Dental care; drugs and medicines for certain disabled veterans; vaccines
Outpatient dental services and treatment, and related dental appliances, shall be furnished under this section only for a dental condition or disability—
which is service-connected and compensable in degree;
which is service-connected, but not compensable in degree, but only if—
the dental condition or disability is shown to have been in existence at the time of the veteran’s discharge or release from active military, naval, air, or space service;
the veteran had served on active duty for a period of not less than 180 days or, in the case of a veteran who served on active duty during the Persian Gulf War, 90 days immediately before such discharge or release;
application for treatment is made within 180 days after such discharge or release, except that (I) in the case of a veteran who reentered active military, naval, air, or space service within 90 days after the date of such veteran’s prior discharge or release from such service, application may be made within 180 days from the date of such veteran’s subsequent discharge or release from such service, and (II) if a disqualifying discharge or release has been corrected by competent authority, application may be made within 180 days after the date of correction; and
the veteran’s certificate of discharge or release from active duty does not bear a certification that the veteran was provided, within the 90-day period immediately before the date of such discharge or release, a complete dental examination (including dental X-rays) and all appropriate dental services and treatment indicated by the examination to be needed;
which is a service-connected dental condition or disability due to combat wounds or other service trauma, or of a former prisoner of war;
which is associated with and is aggravating a disability resulting from some other disease or injury which was incurred in or aggravated by active military, naval, air, or space service;
which is a non-service-connected condition or disability of a veteran for which treatment was begun while such veteran was receiving hospital care under this chapter and such services and treatment are reasonably necessary to complete such treatment;
from which a veteran who is a former prisoner of war is suffering;
from which a veteran who has a service-connected disability rated as total is suffering; or
the treatment of which is medically necessary (i) in preparation for hospital admission, or (ii) for a veteran otherwise receiving care or services under this chapter.
The Secretary concerned shall at the time a member of the Armed Forces is discharged or released from a period of active military, naval, air, or space service of not less than 180 days or, in the case of a veteran who served on active duty during the Persian Gulf War, 90 days provide to such member a written explanation of the provisions of clause (B) of paragraph (1) of this subsection and enter in the service records of the member a statement signed by the member acknowledging receipt of such explanation (or, if the member refuses to sign such statement, a certification from an officer designated for such purpose by the Secretary concerned that the member was provided such explanation).
The total amount which the Secretary may expend for furnishing, during any twelve-month period, outpatient dental services, treatment, or related dental appliances to a veteran under this section through private facilities for which the Secretary has contracted or entered an agreement may not exceed $1,000 unless the Secretary determines, prior to the furnishing of such services, treatment, or appliances and based on an examination of the veteran by a dentist employed by the Department (or, in an area where no such dentist is available, by a dentist conducting such examination under a contract or fee arrangement), that the furnishing of such services, treatment, or appliances at such cost is reasonably necessary.
Except as provided in subparagraph (B) of this paragraph, in any year in which the President’s Budget for the fiscal year beginning October 1 of such year includes an amount for expenditures for contract dental care during such fiscal year in excess of the level of expenditures made for such purpose during fiscal year 1978, the Secretary shall, not later than February 15 of such year, submit a report to the appropriate committees of the Congress justifying the requested level of expenditures for contract dental care and explaining why the application of the criteria prescribed in section 1703 of this title for contracting with private facilities and in the second sentence of section 1710(c) of this title for furnishing incidental dental care to hospitalized veterans will not preclude the need for expenditures for contract dental care in excess of the fiscal year 1978 level of expenditures for such purpose. In any case in which the amount included in the President’s Budget for any fiscal year for expenditures for contract dental care under such provisions is not in excess of the level of expenditures made for such purpose during fiscal year 1978 and the Secretary determines after the date of submission of such budget and before the end of such fiscal year that the level of expenditures for such contract dental care during such fiscal year will exceed the fiscal year 1978 level of expenditures, the Secretary shall submit a report to the appropriate committees of the Congress containing both a justification (with respect to the projected level of expenditures for such fiscal year) and an explanation as required in the preceding sentence in the case of a report submitted pursuant to such sentence. Any report submitted pursuant to this paragraph shall include a comment by the Secretary on the effect of the application of the criteria prescribed in the second sentence of section 1710(c) of this title for furnishing incidental dental care to hospitalized veterans.
A report under subparagraph (A) of this paragraph with respect to a fiscal year is not required if, in the documents submitted by the Secretary to the Congress in justification for the amounts included for Department programs in the President’s Budget, the Secretary specifies with respect to contract dental care described in such subparagraph—
the actual level of expenditures for such care in the fiscal year preceding the fiscal year in which such Budget is submitted;
a current estimate of the level of expenditures for such care in the fiscal year in which such Budget is submitted; and
the amount included in such Budget for such care.
