Month: February 2015

What is Veterans Health Care?

The Veterans Health Administration is the largest single provider of medical care in the United States. Its 22 regions with 154 hospitals and their associated 875 outpatient clinics offer the following services:

– Hospital, outpatient medical, dental, pharmacy and prosthetic services

– Domiciliary, nursing home, and community-based residential care

– Sexual trauma counseling

– Specialized health care for women veterans

– Health and Rehabilitation programs for homeless veterans

– Readjustment counseling

– Alcohol and drug dependency treatment

– Medical evaluation for disorders associated with military service in the Gulf War, or Treatment for exposure to Agent Orange, radiation, and other environmental hazards

– HISA grants

– Other special benefits

An example of one of VA’s 22 regions is Region 19. Geographically one of the largest in the system. Headquartered in Denver this region covers the states of Montana, Wyoming, Utah, Colorado and part of Nevada. Region 19 includes three health-care system hospitals and three satellite hospitals. There are also 33 outpatient clinics in urban centers scattered throughout the five states and 7 Vet Centers in urban areas that provide special services for veterans who served in combat.

The six hospitals in Region 19 offer a wide range of medical specialties and procedures and it is unlikely that any patient would have to be referred to the private care community for any services not offered by these hospitals. But if specialized services are not offered in the region, VA hospitals, region to region, share responsibilities for very specialized treatment and patients needing these specialties not offered in their region are referred to other VA facilities that do offer the care.

Hospitals in the VA system are typically associated with a local medical College where feasible. By acting as teaching hospitals the VA system has access to some of the best doctors and cutting edge medical treatments. In region 19, the Denver Medical Center is affiliated with the medical school, pharmacy, and nursing schools of the University of Colorado Health Sciences Center. The Fort Harrison facility near Helena, Montana is affiliated with nursing schools, pharmacy schools and physician-assistant schools in over 30 universities in the four adjoining states. The Salt Lake City Regional Medical Center is affiliated with the University of Utah Medical School which is located less than a mile away.

One of the disadvantages, in the past, of joining the health system was the difficulty of getting to a regional medical center for treatment. With the installation of outpatient clinics within easy driving distance for health-care beneficiaries, this challenge has become less of a problem than in the past few years. The challenge still remains that major hospitilization, surgery and other specialized treatment must be obtained at a regional hospital. In the case of region 19 this could involve driving distances up to 600 miles one way to obtain the appropriate care.

VA is accommodating to certain low income patients who must drive long distances and the facilities offer, at no charge or reasonable charge, “hoptel” rooms in the hospital or nearby as an alternative to staying in a motel or hotel. Low income patients are also reimbursed at $.11 per mile for travel to the nearest Va health care facility that can provide their needed care.

Other services are also available to certain qualifying veterans who may receive dental care, vision care and hearing aids. In addition, Vet Centers provide special counseling for active-duty veterans who served in combat zones. VA is also the most experienced healthcare provider in the country in services for rehabilitating patients with missing limbs, burn injuries or with other complications due to combat injuries.

Regional VA hospitals often include associated nursing facilities or domiciliary rooms. They will also contract for home health care and hospice services if needed. For those hospitals that don’t have nursing homes or domiciliary, contracts for these services are maintained with facilities in the local community.

Emergency Care in Non-VA facilities is provided as a safety net for veterans under specific conditions. If the non-VA emergency care is for a service-connected condition or if the veteran has been enrolled with health services at least 24 months and has no other health care coverage then emergency care is covered. Also, it must be determined that VA health care facilities were not feasibly available; that a delay in medical attention would have endangered life or health, and that the veteran remains personally liable for the cost of the services in case of a dispute.

Outpatient Pharmacy Services

VA provides free outpatient pharmacy services to:

1. Veterans with a service-connected disability of 50% more.

2. Veterans receiving medication for service-connected conditions.

3. Veterans whose annual income does not exceed the maximum annual rate of the VA Pension.

4. Veterans enrolled in priority group 6 who received medication for service-connected conditions.

5. Veterans receiving medications for conditions related to sexual trauma while serving on active duty.

6. Certain veterans receiving medication for treatment of cancer of the head or neck.

7. Veterans receiving medication for a VA-approved research project.

8. Former prisoners of war.

Other veterans will be charged a co-pay of $8 for each 30-day or less supply of medication. For veterans enrolled in Priority Groups 2 through 6, the maximum co-pay amount for calendar year 2008 is $960.

