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Va Pain Clinic Fails To Renew My Script


john999

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  • HadIt.com Elder

For some reason the VA pain clinic failed to renew my fentanyl patch script. I got my oxycodone today in the mail but no fentanyl patches. When does the constant screw-ups over my medications become malpractice or a tort? Every month no matter who I talk to at the VA, or what I do in advance the VA fails to get my script to me and I run out and go into withdrawl. I call the pain clinic....nobody home. I call advocate....busy. I call phramacy and they email the pain clinic asking why my script was not renewed. This is affecting my mental health being on pins and needles every month. Now I am facing a long weekend and I can't get into contact with my doctor at the pain clinic. I have a heart condition and mental health conditions. This is driving me crazy. I just spoke to the pain clinic head doctor yesterday about these screw-ups.

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  • HadIt.com Elder

[Federal Register: June 11, 2010 (Volume 75, Number 112)]

[Proposed Rules]

[Page 33216-33219]

From the Federal Register Online via GPO Access [wais.access.gpo.gov]

[DOCID:fr11jn10-18]

=======================================================================

-----------------------------------------------------------------------

DEPARTMENT OF VETERANS AFFAIRS

38 CFR Part 17

RIN 2900-AN49

Payment or Reimbursement for Emergency Treatment Furnished by

Non-VA Providers in Non-VA Facilities to Certain Veterans With Service-

Connected or Nonservice-Connected Disabilities

AGENCY: Department of Veterans Affairs.

ACTION: Proposed rule.

-----------------------------------------------------------------------

SUMMARY: The Department of Veterans Affairs (VA) is proposing to amend

its regulations concerning emergency hospital care and medical services

provided to eligible veterans for service-connected and nonservice-

connected conditions at non-VA facilities as a result of the amendments

made by section 402 of the Veterans' Mental Health and Other Care

Improvements Act of 2008. These amendments would require VA payment for

emergency treatment of eligible veterans at non-VA facilities and

expand the circumstances under which payment for such treatment is

authorized. In addition, these amendments would make nonsubstantive

technical changes such as correcting grammatical errors and updating

obsolete citations.

DATES: Comments must be received by VA on or before August 10, 2010.

ADDRESSES: Written comments may be submitted through http://

www.regulations.gov; by mail or hand-delivery to the Director,

Regulations Management (02REG), Department of Veterans Affairs, 810

Vermont Ave., NW., Room 1068, Washington, DC 20420; or by fax to (202)

273-9026. Comments should indicate that they are submitted in response

to ``RIN 2900-AN49-Payment or Reimbursement for Emergency Treatment

Furnished by Non-VA Providers in Non-VA facilities to Certain Veterans

with Service-connected or Nonservice-connected Disabilities.'' Copies

of comments received will be available for public inspection in the

Office of Regulation Policy and Management, Room 1063B, between the

hours of 8 a.m. and 4:30 p.m. Monday through Friday (except holidays).

Please call (202) 461-4902 for an appointment. (This is not a toll-free

number.) In addition, during the comment period, comments may be viewed

online through the Federal Docket Management System (FDMS) at http://

www.regulations.gov.

FOR FURTHER INFORMATION CONTACT: Joseph Duran, Policy Specialist, VHA

CBO Fee Program Office, VHA Chief Business Office, Department of

Veterans Affairs, P.O. Box 469066, Denver, CO 80246. Telephone (303)

398-5191. (This is not a toll-free number.)

SUPPLEMENTARY INFORMATION: Sections 1725 and 1728 of title 38, United

States Code, authorize the Secretary of Veterans Affairs to reimburse

eligible veterans for costs related to non-VA emergency treatment

furnished at non-VA facilities, or to pay providers directly for such

costs.

Specifically, section 1725 authorizes reimbursement for

emergency treatment for eligible veterans with nonservice-connected

conditions.

In contrast, section 1728 authorizes reimbursement for

emergency treatment for eligible veterans with service-connected

conditions.

These statutory provisions are implemented at 38 CFR

17.1000 through 17.1008 for nonservice-connected conditions, and at 38

CFR 17.120 and 17.121 for service-connected conditions.

Sometimes a veteran will require continued, non-emergent treatment after the

veteran's medical condition is stabilized. However, until recently VA

was not authorized to reimburse or pay for treatment provided after

``the veteran can be transferred safely to a [VA] facility or other

Federal facility.'' 38 U.S.C. 1725(f)(1)© (2007). Thus, if no such

facility could immediately accept the transfer, VA was unable to

provide payment to the veteran or medical provider for services

rendered beyond the point the veteran was determined to be stable.

