
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 38USC1725]

 
                      TITLE 38--VETERANS' BENEFITS
 
                        PART II--GENERAL BENEFITS
 
    CHAPTER 17--HOSPITAL, NURSING HOME, DOMICILIARY, AND MEDICAL CARE
 
   SUBCHAPTER III--MISCELLANEOUS PROVISIONS RELATING TO HOSPITAL AND 
           NURSING HOME CARE AND MEDICAL TREATMENT OF VETERANS
 
Sec. 1725. Reimbursement for emergency treatment

    (a) General Authority.--(1) Subject to subsections (c) and (d), the 
Secretary may reimburse a veteran described in subsection (b) for the 
reasonable value of emergency treatment furnished the veteran in a non-
Department facility.
    (2) In any case in which reimbursement is authorized under 
subsection (a)(1), the Secretary, in the Secretary's discretion, may, in 
lieu of reimbursing the veteran, make payment of the reasonable value of 
the furnished emergency treatment directly--
        (A) to a hospital or other health care provider that furnished 
    the treatment; or
        (B) to the person or organization that paid for such treatment 
    on behalf of the veteran.

    (b) Eligibility.--(1) A veteran referred to in subsection (a)(1) is 
an individual who is an active Department health-care participant who is 
personally liable for emergency treatment furnished the veteran in a 
non-Department facility.
    (2) A veteran is an active Department health-care participant if--
        (A) the veteran is enrolled in the health care system 
    established under section 1705(a) of this title; and
        (B) the veteran received care under this chapter within the 24-
    month period preceding the furnishing of such emergency treatment.

    (3) A veteran is personally liable for emergency treatment furnished 
the veteran in a non-Department facility if the veteran--
        (A) is financially liable to the provider of emergency treatment 
    for that treatment;
        (B) has no entitlement to care or services under a health-plan 
    contract (determined, in the case of a health-plan contract as 
    defined in subsection (f)(2)(B) or (f)(2)(C), without regard to any 
    requirement or limitation relating to eligibility for care or 
    services from any department or agency of the United States);
        (C) has no other contractual or legal recourse against a third 
    party that would, in whole or in part, extinguish such liability to 
    the provider; and
        (D) is not eligible for reimbursement for medical care or 
    services under section 1728 of this title.

    (c) Limitations on Reimbursement.--(1) The Secretary, in accordance 
with regulations prescribed by the Secretary, shall--
        (A) establish the maximum amount payable under subsection (a);
        (B) delineate the circumstances under which such payments may be 
    made, to include such requirements on requesting reimbursement as 
    the Secretary shall establish; and
        (C) provide that in no event may a payment under that subsection 
    include any amount for which the veteran is not personally liable.

