Code of Federal Regulations · Section
§ 17.273 — Preauthorization
38 C.F.R. § 17.273
Preauthorization or advance approval is required for any of the following, except when the benefit is covered by the CHAMPVA beneficiary's other health insurance (OHI):
(a) Non-emergent inpatient mental health and substance abuse care including admission of emotionally disturbed children and adolescents to residential treatment centers.
(b) All admissions to a partial hospitalization program (including alcohol rehabilitation).
(c) Dental care. For limitations on dental care, see § 17.272(a)(21)(i) through (xii).
(d) Organ transplants.
(e) CHAMPVA will perform a retrospective medical necessity review during the coordination of benefits process if:
(1) It is determined that CHAMPVA is the responsible payer for services and supplies but CHAMPVA preauthorization was not obtained prior to delivery of the services or supplies; and,
(2) The claim for payment is filed within the appropriate one-year period.
Authorizing Statute
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Rules and regulations38 U.S.C. § 501
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Medical care for survivors and dependents of certain veterans38 U.S.C. § 1781
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Definitions38 U.S.C. § 1701
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Definitions38 U.S.C. § 101
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Assistance for providing automobile and adaptive equipment38 U.S.C. § 3902
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Clothing allowance38 U.S.C. § 1162
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Eligibility for hospital, nursing home, and domiciliary care38 U.S.C. § 1710
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Community residential care38 U.S.C. § 1730
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Agreements with eligible entities or providers; certification processes38 U.S.C. § 1703A
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Contracts and personal services38 U.S.C. § 513
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Definitions38 U.S.C. § 3901
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Establishment38 U.S.C. § 7691
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Care and services during certain disasters and emergencies38 U.S.C. § 1785
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Benefits for discharged members of allied forces38 U.S.C. § 109
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Emergent suicide care38 U.S.C. § 1720J
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Recovery by United States42 U.S.C. § 2651
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Transplant procedures with live donors and related services38 U.S.C. § 1788
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Access to walk-in care38 U.S.C. § 1725A
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Assistance and support services for caregivers38 U.S.C. § 1720G
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Functions of Veterans Health Administration: in general38 U.S.C. § 7301
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Medicaid and CHIP Payment and Access Commission42 U.S.C. § 1396
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Regulations38 U.S.C. § 7304
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Requirement for program38 U.S.C. § 7698
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Hospital care, medical services, and nursing home care abroad38 U.S.C. § 1724
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Veterans Community Care Program38 U.S.C. § 1703
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Center for Innovation for Care and Payment38 U.S.C. § 1703E