38 CFR 17.274 - Cost sharing.

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There are 16 Updates appearing in the Federal Register for 38 CFR 17. View below or at eCFR (GPOAccess)
§ 17.274 Cost sharing.
(a) With the exception of services obtained through VA facilities, CHAMPVA is a cost-sharing program in which the cost of covered services is shared with the beneficiary. CHAMPVA pays the CHAMPVA-determined allowable amount less the deductible, if applicable, and less the beneficiary cost share.
(b) In addition to the beneficiary cost share, an annual (calendar year) outpatient deductible requirement ($50 per beneficiary or $100 per family) must be satisfied prior to the payment of outpatient benefits. There is no deductible requirement for inpatient services or for services provided through VA facilities.
(c) To provide financial protection against the impact of a long-term illness or injury, a calendar year cost limit or “catastrophic cap” has been placed on the beneficiary cost-share amount for covered services and supplies. Credits to the annual catastrophic cap are limited to the applied annual deductible(s) and the beneficiary cost-share amount. Costs above the CHAMPVA-allowable amount, as well as costs associated with non-covered services are not credited to the catastrophic cap computation. After a family has paid the maximum cost-share and deductible amounts for a calendar year, CHAMPVA will pay allowable amounts for the remaining covered services through the end of that calendar year.
(i) Through December 31, 2001, the annual cap on cost sharing is $7,500 per CHAMPVA-eligible family.
(ii) Effective January 1, 2002, the cap on cost sharing is $3,000 per CHAMPVA-eligible family.
(d) If the CHAMPVA benefit payment is under $1.00, payment will not be issued. Catastrophic cap and deductible will, however, be credited.
(Authority: 38 U.S.C. 501, 1781)
[67 FR 4359, Jan. 30, 2002, as amended at 67 FR 6875, Feb. 14, 2002]

Title 38 published on 2013-07-01

The following are only the Rules published in the Federal Register after the published date of Title 38.

For a complete list of all Rules, Proposed Rules, and Notices view the Rulemaking tab.

  • 2014-03-25; vol. 79 # 57 - Tuesday, March 25, 2014
    1. 79 FR 16200 - Payment for Home Health Services and Hospice Care to Non-VA Providers; Delay of Effective Date
      GPO FDSys XML | Text
      DEPARTMENT OF VETERANS AFFAIRS
      Final rule; delay of effective date.
      Effective Date: The effective date for the final rule published May 6, 2013, at 78 FR 26250, is delayed from April 1, 2014 to June 1, 2014.
      38 CFR Part 17

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United States Code
U.S. Code: Title 38 - VETERANS’ BENEFITS

Title 38 published on 2013-07-01

The following are ALL rules, proposed rules, and notices (chronologically) published in the Federal Register relating to 38 CFR 17 after this date.

  • 2014-03-25; vol. 79 # 57 - Tuesday, March 25, 2014
    1. 79 FR 16200 - Payment for Home Health Services and Hospice Care to Non-VA Providers; Delay of Effective Date
      GPO FDSys XML | Text
      DEPARTMENT OF VETERANS AFFAIRS
      Final rule; delay of effective date.
      Effective Date: The effective date for the final rule published May 6, 2013, at 78 FR 26250, is delayed from April 1, 2014 to June 1, 2014.
      38 CFR Part 17