LVMAC Tidbit: VA Revises Regulations on Reimbursement for Emergency Treatment of Veterans
[Editor’s Note: The following is a press release from the VA partially correcting what has been a longstanding problem related to emergency care received outside of the VA.]
WASHINGTON — Today [10 January 2018] the U.S. Department of Veterans Affairs (VA) announced that it has, through a Federal Register notice, revised its regulations concerning payment or reimbursement for emergency treatment for non-service connected conditions at non-VA facilities.
VA will begin processing claims for reimbursement of reasonable costs that were only partially paid by the Veteran’s other health insurance (OHI). Those costs may include hospital charges, professional fees and emergency transportation, such as ambulances.
This change comes on the heels of an earlier announcement that VA was taking immediate action to address delayed payments to community providers, found here.
Effective Jan. 9, VA updated a portion of its regulations in response to an April 2016 U.S. Court of Appeals for Veterans Claims decision that stated VA could no longer deny reimbursement when OHI pays a portion of the treatment expenses.
VA will apply the updated regulations to claims pending with VA on or after April 8, 2016, and to new claims. By law, VA still may not reimburse Veterans for the costs of copayments, cost shares and deductibles required by their OHI.
VA will work directly with community providers to get additional information needed to review and process these claims. Previous claims do not have to be resubmitted unless requested by VA.
More information on the amended regulation along with guidance may be found here.
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As of 11 February 2018