On October 10, 2008, the Veterans' Mental Health and Other Care

Improvements Act of 2008, Public Law 110-387, was enacted.

Section 402 of Public Law 110-387 amended the definition of ``emergency treatment''

in section1725(f)(1), extending VA's payment authority until ``such

time as the veteran can be transferred safely to a [VA] facility or

other Federal facility and such facility is capable of accepting such

transfer,'' or until such transfer was accepted, so long as the non-VA

facility ``made and documented reasonable attempts to transfer the

veteran to a [VA] facility or other Federal facility.'' Section

402(a)(1) amended section 1725(a)(1) by striking the term ``may

reimburse'' and inserting ``shall reimburse'' in its place. This change

would require VA to reimburse the covered costs for emergency care

received at non-VA facilities for eligible veterans, rather than at the

discretion of the Secretary.

Section 402(b) of Public Law 110-387 amended 38 U.S.C. 1728(a).

First,

[[Page 33217]]

section 402(b)(1) authorized VA to reimburse or pay for ``customary and

usual charges of emergency treatment'' when a veteran makes payment

directly to the provider of non-VA emergency care from sources other

than VA, whereas the statute had previously authorized reimbursement

for ``the reasonable value of such care or services.'' This amendment

relates to the amount of payment and will be the subject of another

rulemaking.

Second, section 402(b)(3) made the definition of

``emergency treatment'' in section 1725(f)(1) applicable to section

1728. As described above, the definition of emergency treatment now

includes care or services furnished until ``such time as the veteran

can be transferred safely to a [VA] facility or other Federal facility

and such facility is capable of accepting such transfer,'' or until

such transfer was accepted, so long as the non-VA facility ``made and

documented reasonable attempts to transfer the veteran to a [VA]

facility or other Federal facility.''

This proposed rule would amend the following VA regulations to

comply with the amendments made to 38 U.S.C. 1725 and 1728, and would

make technical changes such as correcting grammatical errors and

updating obsolete regulatory citations: 38 CFR 17.120, 17.121, 17.1002,

17.1005, 17.1006, and 17.1008.

We propose to amend 38 CFR 17.120 by renaming it, ``Payment or

reimbursement for emergency treatment furnished by non-VA providers to

certain veterans with service-connected disabilities.'' This new

heading would clarify that this section covers only eligible veterans

who have service-connected disabilities. This is a nonsubstantive

change made only to improve the clarity of our regulations. We also

propose to amend the introductory text of Sec. 17.120 by striking

``may be paid'' and replacing it with ``will be paid.'' This amendment

reflects the amendment made to 38 U.S.C. 1728(a) by section 402(b)(1),

requiring VA to reimburse the covered costs. In addition, we propose to

revise Sec. 17.120(a) by striking the terms ``care'' and ``medical

services'' and the phrase ``care or services'' in the places they

occur, and replacing them with the term ``emergency treatment.'' This

amendment would reflect the change made by section 402(b)(1), which

replaced the term ``hospital care or medical services'' in section

1728(a) with the term ``emergency treatment.''

We propose to revise Sec. 17.120(b) to replace the former standard

for determining the existence of a medical emergency with the ``prudent

layperson'' standard. Section 402(b)(3) added a new paragraph © to

section 1728, which states that the term ``emergency treatment,'' for

the purposes of section 1728, ``has the meaning given such term in [38

U.S.C.] 1725(f)(1).'' Under section 1725(f)(1)(B), emergency treatment

means medical care furnished ``in a medical emergency of such nature

that a prudent layperson reasonably expects that delay in seeking

immediate medical attention would be hazardous to life or health.''

In addition, we propose to add clarifying language regarding the ``prudent

layperson standard'' derived from current 38 CFR 17.1002(b), the

regulation that implements section 1725(f)(1), which, again, is now the

statutory authority for the definition of ``emergency treatment'' for

both nonservice-connected and service-connected eligible veterans.

We also propose several amendments to 38 CFR 17.121 in order to

implement section 402 and reorganize and clarify existing provisions.

Our proposed substantive changes to Sec. 17.121 are described below.

We propose to strike the phrase ``emergency hospital care and

medical services'' in all places it occurs in Sec. 17.121 and replace

it with the term ``emergency treatment,'' for consistency with the

defined term in section 1725(f)(1).

