Code of Federal Regulations · Section
§ 17.902 — Preauthorization
38 C.F.R. § 17.902
(a) Preauthorization from VA is required for the following services or benefits under §§ 17.900 through 17.905: Rental or purchase of durable medical equipment with a total rental or purchase price in excess of $300, respectively; day health care provided as outpatient care; dental services; homemaker services; outpatient mental health services in excess of 23 visits in a calendar year; substance abuse treatment; training; transplantation services; and travel (other than mileage at the General Services Administration rate for privately owned automobiles). Authorization will only be given in spina bifida cases where it is demonstrated that the care is medically necessary. In cases of other covered birth defects, authorization will only be given where it is demonstrated that the care is medically necessary and related to the covered birth defects.
Requests for provision of health care requiring preauthorization shall be made to the Health Administration Center and may be made by telephone, facsimile, mail, or hand delivery. The application must contain the following:
(1) Name of child,
(2) Child's Social Security number,
(3) Name of veteran,
(4) Veteran's Social Security number,
(5) Type of service requested,
(6) Medical justification,
(7) Estimated cost, and
(8) Name, address, and telephone number of provider.
(b) Notwithstanding the provisions of paragraph (a) of this section, preauthorization is not required for a condition for which failure to receive immediate treatment poses a serious threat to life or health. Such emergency care should be reported by telephone to the Health Administration Center within 72 hours of the emergency.
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