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VA - Medical Benefits

 

WAIS Document Retrieval[Code of Federal Regulations]
[Title 38, Volume 1]
[Revised as of July 1, 2001]
From the U.S. Government Printing Office via GPO Access
[CITE: 38CFR17.38]

[Page 582-584]

TITLE 38--PENSIONS, BONUSES, AND VETERANS' RELIEF

CHAPTER I--DEPARTMENT OF VETERANS AFFAIRS

PART 17--MEDICAL--Table of Contents

Sec. 17.38 Medical benefits package.

(a) Subject to paragraphs (b) and (c) of this section, the following 
hospital and outpatient care constitutes the ``medical benefits 
package'' (basic care and preventive care):
(1) Basic care.
(i) Outpatient medical, surgical, and mental healthcare, including 
care for substance abuse.
(ii) Inpatient hospital, medical, surgical, and mental healthcare, 
including care for substance abuse.
(iii) Prescription drugs, including over-the-counter drugs and 
medical and surgical supplies available under the VA national formulary 
system.
(iv) Emergency care in VA facilities; and emergency care in non-VA 
facilities in accordance with sharing contracts or if authorized by 
Secs. 17.52(a)(3), 17.53, 17.54, 17.120-132.
(v) Bereavement counseling as authorized in Sec. 17.98.
(vi) Comprehensive rehabilitative services other than vocational 
services provided under 38 U.S.C. chapter 31.

[[Page 583]]

(vii) Consultation, professional counseling, training, and mental 
health services for the members of the immediate family or legal 
guardian of the veteran or the individual in whose household the veteran 
certifies an intention to live, if needed to treat:
(A) The service-connected disability of a veteran; or
(B) The nonservice-connected disability of a veteran where these 
services were first given during the veteran's hospitalization and 
continuing them is essential to permit the veteran's release from 
inpatient care.
(viii) Durable medical equipment and prosthetic and orthotic 
devices, including eyeglasses and hearing aids as authorized under 
Sec. 17.149.
(ix) Home health services authorized under 38 U.S.C. 1717 and 1720C.
(x) Reconstructive (plastic) surgery required as a result of disease 
or trauma, but not including cosmetic surgery that is not medically 
necessary.
(xi) Respite, hospice, and palliative care.
(xii) Payment of travel and travel expenses for veterans eligible 
under Sec. 17.143 if authorized by that section.
(xiii) Pregnancy and delivery services, to the extent authorized by 
law.
(xiv) Completion of forms (e.g., Family Medical Leave forms, life 
insurance applications, Department of Education forms for loan repayment 
exemptions based on disability, non-VA disability program forms) by 
healthcare professionals based on an examination or knowledge of the 
veteran's condition, but not including the completion of forms for 
examinations if a third party customarily will pay health care 
practitioners for the examination but will not pay VA.
(2) Preventive care, as defined in 38 U.S.C. 1701(9), which 
includes:
(i) Periodic medical exams.
(ii) Health education, including nutrition education.
(iii) Maintenance of drug-use profiles, drug monitoring, and drug 
use education.
(iv) Mental health and substance abuse preventive services.
(v) Immunizations against infectious disease.
(vi) Prevention of musculoskeletal deformity or other gradually 
developing disabilities of a metabolic or degenerative nature.
(vii) Genetic counseling concerning inheritance of genetically 
determined diseases.
(viii) Routine vision testing and eye-care services.
(ix) Periodic reexamination of members of high-risk groups for 
selected diseases and for functional decline of sensory organs, and the 
services to treat these diseases and functional declines.
(b) Provision of the ``medical benefits package''. Care referred to 
in the ``medical benefits package'' will be provided to individuals only 
if it is determined by appropriate healthcare professionals that the 
care is needed to promote, preserve, or restore the health of the 
individual and is in accord with generally accepted standards of medical 
practice.
(1) Promote health. Care is deemed to promote health if the care 
will enhance the quality of life or daily functional level of the 
veteran, identify a predisposition for development of a condition or 
early onset of disease which can be partly or totally ameliorated by 
monitoring or early diagnosis and treatment, and prevent future disease.
(2) Preserve health. Care is deemed to preserve health if the care 
will maintain the current quality of life or daily functional level of 
the veteran, prevent the progression of disease, cure disease, or extend 
life span.
(3) Restoring health. Care is deemed to restore health if the care 
will restore the quality of life or daily functional level that has been 
lost due to illness or injury.
(c) In addition to the care specifically excluded from the ``medical 
benefits package'' under paragraphs (a) and (b) of this section, the 
``medical benefits package'' does not include the following:
(1) Abortions and abortion counseling.
(2) In vitro fertilization.
(3) Drugs, biologicals, and medical devices not approved by the Food 
and Drug Administration unless the treating medical facility is 
conducting formal clinical trials under an Investigational Device 
Exemption (IDE) or an Investigational New Drug (IND) application, or the 
drugs, biologicals, or

[[Page 584]]

medical devices are prescribed under a compassionate use exemption.
(4) Gender alterations.
(5) Hospital and outpatient care for a veteran who is either a 
patient or inmate in an institution of another government agency if that 
agency has a duty to give the care or services.
(6) Membership in spas and health clubs.

(Authority: 38 U.S.C. 101, 501, 1701, 1705, 1710, 1721, 1722)

[64 FR 54217, Oct. 6, 1999]

 

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