergency treatment was furnished, the veteran
was enrolled in the VA health care system and had received medical
services under authority of 38 U.S.C. chapter 17 within the 24-month
period preceding the furnishing of such emergency treatment;
(f) The veteran is financially liable to the provider of emergency
United States shall be fined in accordance with Title 18, United States
treatment for that treatment;
(g) The veteran has no coverage under a health-plan contract for
payment or reimbursement, in whole or in part, for the emergency
treatment (this condition cannot be 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, e.g., failure to submit a bill or medical records
within specified time limits, or failure to exhaust appeals of the
denial of payment);
(h) If the condition for which the emergency treatment was
Code, or imprisoned not more than one year, or both.
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 treatment; and the veteran has no contractual or
legal recourse against a third party that could reasonably be pursued
for the purpose of extinguishing, in whole or in part, the veteran's
liability to the provider; and
(i) The veteran is not eligible for reimbursement under 38 U.S.C.
1728 for the emergency treatment provided (38 U.S.C. 1728 authorizes VA
payment or reimbursement for emergency treatment to a limited group of
veterans, primarily those who receive emergency treatment for a
service-connected disability).
(Authority: 38 U.S.C. 1725)
38 CFR 17.1003 Emergency transportation.
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Notwithstanding the provisions of Sec. 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 such facility (or payment or
reimbursement could have been authorized under 38 U.S.C. 1725 for
emergency treatment if 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 has no coverage under a health-plan contract for
reimbursement or payment, in whole or in part, for the emergency
transportation or any emergency treatment authorized under 38 U.S.C.
1728 (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); and
(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
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