Determination of Eligible Services. ATHP may obtain information from AVAHS before delivering a particular Direct Care Services about whether the Eligible Veteran is eligible for the specific services proposed to be provided by submitting a request for verification for eligibility. AVAHS will verify service eligibility (and any special conditions that may apply) by contacting VA Health and Eligibility within 7 days of such request. Advance request for verification is not a condition of reimbursement for any Direct Care Service for Eligible Veterans under this Agreement. VA recommends that ATHP verify eligibility of an otherwise Eligible Veteran for the following services, which have restricted eligibility requirements: dental, prosthetics (including hearing aids and eyeglasses), long-term care (including nursing home care), and transplant services. ATHP may request this verification when services for a non-AN/AI Veteran are initially preauthorized under 5.2.2.2.; however, the eligibility of a particular Eligible Veteran for the service may change during the authorization period. The following services are specifically excluded from VA’s Medical Benefits Package at 38 C.F.R. 17.38: cosmetic surgery that is not medically necessary; abortions and abortion counseling; in vitro fertilization; drugs, biologicals and medical devices not approved by the Food and Drug Administration (“FDA”); gender alterations; and memberships in spas and health clubs.
Determination of Eligible Services. THP may seek information from VA before delivering any direct care service as to whether the AI/AN Eligible Veteran is eligible for the specific services proposed to be provided by submitting a request for verification for eligibility. THP may verify eligibility (and any special conditions that may apply) by contacting VA Health and Eligibility (fill in necessary contact information). In particular, VA recommends that THP verify eligibility of an otherwise AI/AN Eligible Veteran for the following services, which have restricted eligibility requirements: dental, prosthetics (including hearing aids and eyeglasses), long-term care (including nursing home care), and transplant services.
Determination of Eligible Services. THP may seek information from VA before delivering any direct care service as to whether the Eligible AI/AN Veteran is eligible for the specific services proposed to be provided by submitting a request for verification for eligibility. THP may verify eligibility (and any special conditions that may apply) by contacting VA Health and Eligibility office within VA Healthcare System. In particular, VA recommends that THP verify eligibility of Eligible AI/AN Veteran for the following services, which have restricted eligibility requirements: dental, prosthetics (including hearing aids and eyeglasses), long-term care (including nursing home care), and transplant services. Applicability of Agreement. This Agreement governs payment for only those direct care services provided by the THP, including applicable pharmaceuticals, provided to an Eligible AI/AN Veteran after the effective date of this Agreement. Reimbursement Rates