We also propose to amend Sec. 17.121 to include the provisions in section 402(a)(2) authorizing

reimbursement of non-emergent treatment in certain circumstances. This

revision would authorize VA to pay or reimburse for the costs of

continued, non-emergent treatment furnished to eligible veterans beyond

the point of stabilization if both ``the non-VA facility notified VA at

the time that the veteran could be safely transferred'' but the

transfer was not accepted and ``the non-VA facility made and documented

reasonable attempts to transfer the veteran to a VA facility (or other

Federal facility with which VA has an agreement to furnish health care

services for veterans).''

Proposed Sec. 17.121(a) would establish the clinical decision

maker as the designated VA clinician at the VA facility for purposes of

payments or reimbursement of costs under the proposed rule. Although

not required by Public Law 110-387, this change adopts similar

customary practice utilized in the health care industry. In the health

care industry, it is customary practice to utilize the services of

health care professionals, such as nurses, for purposes of clinical

review. For this reason, establishing the clinical decision maker as a

``designated VA clinician'' would align VA with customary health care

industry practice (see Utilization Review Accreditation Commission) as

well as promote greater efficiency in the use of VA physician services.

Proposed Sec. 17.121(b)(2) would define a reasonable attempt to

mean contact with the local VA facility's transfer coordinator,

administrative officer of the day, or designated staff in the facility

responsible for accepting transfer of patients, and would require

documentation of such contact in the veteran's progress/physicians'

notes, discharge summary, or other applicable medical record for that

episode of care. It is VA's expectation that documentation within the

applicable medical record represents standard business practice

throughout the health care industry. Additionally, by regulating the

contact and documentation requirements in this way, potentially

eligible veterans would be appropriately afforded ample opportunity to

qualify for this expanded benefit.

Based on the nature of the amendments made by section 402, we

interpret Congress's intent to be that payment for continued non-

emergent non-VA care be limited only to those circumstances where a VA

or Federal facility with which VA has an agreement to provide care are

unavailable to provide treatment. As such, we would clarify Sec.

17.121© to state that in the event that a stabilized veteran refuses

transfer to an available VA or Federal facility with which VA has an

agreement to provide care, we would limit VA payment for an otherwise

eligible veteran to the point of stability as determined by a VA

clinician.

Finally, we propose to amend the authority citation for Sec.

17.121 to be consistent with the authority citation for Sec. 17.120.

With respect to reimbursement for eligible veterans with

nonservice-connected conditions, the introductory text of 38 CFR

17.1002 would be amended by striking ``may'' in the first paragraph and

replacing it with ``will.'' This amendment would reflect the amendment

made to section 1725(a)(1) by section 402(a)(1), requiring VA to

reimburse the covered costs. Section 17.1002(d) would be removed and

paragraphs (e) through (i) would be redesignated as paragraphs (d)

through (h).

Proposed paragraph © of Sec. 17.1005 would implement the

provisions of section 402(b)(3), allowing for reimbursement of non-

emergent treatment in certain circumstances. In addition, proposed

paragraph © includes nonsubstantive language changes for clarity

purposes. Based on

[[Page 33218]]

the nature of the amendments made by section 402, we interpret

Congress's intent to be that payment for continued non-emergent non-VA

care be limited only to those circumstances where a VA or Federal

facility with which VA has an agreement to provide care are unavailable

to provide treatment. As such, proposed paragraph (d) of Sec. 17.1005

would be inserted after the newly added paragraph © and would limit

VA payment for non-VA emergency treatment when a stabilized veteran who

is in need of continued non-emergent treatment refuses transfer to a VA

or other Federal facility with which VA has an agreement. When a

stabilized veteran refuses transfer to an available VA or other Federal

facility with which VA has an agreement to furnish health care services

for veterans, VA authorization for payment would be limited to the

point of stability.

We propose to amend Sec. 17.1006 to update clinical decision maker

terminology consistent with the proposed amendment to Sec. 17.121(a)

described above. Currently listed as ``the Fee Service Review Physician

or equivalent officer,'' we would change this term to ``the designated

VA clinician.''

Finally, we propose to amend Sec. 17.1008 to add, after

``emergency treatment'' and before ``shall,'' the following: ``and any

non-emergent hospital care that is authorized under Sec. 17.1005© of

this part.'' This statement would update Sec. 17.1008 to comply with

the new provisions added by section 402.