Dental services and related appliances for a dental condition or disability described in paragraph (1)(B) of subsection (a) shall be furnished on a one-time completion basis, unless the services rendered on a one-time completion basis are found unacceptable within the limitations of good professional standards, in which event such additional services may be afforded as are required to complete professionally acceptable treatment.
Dental appliances, wheelchairs, artificial limbs, trusses, special clothing, and similar appliances to be furnished by the Secretary under this section may be procured by the Secretary either by purchase or by manufacture, whichever the Secretary determines may be advantageous and reasonably necessary.
The Secretary shall furnish to each veteran who is receiving additional compensation or allowance under chapter 11 of this title, or increased pension as a veteran of a period of war, by reason of being permanently housebound or in need of regular aid and attendance, such drugs and medicines as may be ordered on prescription of a duly licensed physician as specific therapy in the treatment of any illness or injury suffered by such veteran. The Secretary shall continue to furnish such drugs and medicines so ordered to any such veteran in need of regular aid and attendance whose pension payments have been discontinued solely because such veteran’s annual income is greater than the applicable maximum annual income limitation, but only so long as such veteran’s annual income does not exceed such maximum annual income limitation by more than $1,000.
In order to assist the Secretary of Health and Human Services in carrying out national immunization programs under other provisions of law, the Secretary may authorize the administration of immunizations to eligible veterans who voluntarily request such immunizations in connection with the provision of care for a disability under this chapter in any Department health care facility. Any such immunization shall be made using vaccine furnished by the Secretary of Health and Human Services at no cost to the Department. For such purpose, notwithstanding any other provision of law, the Secretary of Health and Human Services may provide such vaccine to the Department at no cost. Section 7316 of this title shall apply to claims alleging negligence or malpractice on the part of Department personnel granted immunity under such section.
Source
(Pub. L. 85–857,Notes
Editorial Notes
Prior Provisions
Amendments
Statutory Notes and Related Subsidiaries
Effective Date of 2018 Amendment
Effective Date of 1993 Amendment
Effective Date of 1990 Amendment
Effective Date of 1988 Amendment
Effective Date of 1986 Amendments
Effective Date of 1981 Amendment
The amendments made by clauses (1)(A), (1)(C), and (2) of subsection (a) [amending this section] shall take effect on
The amendment made by clause (1)(B) of subsection (a) [amending this section] shall apply only to veterans discharged or released from active military, naval, or air service after
Effective Date of 1979 Amendments
Effective Date of 1978 Amendment
Effective Date of 1976 Amendment
Effective Date of 1973 Amendment
Effective Date of 1970 Amendment
Effective Date of 1967 Amendment
Effective Date of 1964 Amendment
Savings Provision
Pilot Program to Furnish Dental Care From the Department of Veterans Affairs to Certain Veterans Diagnosed With Ischemic Heart Disease
In General.—
Beginning not later than one year after the date of the enactment of this Act [
Locations.—
In general.—
The Secretary shall select not more than four States in which to carry out the pilot program.
Selection criteria.—
In selecting States under paragraph (1), the Secretary shall prioritize States in which—
the Department of Veterans Affairs serves a high proportion, as determined by the Secretary, of veterans residing in rural or highly rural areas (as determined through the use of the Rural-Urban Commuting Areas coding system of the Department of Agriculture);
dental clinics operated by the Department of Veterans Affairs currently utilize teledentistry;
the Department of Veterans Affairs does not currently operate a dental clinic; or
the Secretary determines a large percentage of veterans enrolled in the system of annual patient enrollment of the Department of Veterans Affairs established and operated under paragraphs [sic] (1) or (2) of section 1705(a) of title 38, United States Code, visit emergency rooms for dental emergencies at high rates.
Participation Limitation.—
Participation in a pilot program established pursuant to this section shall be limited to a covered veteran who receives health care in a facility of the Department located in a State selected under subsection (b).
Use of Certain Methods to Provide Care.—
Mobile dental clinics.—
In carrying out the pilot program, the Secretary shall test the efficacy of mobile dental clinics to service rural areas that do not have a population base to warrant a full-time clinic but where there are covered veterans in need of dental care.
Home-based dental care.—
In carrying out the pilot program, the Secretary shall test the efficacy of portable dental care units to service rural veterans in their homes, as the Secretary considers medically appropriate.
Administration.—
Community care network review.—
In general.—
Before commencing the pilot program, the Secretary shall work with third party administrators to conduct a review of dental providers who are part of the community care network of the Department in each State selected under subsection (b)(1) to ensure—
dental providers who are no longer accepting patients from the Department—
are not still listed as providers accepting referrals from the Department; and
are not sent referrals from the Department; and
dental providers participating in each such network are capable of receiving an influx of patients from the Department under the pilot program.
Expansion of network.—
If, pursuant to a review under subparagraph (A), the Secretary determines the community care network in a State selected under subsection (b)(1) is not capable of receiving an influx of patients under the pilot program, the Secretary shall coordinate with the Third Party Administrator for such State to ensure the dental provider network of such community care network is sufficiently expanded before the initiation of the pilot program.
