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9.2. Fee Basis Services
Bowel and Bladder Care. Bowel and bladder care for certain Veterans with SCI/D are considered supportive medical services due to the possibility of medical complications which would result in the need for hospitalization. The clinic of jurisdiction, or medical facility, authorizes such care under the fee-basis program to enrolled Veterans with SCI/D who are dependent upon others for bowel and bladder care while residing in the community. NOTE: Fee-Basis SCI/D bladder and bowel care were previously described in M-1, Part 1, Chapter 18.
Authorizations for Care. Recommendations from the nearest SCI Center should be obtained before medical services for bowel and bladder care are denied to any Veteran with SCI/D. When bowel and bladder care is not desired or cannot be procured through a skilled licensed provider, an individual may serve as a home health attendant and receive reimbursement for provision of this care, only when trained by VHA personnel or the Veteran is trained in attendant care management, and care is overseen by VHA personnel. A relative (by blood or marriage) of a Veteran in the fee-basis program is not to be excluded from treating the Veteran for a fee, as long as professional and training requirements are met. Reimbursement does not exceed the 5th step of the General Schedule hourly rate paid to nursing assistants providing this care at a VA medical center. In no instance shall fee-basis bowel and bladder care be authorized for a Veteran who can perform this function unassisted. Bowel and bladder care at VA expense may be authorized for all Veterans based on clinical need, including those receiving Aid and Attendance benefits.