List of Subjects in 38 CFR Part 17

Administrative practice and procedure, Alcohol abuse, Alcoholism,

Claims, Day care, Dental health, Drug abuse, Foreign relations,

Government contracts, Grant programs--health, Grant programs--Veterans,

Health care, Health facilities, Health professions, Health records,

Homeless, Medical and dental schools, Medical devices, Medical

research, Mental health programs, Nursing homes, Philippines, Reporting

and recordkeeping requirements, Scholarships and fellowships, Travel

and transportation expenses, Veterans.

Approved: June 8, 2010.

Robert C. McFetridge,

Director of Regulation Policy and Management, Office of the General

Counsel.

For the reasons set forth in the preamble, VA proposes to amend 38

CFR part 17 as follows:

PART 17--MEDICAL

1. The authority citation for part 17 continues to read as follows:

Authority: 38 U.S.C. 501, 1721, and as noted in specific

sections.

2. Amend Sec. 17.120 by:

a. Revising the section heading.

b. In the introductory text, removing ``may be paid'' and adding,

in its place, ``will be paid'', removing ``care'' and adding, in its

place, ``emergency treatment'', and removing ``medical services'' and

adding, in its place, ``emergency treatment''.

c. Revising paragraph (a) introductory text.

d. In paragraph (a)(3), removing ``United State'' and adding, in

its place, ``United States'' and adding the word ``or'' at the end of

paragraph (a)(3).

e. In paragraph (a)(4), removing ``Sec. 17.48(j); and'' and

adding, in its place,'' Sec. 17.47(i);''.

f. Revising paragraph (b).

The revisions read as follows:

Sec. 17.120 Payment or reimbursement for emergency treatment

furnished by non-VA providers to certain veterans with service-

connected disabilities.

* * * * *

[[Page 33219]]

(a) For veterans with service connected disabilities. Emergency

treatment not previously authorized was rendered to a veteran in need

of such emergency treatment:

* * * * *

(b) In a medical emergency. Emergency treatment, not previously

authorized, including ambulance services, was rendered in a medical

emergency of such 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 is met by 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

of the individual in serious jeopardy, serious impairment to bodily

functions, or serious dysfunction of any bodily organ or part); and

* * * * *

3. Section 17.121 is revised to read as follows:

Sec. 17.121 Limitations on payment or reimbursement of the costs of

emergency treatment not previously authorized.

(a) Emergency Treatment. Except as provided in paragraph (b) of

this section, VA will not approve claims for payment or reimbursement

of the costs of emergency treatment not previously authorized for any

period beyond the date on which the medical emergency ended. For the

purpose of payment or reimbursement of the expense of emergency

treatment not previously authorized, VA considers that an emergency

ends when the designated VA clinician at the VA facility has determined

that, based on sound medical judgment, a veteran:

(1) Who received emergency treatment could have been transferred

from the non-VA facility to a VA medical center for continuation of

treatment for the disability, or

(2) Who received emergency treatment could have reported to a VA

medical center for continuation of treatment for the disability.

(b) Continued non-emergent treatment. Claims for payment or

reimbursement of the costs of emergency treatment not previously

authorized may only be made for continued, non-emergent treatment, if:

(1) The non-VA facility notified VA at the time the veteran could

be safely transferred to a VA facility (or other Federal facility with

which VA has an agreement to furnish health care services for

veterans), and the transfer of the veteran was not accepted; and

(2) The non-VA facility made and documented reasonable attempts to

request transfer of the veteran to a VA facility (or to another Federal

facility with which VA has an agreement to furnish health care services

for veterans), which means that the non-VA facility contacted either

the VA Transfer Coordinator, Administrative Officer of the Day, or

designated staff responsible for accepting transfer of patients, at a

local VA (or other Federal facility) and documented such contact in the

veteran's progress/physicians' notes, discharge summary, or other

applicable medical record.

© Refusal of transfer. If a stabilized veteran who requires

continued non-emergent treatment refuses to be transferred to an

available VA facility (or other Federal facility with which VA has an

agreement to furnish health care services for veterans), VA will make

payment or reimbursement only for the expenses related to the initial

evaluation and the emergency treatment furnished to the veteran up to

the point of stabilization, as set forth in paragraph (a) of this

section.

(Authority: 38 U.S.C. 1724, 1728, 7304)

4. Amend Sec. 17.1002 by:

a. Revising the introductory text.

b. Removing paragraph (d).

c. Redesignating paragraphs (e) through (i) as new paragraphs (d)

through (h) respectively.