Notice to covered veterans.—
In carrying out the pilot program, the Secretary shall inform all covered veterans in States selected under subsection (b)(1) of the covered care available under the pilot program.
Loss of eligibility.—
Any veteran participating in the pilot program who ceases to be a covered veteran shall be removed from the pilot program on the date that is 90 days after the Secretary determines the participant is no longer a covered veteran.
Continuity of care.—
In general.—
Upon the termination of the pilot program, the Secretary shall provide to all veterans participating in the pilot program at the time of such termination—
information on how to enroll in the dental insurance plan of the Department of Veterans Affairs under section 1712C of title 38, United States Code;
if appropriate, information on the VETSmile program of the Department of Veterans Affairs, or any successor program; and
contact information for dental providers in the surrounding community who provide low- or no-cost dental care and whom the Secretary has confirmed are available to take on new patients.
Continuation of treatment plan.—
Any veteran participating in the pilot program may continue to receive services under the pilot program after the termination of the pilot program to complete a treatment plan commenced under the pilot program, as determined necessary by the Secretary.
Reports.—
Annual report.—
Not later than one year after the commencement of the pilot program, and annually thereafter for the duration of the pilot program, the Secretary of Veterans Affairs shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the pilot program that includes—
an identification of the States participating in the pilot program;
a description of the implementation and operation of the pilot program;
the number of participants in the pilot program, disaggregated by—
State; and
disability rating;
an identification of any barriers or challenges to implementing the pilot program;
aggregated feedback from participants in the pilot program, including from interviews and surveys;
the average annual cost of providing covered care to a participant in the pilot program, disaggregated by—
State;
disability rating; and
whether the care was provided through the community care network or through a provider of the Department;
an analysis of the communication and collaboration of the Department with Third Party Administrators and community care dental providers, disaggregated by State;
an analysis of any cost savings by the Department with respect to the treatment of ischemic heart disease;
an assessment of the impact of the pilot program on appointments for care, prescriptions, hospitalizations, emergency room visits, wellness, employability, satisfaction, and perceived quality of life of covered veterans related to their diagnosis of ischemic heart disease;
an analysis and assessment of the efficacy of mobile clinics and portable dental care units, to the extent such modalities are used, to service the needs of covered veterans under the pilot program;
an analysis and assessment of the usage of teledentistry to service the needs of covered veterans under the pilot program, to include a cost benefit analysis of such services; and
such other matters as the Secretary considers appropriate.
Final report.—
Not later than 90 days before the completion of the pilot program, the Secretary shall submit to the Committees on Veterans’ Affairs of the House of Representatives and the Senate a report on the pilot program that—
includes the matters required under paragraph (1);
includes recommendations on whether the pilot program should be continued, expanded, or adopted throughout the Department; and
indicates whether the Secretary requests action by Congress to make the pilot program permanent.
Impact on Community Care.—
Participants in the pilot program shall be able to access covered care in the community under section 1703 of title 38, United States Code.
Definitions.—
In this section:
The term ‘covered care’ means dental care that is consistent with the dental services and treatment furnished by the Secretary of Veterans Affairs to veterans pursuant to section 1712(a)(1)(G) of title 38, United States Code.
The term ‘covered veteran’ means a veteran who—
is enrolled in the system of annual patient enrollment of the Department established and operated under paragraphs [sic] (1) or (2) of section 1705(a) of title 38, United States Code;
is not eligible for dental services and treatment and related dental appliances under the laws administered by the Secretary as of the date of the enactment of this Act; and
has a diagnosis of ischemic heart disease.
The term ‘Third Party Administrator’ has the meaning given such term in section 1703F of such title.”
Pilot Program on Provision of Dental Insurance Plans to Veterans and Survivors and Dependents of Veterans
Ratification of Actions During Period of Expired Authority
Disability of Veterans of Spanish-American War
Pilot Program of Mobile Health-Care Clinics
Pilot Program of Community-Based Residential Care for Homeless Chronically Mentally Ill and Other Veterans
Report on Treatment and Services for Chronically Mentally Ill Veterans
Veterans Discharged or Released From Active Service Who Reentered Such Service Within One Year, and Were Discharged or Released Before August 13, 1981
Section 1712(b)(1)(B)(iii)(I) [now 1712(a)(1)(B)(iii)(I), formerly 612(b)(1)(B)(iii)(I)] of title 38, United States Code, shall apply only to veterans discharged or released from active military, naval, or air service after
A veteran who before
was discharged or released from active military, naval, or air service,
reentered such service within one year after the date of such discharge or release, and
was discharged or released from such subsequent service,
may be provided dental services and treatment in the same manner as provided for in section 1712(b) [now 1712(a), formerly 612(b)] of title 38, United States Code, if the veteran is otherwise eligible for such services and treatment and if application for such services and treatment is or was made within one year from the date of such subsequent discharge or release.”