Citation Nr: A25089286 Decision Date: 10/16/25 Archive Date: 10/16/25 DOCKET NO. 220628-255957 DATE: October 16, 2025 ORDER The appeal concerning entitlement to payment of the cost of home health services furnished by the appellant in November 2019 is dismissed. The appeal concerning entitlement to payment of the cost of home health services furnished by the appellant from January 26, 2020, to February 8, 2020, is dismissed. FINDINGS OF FACT 1. The medical services furnished by the appellant in November 2019 were pursuant to a Veterans Care Agreement (VCA), which is subject to a specific administrative dispute resolution process that does not allow for appellate review by the Board of Veterans' Appeals (Board). 2. The medical services furnished by the appellant from January 26, 2020, to February 8, 2020, were pursuant to a VCA, which is subject to a specific administrative dispute resolution process that does not allow for appellate review by the Board. CONCLUSIONS OF LAW 1. The criteria for dismissal of the appeal concerning entitlement to payment of the cost of home health services furnished by the appellant in November 2019 have been met. 38 U.S.C. § 1703A (d), (h); 38 C.F.R. §§ 1703A, 17.4120, 17.4135. 2. The criteria for dismissal of the appeal concerning entitlement to payment of the cost of home health services furnished by the appellant from January 26, 2020, to February 8, 2020, is proper have been met. 38 U.S.C. § 1703A (d), (h); 38 C.F.R. §§ 1703A, 17.4120, 17.4135. REASONS AND BASES FOR FINDINGS AND CONCLUSIONS The appellant, Providence Home Care Services, Inc. (vendor), is a non-VA medical provider who rendered services to the Veteran in November 2019 and from January 26, 2020, to February 8, 2020, on behalf of VA, furnished through a VCA. See generally 38 C.F.R. §§ 17.4110-17.4135. This matter is on appeal before the Board from decisions of a Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Agency of Original Jurisdiction (AOJ). In June 2022, the Board received a VA Form 10182, Decision Review Request: Board Appeal electing the Evidence Submission docket. 1. Veterans Care Agreement The appellant asserts that it was not paid for the billed charges associated with the episodes of care in November 2019 and from January 26, 2020, to February 8, 2020, that were furnished to the Veteran pursuant to the VCA. The evidence shows that the appellant provided home health services to the Veteran in November 2019 and from January 26, 2020, to February 8, 2020, and billed for the cost of these services. A January 2022 Explanation of Payment reported that the appellant was paid the full amount billed for home health services for the period from January 26, 2020, to February 8, 2020. In an undated Report of Contact, a representative from a VHA Office of Finance, Payment Operations and management, indicated that payment to the vendor had been made on January 18, 2022, for the full amount billed for the January 26, 2020, to February 8, 2020, episode of care, and that the claim related to the November 2019 episode of care had been resurrected and referred for further processing pursuant to the VCA. When VA hospital care, a medical service, or an extended care service required by a covered individual is not feasibly available from a VA facility or through a contract or sharing agreement entered into pursuant to another provision of law, VA may furnish such care or service through a VCA with an eligible non-VA provider. 38 U.S.C. § 1703A(a)(1)(A)-(B). Importantly, the controlling statutory authority and accompanying regulation provides a specific procedure for resolving disputes between VA and a non-VA service provider under a VCA. 38 U.S.C. § 1703A; 38 C.F.R. § 17.4135. The controlling statute, 38 U.S.C. § 1703A, explicitly authorizes VA to "promulgate administrative procedures for eligible entities and providers to present all disputes arising under or related to Veterans Care Agreements," and specifies that "[s]uch procedures constitute the eligible entities' and providers' exhaustive and exclusive administrative remedies." 38 U.S.C. § 1703A(h)(1-2). The statute also indicates that only after exhaustion of these administrative remedies may the provider or entity seek judicial review, and that review may then be sought in Federal District Court or the U.S. Court of Federal Claims in accordance with 28 U.S.C. § 1346 (known as the Tucker Act). 38 U.S.C. § 1703A(h)(3). Additionally, payment by VA under a VCA shall, unless rejected and refunded by the provider within 30 days of receipt, constitute payment in full and extinguishes any liability on the part of the covered individual (e.g., veteran entitled to VA medical services) for the treatment or care provided. 38 U.S.C. § 1703A(e)(2)(B). As mandated by the section 1703A statutory authority, the controlling regulation "establishes the administrative procedures and requirements for asserting and resolving disputes arising under or related to a Veterans Care Agreement," including disputes concerning a claim for payment. 38 C.F.R. § 17.4135(a)(1). Under the aforementioned procedures, a decision by the "responsible [VHA] official" concerning a VCA dispute is the exclusive administrative remedy for a service provider or entity, and a written decision by a designated responsible VA official constitutes VA's final decision on the dispute. 38 C.F.R. § 17.4135(a)(3-5), (c)(5); see also 84 Fed. Reg. 21668, 21675 (Interim Final Rule) (May 14, 2019), implementing 38 C.F.R. § 17.4135, which states: Paragraph (c)(5) of § 17.4135 will establish that the written decision issued by the responsible VA official constitutes VA's final decision on the dispute. This language serves to clarify that VA maintains no administrative process to appeal such a decision and to emphasize the reality that, under section 1703A(h)(2), this disputes process constitutes entities' and providers' exhaustive and exclusive administrative remedy. In other words, a decision that is not subject to any administrative appeal. In sum, the controlling statute and regulation provide exclusive VCA administrative dispute resolution authority to VHA, which is the AOJ. Therefore, the Board, as a VA administrative appeals body, does not have the authority to review or resolve VCA disputes, including a disagreement concerning payment. 38 U.S.C. §§ 7101, 1703A(h)(1-2); 38 C.F.R. § 17.4135(a)(3-5), (c)(5); 84 Fed. Reg. 21668, 21675 (May 14, 2019). Consequently, the instant appeal seeking payment under a VCA must be dismissed. S. B. MAYS Veterans Law Judge Board of Veterans' Appeals Attorney for the Board M. Thomas, Counsel The Board's decision in this case is binding only with respect to the instant matter decided. This decision is not precedential and does not establish VA policies or interpretations of general applicability. 38 C.F.R. § 20.1303.