Co-pays apply to prescription and over-the-counter medications, such as aspirin, cough syrup or vitamins, dispensed by a VA pharmacy. However, veterans may prefer to purchase over-the-counter drugs, such as aspirin or vitamins, at a local pharmacy rather than making the co-pay. Co-pays are not charges for medications injected during the course of treatment or for medical supplies, such as syringes or alcohol wipes.

Veterans receiving pension can also have their prescriptions from doctors in the private sector provided by a VA pharmacy for free or with co-pay depending on their income.

A face-to-face interview with a pharmacy specialist must be conducted with any new prescription. This is part of the process that helps VA control unnecessary drug reactions or interactions with other drugs. Subsequent refills can be ordered on the phone and will be sent through the mail or picked up in person.

Long Term Care Benefits

The following was taken from the department of Veterans Affairs fact sheet dated January 2005 and distributed by the office of public affairs media relations.

VA LONG TERM CARE

The Department of Veterans Affairs (VA) offers a spectrum of geriatric and extended care services to veterans enrolled in its health care system. More than 90% of VA’s medical centers provide home and community-based outpatient long-term care programs. This patient-focused approach supports the wishes of most patients to live at home in their own communities for as long as possible. In addition, nearly 65,000 veterans will receive inpatient long-term care this year through programs of VA or state veterans homes.

NON-INSTITUTIONAL CARE

Veterans can receive home-based primary care, contract home health care, adult day health care, homemaker and home health aide services, home respite care, home hospice care and community residential care. In fiscal year 2003, 50% of VA’s total extended care patient population received care in non-institutional settings, including:

HOME-BASED PRIMARY CARE

This program (formerly Hospital Based Home Care) began in 1970 and provides long-term primary medical care to chronically ill veterans in their own homes under the coordinated care of an interdisciplinary treatment team. This program has led to guidelines for medical education in home care, use of emerging technology in home care and improved care for veterans with dementia and their families who support them. In 2003, home-based primary care programs were located in 76 VA medical centers.

CONTRACT HOME HEALTH CARE

Professional home care services, mostly nursing services, are purchased from private-sector providers at every VA medical center. The program is commonly called “fee basis” home care.

ADULT DAY HEALTH CARE

Adult Day Health Care programs provide health maintenance and rehabilitative services to veterans in a group setting during daytime hours. VA introduced this program in 1985. In 2004, VA operated 21 programs directly and provided contract ADHC services at 112 VA medical centers. Two state homes have received recognition from VA to provide ADHC, which has recently been authorized under the State Home Per Diem Program.

HOMEMAKER AND HOME HEALTH AIDE

VA began a program in 1993 of health-related services for service-connected veterans needing nursing home care. These services are provided in the community by public and private agencies under a system of case management provided directly by VA staff. VA purchased H/HHA services at 122 medical centers in 2004.

COMMUNITY RESIDENTIAL CARE

The community residential care program provides room, board, limited personal care and supervision to veterans who do not require hospital or nursing home care but are not able to live independently because of medical or psychiatric conditions, and who have no family to provide care. The veteran pays for the cost of this living arrangement. VA’s contribution is limited to the cost of administration and clinical services, which include inspection of the home and periodic visits to the veteran by VA health care professionals.Medical care is provided to the veteran primarily on an outpatient bases at VA facilities. Primarily focused on psychiatric patients in the past, this program will be increasingly focused on older veterans with multiple chronic illnesses that can be managed in the home under proper care and supervision.

RESPITE CARE

Respite care temporarily relieves the spouse or other caregiver from the burden of caring for a chronically ill or disabled veteran at home. In the past, respite care admission was limited to an institutional setting, typically a VA nursing home. The Veterans Millennium Health Care and Benefits Act expanded respite care to home and other community settings, and home respite care was provided at 15 VA medical centers in fiscal year 2003. Currently, respite care programs are operating in 136 VA medical centers, with each program typically providing care to approximately five veterans on any given day. Respite care is usually limited to 30 days per year.

HOME HOSPICE CARE

Home hospice care provides comfort-oriented and supportive services in the home for persons in the advanced stages of incurable disease. The goal is to achieve the best possible quality of life through relief of suffering, control of symptoms, and restoration or maintenance of functional capacity. Services are provided by an interdisciplinary team of health care providers and volunteers. Bereavement care is available to the family following the death of the patient. Hospice services are available 24 hours a day, seven days a week. VA provided home hospice care at 73 medical centers in fiscal year 2003, the first year the service was offered.

DOMICILIARY CARE

Domiciliary care is a residential rehabilitation program that provides short-term minimal medical care as they recover from medical, psychiatric or psychosocial problems. Most domiciliary patients return to the community after a period of rehabilitation.

