Citation Nr: A25035154 Decision Date: 04/16/25 Archive Date: 04/16/25 DOCKET NO. 210607-236669 DATE: April 16, 2025 ORDER The appeal concerning entitlement to payment of the cost of non-Department of Veterans Affairs (VA) medical services provided on February 2, 2021, is dismissed. FINDING OF FACT The Veteran received care through the Veterans Community Care Program by an authorized in-network provider on February 2, 2021; the billing process and rates of payment are governed by statutory and contractual authority that does not allow for review by the Board. CONCLUSION OF LAW The criteria for dismissal of the appeal for entitlement to payment for medical services provided by the appellant on February 2, 2021, have been met. 38 U.S.C. §§ 1703, 1703D, 7105; 38 C.F.R. §§ 17.4030, 17.4035. REASONS AND BASES FOR FINDING AND CONCLUSION The appellant, Aegis Sciences Corporation, is a non-VA healthcare provider who rendered services to the Veteran on February 2, 2021, as an in-network provider of the Veterans Community Care Program. See generally 38 U.S.C. § 1703(c), (h). This matter comes before the Board of Veterans' Appeals (Board) on appeal from a determination made by a Department of Veterans Affairs (VA) Veterans Health Administration (VHA) Agency of Original Jurisdiction (AOJ). In a June 7, 2021, VA Form 10182, Decision Review Request: Board Appeal (Notice of Disagreement), the appellant elected the Direct Review docket; therefore, the Board may only consider the evidence of record at the time of the AOJ decision on appeal. 38 C.F.R. § 20.301. The appellant contends that the medical services furnished to the Veteran on February 2, 2021, were authorized under the Veterans Community Care Program. At the outset, the record reflects that the appellant is a provider within the Veterans Community Care Program network of non-VA healthcare providers and the Veteran was authorized to receive certain medical services in January 2021. Specifically, VA records show that non-VA services for the Veteran were authorized through a Contract Nursing Home (CNH) from January 15, 2021, to February 15, 2021, and that all provider services, including lab services, are included in the per diem rate that is paid to the CNH. VA was directed to enter contracts to establish this network of non-VA healthcare providers to provide sufficient access to medical services. 38 U.S.C. § 1703(h). This included contracting with a third party administrator to process claims for compensation for the medical services provided by the in-network non-VA healthcare providers. 38?U.S.C. §?1703D(g)(1). The process for billing for the medical services, including correction of those claims and the rates paid by VA for such services, are governed by the contractual agreements that this appellant entered into with VA to be a Community Care Network provider. 38?U.S.C. §?1703D(a)-(g), (i); 38?C.F.R. §§ 17.4030, 17.4035. Therefore, the governing statute and implementing regulations have established a process for billing medical services furnished through the Veterans Community Care Program that does not contemplate Board review. 38 U.S.C. §§ 1703(h), 1703D; 38 C.F.R. § 17.4030. Moreover, the payment rates paid by VA for the services furnished by a healthcare provider within the Community Care Network are set forth in the terms within the contract the appellant signed to enter into the VCCP. 38 CFR § 17.4035. In sum, the applicable statutes and regulations governing the Veterans Community Care Program do not contemplate Board review of a question on whether payment is warranted for in-network medical services. Consequently, the instant appeal seeking payment of the cost of medical services provided on February 2, 2021, must be dismissed. 38 U.S.C. §§ 1703(h), 1703D; 38 C.F.R. §§ 17.4030, 17.4035. A. Odya-Weis Acting Veterans Law Judge Board of Veterans' Appeals Attorney for the Board April Maddox, 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.