PRIA, Government Policy, Made Personal

Summary

The VA may pay for a newborn’s medical care and the transportation needed to get that care for up to seven days after birth when the baby’s mother is getting VA maternity care and she delivered in a VA facility, in a facility under a VA delivery contract, or somewhere else if she gave birth before reaching one of those facilities. Covered care means the baby’s routine and other post-delivery medical needs, including care at another hospital (for example, a pediatric specialty hospital) that accepts the baby. The VA Secretary may approve more than seven days of care and travel if the baby needs extra treatment, following rules the Secretary makes. Travel can be for the baby and parents and can include ambulance or air ambulance for transfers or true medical emergencies. The VA will pay providers directly unless a contract covers the cost, and contract terms apply when there is one. If the VA pays a provider for the baby’s care or transport, the parent no longer owes that money unless the provider rejects or returns the payment within 30 days. Payments come from the VA’s Medical Services appropriations account. A “covered entity” means anyone or any organization that provided or paid for the care or transportation.

Title 38, §1786

Veterans' Benefits, Source: USLM XML via OLRC

(a)In General.—

Except as provided in subsection (c), the Secretary may furnish health care services described in subsection (b) and transportation necessary to receive such services to a newborn child of a woman veteran who is receiving maternity care furnished by the Department for not more than seven days after the birth of the child if the veteran delivered the child in— (1)

(2)another facility pursuant to a Department contract for services relating to such delivery; or

(3)another location, including a health care facility, if the veteran delivers the child before arriving at a facility described in paragraph (1) or (2).

(b)Covered Health Care Services.—

Health care services described in this subsection are all post-delivery care services, including routine care services, that a newborn child requires, including necessary health care services provided by a facility other than the facility where the newborn child was delivered (including a specialty pediatric hospital) that accepts transfer of the newborn child and responsibility for treatment of the newborn child.

(c)Exception Based on Medical Necessity.—

Pursuant to such regulations as the Secretary shall prescribe to carry out this section, the Secretary may furnish more than seven days of health care services described in subsection (b), and may furnish transportation necessary to receive such services, to a newborn child based on medical necessity if the child is in need of additional care, including if the child has been discharged or released from a hospital and requires readmittance to ensure the health and welfare of the child.

(d)Transportation.—

(1)Transportation furnished under subsection (a) to, from, or between care settings to meet the needs of a newborn child includes costs for either or both the newborn child and parents.

(2)Transportation furnished under subsection (a) includes transportation by ambulance, including air ambulance, or other appropriate medically staffed modes of transportation—

(A)to another health care facility (including a specialty pediatric hospital) that accepts transfer of the newborn child or otherwise provides post-delivery care services when the treating facility is not capable of furnishing the care or services required; or

(B)to a health care facility 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.

(3)Amounts paid by the Department for transportation under this section shall be derived from the Medical Services appropriations account of the Department.

(e)Reimbursement or Payment for Health Care Services or Transportation.—

(1)Pursuant to regulations the Secretary shall prescribe to establish rates of reimbursement and any limitations thereto under this section, the Secretary shall directly reimburse a covered entity for health care services or transportation services provided under this section, unless the cost of the services or transportation is covered by an established agreement or contract. If such an agreement or contract exists, its negotiated payment terms shall apply.

(2)(A)Reimbursement or payment by the Secretary under this section on behalf of an individual to a covered entity shall, unless rejected and refunded by the covered entity within 30 days of receipt, extinguish any liability on the part of the individual for the health care services or transportation covered by such payment.

(B)Neither the absence of a contract or agreement between the Secretary and a covered entity nor any provision of a contract, agreement, or assignment to the contrary shall operate to modify, limit, or negate the requirements of subparagraph (A).

(3)In this subsection, the term “covered entity” means any individual, transportation carrier, organization, or other entity that furnished or paid for health care services or transportation under this section.

Notes & Related Subsidiaries

Editorial Notes

Prior Provisions

A prior section 1786 was renumbered section 3686 of this title. Another prior section 1786, added Pub. L. 89–358, § 3(b), Mar. 3, 1966, 80 Stat. 23, related to the examination of records, prior to repeal by section 316(1) of Pub. L. 92–540. See section 3690 of this title.

Amendments

2021—Subsec. (a). Pub. L. 116–315, § 3006(a)(1)(A), inserted “and transportation necessary to receive such services” after “described in subsection (b)” in introductory provisions. Pub. L. 116–283, § 9102(1), substituted “Except as provided in subsection (c), the Secretary” for “The Secretary” in introductory provisions. Subsec. (a)(3). Pub. L. 116–315, § 3006(a)(1)(B)–(D), added par. (3). Subsec. (b). Pub. L. 116–315, § 3006(a)(2), inserted before period at end “, including necessary health care services provided by a facility other than the facility where the newborn child was delivered (including a specialty pediatric hospital) that accepts transfer of the newborn child and responsibility for treatment of the newborn child”. Subsec. (c). Pub. L. 116–283, § 9102(2), added subsec. (c). Subsecs. (d), (e). Pub. L. 116–315, § 3006(a)(3), added subsecs. (d) and (e).

Statutory Notes and Related Subsidiaries

Treatment of Certain Expenses Already Incurred Pub. L. 116–315, title III, § 3006(b), Jan. 5, 2021, 134 Stat. 4995, provided that: “(1) In general.—Pursuant to such

Regulations

as the Secretary of Veterans Affairs shall prescribe, with respect to transportation furnished in order for a newborn child of a veteran to receive health care services under section 1786 of title 38, United States Code, during the period specified in paragraph (2), the Secretary may—“(A) waive a debt owed by the veteran to the Department of Veterans Affairs or reimburse expenses already paid by the veteran to the Department for such transportation; “(B) reimburse the veteran for expenses already paid by the veteran to a covered entity for such transportation; or “(C) reimburse a covered entity for the costs of such transportation. “(2) Period specified.—The period specified in this paragraph is the period beginning on May 5, 2010, and ending on the date of the enactment of this Act [Jan. 5, 2021]. “(3) Covered entity defined.—In this subsection, the term ‘covered entity’ has the meaning given that term in section 1786(e)(3) of title 38, United States Code, as added by subsection (a).”

§1786 Care for Newborn Children of Women Veterans Receiving Maternity Care