Domiciliary care is provided by VA and state homes. VA currently operates 43 facilities. State homes operate 49 domiciliaries in 33 states. VA also provides a number of psychiatric residential rehabilitation programs, including ones for veterans coping with post-traumatic stress transitional residences for homeless chronically mentally ill veterans and veterans recovering from substance abuse.

TELEHEALTH

For most of VA’s non-institutional care, telehealth communication technology can play a major role in coordinating veterans’ total care with the goal of maintaining independence. Telehealth offers the possibility of treating chronic illnesses cost-effectively while contributing to the patient satisfaction generally found with care available at home.

GERIATRIC EVALUATION AND MANAGEMENT

Older veterans with multiple medical, functional or psychosocial problems and those with particular geriatric problems receive assessment and treatment from an interdisciplinary team of VA health professionals. GEM services can be found on inpatient units, in outpatient clinics and in geriatric primary care clinics. In 2004, there were 57 inpatient GEM programs and more than 195,000 visits to GEM and geriatric primary care clinics.

GERIATRIC RESEARCH, EDUCATION AND CLINICAL CENTERS

These centers increase the basic knowledge of aging for health care providers and improve the quality of care through the development of improved models of clinical services. Each GRECC has an identified focus of research in the basic biomedical, clinical and health services areas, such as the geriatric evaluation and management program. Medical and associated health students and staff in geriatrics and gerontology are trained at these centers. Begun in 1975, there are now 21 GRECCs in all but two of VA’s health networks.

NURSING HOME CARE

VA’s nursing home programs include VA-operated nursing home care units, contract community nursing homes and state homes. VA contracts with approximately 2500 community nursing homes. The state home program is growing and currently encompasses 114 nursing homes in 47 states and Puerto Rico. In fiscal year 2003, approximately 70 percent of VA’s institutional nursing home care occurred in contract community and state home nursing homes.

Nursing home care units are located at VA hospitals where they are supported by an array of clinical specialties. The community nursing home program has the advantage of begin offered in many local communities where veterans can receive care near their homes and families. VA contracts for the care of veterans in community nursing homes approved by VA. The state home program is based on a joint cost sharing agreement between the VA, the veteran and the state.

WHO IS ELIGIBLE FOR NURSING HOME CARE

– Any veteran who has a service-connected disability rating of 70 percent or more

– A veteran who is rated 60 percent service-connected and is unemployable or has an official rating of “permanent and total disabled,”

-A veteran with combines disability ratings of 70 percent or more;

-A veteran whose service-connected disability is clinically determined to require nursing home care;

-Nonservice-connected veterans and those officially referred to as “zero percent, noncompensable, service-connected” veterans who require nursing home care for any nonservice-connected disability and who meet income and asset criteria; or

-If space and resources are available, other veterans on a case-by-case basis with priority given to service-connected veterans and those who need care for post-acutre rehabilitation, respite, hospice, geriatric evaluation and management, or spinal cord injury.

HISA GRANTS

A local Regional Medical Center can pay veterans a grant to allow for home improvement and structural alteration — HISA grants. These are necessary alterations in order to accommodate disability in the home. As a general rule these grants are typically provided to veterans who are receiving VA health care and who are service-connected disabled. Certain service-connected disabled veterans can receive a lifetime benefit of $4200 for home improvement projects to aid with disability.

A clause in the eligibility statutes opens the door for veterans who are on Medicaid or receiving pension with aid and attendance or housebound ratings to also receive these grants. Also very low income — means tested veterans — may also receive the grant. For this class of veterans the grant is a lifetime payment of $1200.

Although they are reluctant to provide these grants to veterans who are not in the health-care system, the medical center HISA committee will do so if adequate documentation is provided to justify the grant.

Millennium Act and the VA’s Efforts to Increase Long-Term Care Capacity Public Law 106-117, the Veterans Millennium Health Care and Benefits Act, enacted in November 1999, requires VA to provide extended care services in its facilities, including nursing home care, with the goal of providing as much care as in 1998.

The budget for Va long-term care grew by more then $850 million between fiscal year 1998 and fiscal year 2003, and the number of full time employees increased in nursing home care units and outpatient programs.

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Who Is Eligible for the Aid and Attendance Pension Benefit?

Filing a claim can be time-consuming and complicated. It’s important to get help.
Applications for Pension that involve a rating, evidence of prospective, recurring medical expenses, appointments for VA powers of attorney and fiduciaries, and an understanding of the actual application process should not be attempted without prior knowledge. We recommend you purchase our book to avoid lengthy delays in a decision or possible denials of the claim. Not only does the book help you understand how to shorten the decision process from VA and ensure a successful claim but the support forms we provide also help you present medical evidence and costs in a format familiar to VA service representatives. Applications that also involve reallocation of assets in order to qualify should not be attempted without the help of a qualified veterans aid and attendance benefit consultant.