The revision reads as follows:

Sec. 17.1002 Substantive conditions for payment or reimbursement.

Payment or reimbursement under 38 U.S.C. 1725 for emergency

treatment will be made only if all of the following conditions are met:

* * * * *

5. In Sec. 17.1005, revise paragraph (b) and add paragraphs ©

and (d) as follows:

Sec. 17.1005 Payment limitations.

* * * * *

(b) Except as provided in paragraph © of this section, VA will

not approve claims for payment or reimbursement of the costs of

emergency treatment not previously authorized for any period beyond the

date on which the medical emergency ended. For the purpose of payment

or reimbursement of the expense of emergency treatment not previously

authorized, VA considers that an emergency ends when the designated VA

clinician at the VA facility has determined that, based on sound

medical judgment, a veteran:

(1) Who received emergency treatment could have been transferred

from the non-VA facility to a VA medical center for continuation of

treatment for the disability, or

(2) Who received emergency treatment could have reported to a VA

medical center for continuation of treatment for the disability.

© Claims for payment or reimbursement of the costs of emergency

treatment not previously authorized may only be made for continued,

non-emergent treatment, if:

(1) The non-VA facility notified VA at the time the veteran could

be safely transferred to a VA facility (or other Federal facility with

which VA has an agreement to furnish health care services for veterans)

and the transfer of the veteran was not accepted, and

(2) The non-VA facility made and documented reasonable attempts to

request transfer of the veteran to VA (or to another Federal facility

with which VA has an agreement to furnish health care services for

veterans), which means that the non-VA facility contacted either the VA

Transfer Coordinator, Administrative Officer of the Day, or designated

staff responsible for accepting transfer of patients at a local VA (or

other Federal facility) and documented such contact in the veteran's

progress/physicians' notes, discharge summary, or other applicable

medical record.

(d) If a stabilized veteran who requires continued non-emergent

treatment refuses to be transferred to an available VA facility (or

other Federal facility with which VA has an agreement to furnish health

care services for veterans), VA will make payment or reimbursement only

for the expenses related to the initial evaluation and the emergency

treatment furnished to the veteran up to the point of stabilization as

set forth in paragraph (a) of this section.

* * * * *

Sec. 17.1006 [Amended]

6. Amend Sec. 17.1006 by removing ``Fee Service Review Physician

or equivalent officer'' and adding, in its place, ``designated VA

clinician''.

Sec. 17.1008 [Amended]

7. Amend Sec. 17.1008 by removing ``treatment'' in both places it

appears, and adding, in each place, ``treatment and any non-emergent

treatment that is authorized under Sec. 17.1005© of this part''.

[FR Doc. 2010-14110 Filed 6-10-10; 8:45 am]

BILLING CODE P

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  • HadIt.com Elder

I don't particularly want to test it but my opinion is if a 50% or more Veteran uses an ambulance to go to nearest hospital and follows notification procedures have someone call VA Fee Service and tell them name of veteran last four of social security full name and address and what emergency is for and what facility than they have to pay.

I also think that Veterans with Insurance miss that the VA should pay any of the copays so that when the bills are paid the Veteran pays nothing.

Wings thanks for your post it is very helpful. My experience is that Fee Service always denies the claim but eventually pay. I remember Chucks ordeal very well and also miss Meg as fierce a Veterans Advocate as I have ever known, I know that many her called her Mother Meg and she helped more than any of us will ever know.

Part of the Magic at Hadit is the support that Veterans get from Members

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Make a written request to the Director of this VAMC to prevent this crap from continuing to happen in the future.

He or she answers to the VISN director.

I suggest sending a CC: to the director of this VISN too.

I had a problem and was able to get a NY VISN director on the phone easier than getting the local VAMC to deal with it.

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  • HadIt.com Elder

I sent the Director of Medical Services at the VAMC a blistering letter. Should I send a copy to the Director of the VAMC? What is that person's title....Director, Tampa VAMC etc? I have sent two letters in the last month to the director of medical services. My congress person will just forward my letter to the same group of idiots and send me the answer. You know the director of medical services at my VAMC is not even a doctor. She is an "acting director". Who runs the local VAMC? They are all phantoms. I don't want to be admitted to my VAMC under any conditions especially not for detox. I don't need the torture. I am an out patient and I want to stay far out of their clutches.

The VA has an in-patient pain clinic, but I am afraid to go there. If it is anything like the psychiatric ward it would be hell on earth.

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