    (2) Subject to paragraph (1), the Secretary may provide 
reimbursement under this section only after the veteran or the provider 
of emergency treatment has exhausted without success all claims and 
remedies reasonably available to the veteran or provider against a third 
party for payment of such treatment.
    (3) Payment by the Secretary under this section on behalf of a 
veteran to a provider of emergency treatment shall, unless rejected and 
refunded by the provider within 30 days of receipt, extinguish any 
liability on the part of the veteran for that treatment. Neither the 
absence of a contract or agreement between the Secretary and the 
provider nor any provision of a contract, agreement, or assignment to 
the contrary shall operate to modify, limit, or negate the requirement 
in the preceding sentence.
    (d) Independent Right of Recovery.--(1) In accordance with 
regulations prescribed by the Secretary, the United States shall have 
the independent right to recover any amount paid under this section 
when, and to the extent that, a third party subsequently makes a payment 
for the same emergency treatment.
    (2) Any amount paid by the United States to the veteran (or the 
veteran's personal representative, successor, dependents, or survivors) 
or to any other person or organization paying for such treatment shall 
constitute a lien in favor of the United States against any recovery the 
payee subsequently receives from a third party for the same treatment.
    (3) Any amount paid by the United States to the provider that 
furnished the veteran's emergency treatment shall constitute a lien 
against any subsequent amount the provider receives from a third party 
for the same emergency treatment for which the United States made 
payment.
    (4) The veteran (or the veteran's personal representative, 
successor, dependents, or survivors) shall ensure that the Secretary is 
promptly notified of any payment received from any third party for 
emergency treatment furnished to the veteran. The veteran (or the 
veteran's personal representative, successor, dependents, or survivors) 
shall immediately forward all documents relating to such payment, 
cooperate with the Secretary in the investigation of such payment, and 
assist the Secretary in enforcing the United States right to recover any 
payment made under subsection (c)(3).
    (e) Waiver.--The Secretary, in the Secretary's discretion, may waive 
recovery of a payment made to a veteran under this section that is 
otherwise required by subsection (d)(1) when the Secretary determines 
that such waiver would be in the best interest of the United States, as 
defined by regulations prescribed by the Secretary.
    (f) Definitions.--For purposes of this section:
        (1) The term ``emergency treatment'' means medical care or 
    services furnished, in the judgment of the Secretary--
            (A) when Department or other Federal facilities are not 
        feasibly available and an attempt to use them beforehand would 
        not be reasonable;
            (B) when such care or services are rendered 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; and
            (C) until such time as the veteran can be transferred safely 
        to a Department facility or other Federal facility.

        (2) The term ``health-plan contract'' includes any of the 
    following:
            (A) An insurance policy or contract, medical or hospital 
        service agreement, membership or subscription contract, or 
        similar arrangement under which health services for individuals 
        are provided or the expenses of such services are paid.
            (B) An insurance program described in section 1811 of the 
        Social Security Act (42 U.S.C. 1395c) or established by section 
        1831 of that Act (42 U.S.C. 1395j).
            (C) A State plan for medical assistance approved under title 
        XIX of such Act (42 U.S.C. 1396 et seq.).
            (D) A workers' compensation law or plan described in section 
        1729(a)(2)(A) of this title.
            (E) A law of a State or political subdivision described in 
        section 1729(a)(2)(B) of this title.

        (3) The term ``third party'' means any of the following:
            (A) A Federal entity.
            (B) A State or political subdivision of a State.
            (C) An employer or an employer's insurance carrier.
            (D) An automobile accident reparations insurance carrier.
            (E) A person or entity obligated to provide, or to pay the 
        expenses of, health services under a health-plan contract.

(Added Pub. L. 106-117, title I, Sec. 111(a), Nov. 30, 1999, 113 Stat. 
1553.)

                       References in Text

    The Social Security Act, referred to in subsec. (f)(2), is act Aug. 
14, 1935, ch. 531, 49 Stat. 620, as amended. Title XIX of the Act is 
classified generally to subchapter XIX (Sec. 1396 et seq.) of chapter 7 
of Title 42, The Public Health and Welfare. For complete classification 
of this Act to the Code, see section 1305 of Title 42 and Tables.


                             Effective Date

    Pub. L. 106-117, title I, Sec. 111(c), Nov. 30, 1999, 113 Stat. 
1556, provided that: ``The amendments made by this section [enacting 
this section and amending section 1729A of this title] shall take effect 
180 days after the date of the enactment of this Act [Nov. 30, 1999].''


                         Implementation Reports

    Pub. L. 106-117, title I, Sec. 111(d), Nov. 30, 1999, 113 Stat. 
1556, provided that: ``The Secretary [of Veterans Affairs] shall include 
with the budget justification materials submitted to Congress in support 
of the Department of Veterans Affairs budget for fiscal year 2002 and 
for fiscal year 2003 a report on the implementation of section 1725 of 
title 38, United States Code, as added by subsection (a). Each such 
report shall include information on the experience of the Department 
under that section and the costs incurred, and expected to be incurred, 
under that section.''

                  Section Referred to in Other Sections

    This section is referred to in section 1729A of this title.