Eligibility Rules for Pension
To receive Pension, a veteran must have served on active duty, at least 90 days, during a period of war. There must be an honorable discharge. Single surviving spouses of such veterans are also eligible. If younger than 65, the veteran must be totally disabled. If age 65 and older, there is no requirement for disability. There is no disability requirement for a single surviving spouse.

The veteran household cannot have income — adjusted for unreimbursed medical expenses — exceeding the Maximum Allowable Pension Rate– MAPR — for that veteran’s Pension income category. If the adjusted income exceeds MAPR, there is no benefit. If adjusted income is less than the MAPR, the veteran receives a Pension income that is equal to the difference between MAPR and the household income adjusted for unreimbursed medical expenses. The Pension income is calculated, based on 12 months of future household income, but paid monthly.

The Special Case for Long Term Care Costs
A special provision for calculating Pension income, allows household income to be reduced by 12 months worth of future, recurring medical expenses. Normally, income is only reduced by medical expenses incurred in the month of application. These allowable, annualized medical expenses are such things as insurance premiums, the cost of home care, the cost of paying any person to provide care, the cost of adult day care, the cost of assisted living and the cost of a nursing home facility. In most cases, these expenses are only deductible if there is a rating.

This special provision can allow veteran households earning more than the annual MAPR to qualify for Pension. As an example, a veteran household earning $6,000 a month could still qualify for Pension if the veteran is paying $4,500 to $6,000 a month for nursing home costs. The applicant must submit appropriate evidence for a rating and for recurring costs in order to qualify for this special provision. VA normally does not tell applicants about this special treatment of medical expenses or how to qualify for it. Our book provides ample information on this special treatment and provides appropriate forms to present medical and cost evidence in the most favorable manner.

For an explanation of the special annualized treatment of unreimbursed long term care costs and insurance premiums please go to the article entitled “Understanding the special case of long term care medical costs.”

Dealing with Assets That May Disqualify the Applicant
There is also an asset test to qualify for Pension. Any asset or investment that could be easily converted into income might disqualify the claimant. An asset ceiling of $80,000 is often cited in the media as being the test. The $80,000 has to do with VA internal filing requirements and is not an actual test. In reality, there is no dollar amount for the test and any level of assets could block the award. The asset test ultimately becomes a subjective decision made by the veterans service representative, processing the application.

A home, used as a residence, vehicles and difficult-to-sell property are generally excluded from the asset test. VA will allow assets to be transferred or converted to income in order to meet the asset test. There is no look back penalty for transferring assets as there is with Medicaid. There are specific rules governing transfers of assets and what constitutes income from assets and it must be done correctly.

We recommend using a qualified aid and attendance benefit consultant when dealing with assets that may disqualify. It is extremely important that assets that might be gifted or converted to income also meet Medicaid gifting rules in case the veteran or the surviving spouse may have to apply for Medicaid. The consultant can help avoid Medicaid penalties associated with reallocating assets.

The Rating
A rating for “aid and attendance” or “housebound” allows VA to pay additional benefits beyond the regular Pension benefit ceiling in order to help cover the additional costs associated with added disabilities. A rating for these allowances is determined by a veteran service representative who has been trained to recognize from medical reports and interviews whether the veteran or his surviving spouse needs the additional care.

Determinations of a need for aid and attendance or housebound benefits may be based on medical reports and findings by private physicians or from hospital facilities. Authorization of aid and attendance benefits without a rating decision is automatic if evidence establishes the claimant is a patient in a nursing home. Aid and attendance is also automatic if the claimant is blind or nearly blind or having severe visual problems.

According to 38 CFR Part Three, the following criteria are used to determine the need for aid and attendance:

•  inability of claimant to dress or undress himself (herself), or to keep himself (herself) ordinarily clean and presentable;

•  frequent need of adjustment of any special prosthetic or orthopedic appliances which by reason of the particular disability cannot be done without aid (this will not include the adjustment of appliances which normal persons would be unable to adjust without aid, such as supports, belts, lacing at the back, etc.);

•  inability of claimant to feed himself (herself) through loss of coordination of upper extremities or through extreme weakness;

•  inability to attend to the wants of nature;

•  or incapacity, physical or mental, which requires care or assistance on a regular basis to protect the claimant from hazards or dangers incident to his or her daily environment.

Not all of the disabling conditions in the list above are required to exist before a favorable rating may be made. The personal functions which the veteran is unable to perform are considered in connection with his or her condition as a whole. It is only necessary that the evidence establish that the veteran is so helpless as to need “regular” (scheduled and ongoing) aid and attendance from someone else, not that there be a 24-hour need.

“Bedridden” is a definition that allows a rating for aid and attendance by itself. “Bedridden” is a condition which requires that the claimant remain in bed. A person who has voluntarily taken to bed or who has been told by the doctor to remain in bed will not necessarily receive the favorable rating for aid and attendance. There must be an actual need for personal assistance from others.

Housebound means “permanently housebound by reason of disability or disabilities.” This requirement is met when the veteran or his or her widow is substantially confined to his or her dwelling and the immediate premises or, if institutionalized, to the ward or clinical area, and it is reasonably certain that the disability or disabilities and resultant confinement will continue throughout his or her lifetime.

A person who cannot leave his immediate premises unless under the supervision of another person is considered housebound. This might include the inability to drive because of the disability.

A housebound rating does not mean a person needs to be confined to a personal residence. It can apply to any place where the person is living whether in a facility or in the home of someone else.

In order to receive one of these ratings the claimant must check the “Yes” box on VA Form 21-526 (claim for a living veteran) or VA Form 21-534 (claim for death Pension from a surviving spouse) that states: “Are you claiming a special monthly Pension because you need the regular assistance of another person, are blind, nearly blind, or having severe visual problems, or are housebound?” Failure to check this box may result in no rating and in some cases a denial of the claim as well as a loss of the rating allowance.

Medical evidence for a rating for “aid and attendance” or “housebound” for living arrangements other than a nursing home should be submitted with the application to avoid a delay in the approval process. Waiting for the regional office to order medical records is a time-consuming process, mainly because doctors offices don’t respond quickly to these kinds of requests.

We recommend a report completed by the physician, and obtained by the family prior to submission of the claim. This report is then included with the initial application. We provide in our book a form entitled “Form 1 — Statement of Attending Physician (used to determine rating for A&A or HB).” This document is similar to a form used internally by VA to obtain information from veterans medical facilities for determining a rating. It is in a format that a veterans service representative would recognize.

Ratings are requested by checking the appropriate box for aid and attendance or housebound on VA Form 21-526 or VA Form 21-534.

How Pension Is Calculated
The monthly award is based on VA totaling 12 months of estimated future income and subtracting from that 12 months of estimated future, recurring and predictable medical expenses. Allowable medical expenses are reduced by a deductible to produce an adjusted medical expense which in turn is subtracted from the estimated 12 months of future income.

The new income derived from subtracting adjusted medical expenses from income is called “countable” income or IVAP (Income for Veterans Affairs Purposes). This countable income is then subtracted from the Maximum Allowable Pension Rate — MAPR — and that result is divided by 12 to determine the monthly income Pension award. This award is paid in addition to the family income that already exists. See examples below.

Example #1 — Veteran is in assisted living with aid and attendance allowance. Monthly family income is $4,000 a month. Spouse is living at home. Unreimbursed medical expenses include prescription drugs, Medicare premiums, Medicare supplement premiums, and 12 months of prospective assisted living monthly costs. Family meets the asset test.

Example #2 — Veteran receiving paid home care with aid and attendance allowance. Monthly family income is $1,900 a month. Unreimbursed medical expenses include prescription drugs, Medicare premiums, Medicare supplement premiums, and 12 months of prospective home health aide monthly costs. Family meets the asset test.

Example #3 — Surviving spouse receiving paid home care with aid and attendance allowance. Monthly income is $850 a month. Unreimbursed medical expenses include prescription drugs, Medicare premiums, Medicare supplement premiums, and 12 months of prospective home health aide monthly costs. Surviving spouse meets the asset test.

   

This article is courtesy of veteransinfocenter.org.

Did you know?

Great story about another great hero!

Just Cruisin 2

Remember Van Thurman Barfoot? Need a hint? He was
the guy who fought with his homeowners’ association
over putting a flagpole in his front yard in 2009.
He didn’t back down and got his flagpole. Even at
age 90 he would hoist the flag in the morning and
lower and fold it at dusk every day.

Barfoot died in 2012 when he was 92 of
complications from a fall. But we don’t remember
hearing his story before, until a friend passed
along some interesting information. So please read
on and learn a little about the man.

barfoot

He was born on June 5, 1919 in Edinburg,
Mississippi. He joined the Army in 1940 and spent
the following 34 years in uniform and retired with
the rank of Colonel. He fought in World War II, the
Korean War, and the Vietnam War and was awarded a
Medal of Honor, the Silver Star…

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