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.
Annualization of Home Care Costs
Medical expenses for home care aides are allowed prospectively for annualization if those expenses are reasonably predictable. The evidence would also have to show that the need for care is ongoing and regular. Expenses may be allowed whether the care recipient has a rating for aid and attendance or housebound or is not rated. However, deductible payments to a non-rated beneficiary are more restrictive.
Evidence must be submitted indicating an ongoing need for the care and the level of care in order for the Veterans Service Representative to consider the medical expense as recurring and eligible to be annualized. A form such as the one we provide in our block entitled “Form 2 — Care Provider Report (used to provide evidence of recurring medical expenses)” should be used for this purpose. Also a copy of a contract between the provider and the recipient, covering at least a year, and outlining the provisions and the cost should be submitted to prove the intent of the care recipient and the provider.
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.”
The non-veteran spouse of a living veteran may also be eligible for annualization of home health aide costs. If the home care is being furnished by a licensed health professional, then not much further proof is necessary other than the documentation proving the care is being provided. If the provider is not licensed, we are not sure much could be done to allow deduction for anything other than direct medical services. As outlined below, payments to nonlicensed providers are only allowed if the care recipient has a rating for “aid and attendance” or “housebound.” Unfortunately, a non-veteran spouse of a living veteran cannot receive a rating and therefore would not be eligible for annualization of costs.
Our readers could try the suggested approach outlined for assisted living and other similar facilities in order to request annualization and deduction for non-rated beneficiaries, but there is no assurance VA would allow the deductions. The idea is to try to convince the service representative the spouse should have a rating even though officially none is allowed.
VA will not rate a non-veteran spouse of a living veteran for “aid and attendance” or “housebound” and even though the spouse’s home care medical expenses may be annualized to produce a benefit, the Pension award will be much smaller without the allowance for a rating. Of course, a death claim is different because the surviving spouse can receive a rating in that case.
For information on ratings please go to the article entitled “Who is eligible for the aid and attendance Pension benefit?”
Home Care Recipient Is Not Rated
Payments for care at home for a recipient who is not rated for housebound, or aid and attendance are only allowed for annualization if made to a licensed health professional. The term “licensed health professional” refers to an individual licensed to furnish health services by the state in which the services are provided. The term includes registered nurses, licensed vocational nurses and licensed practical nurses. Some states also license non-medical home care providers to provide services as well. Since this is a fairly new practice, we don’t know if these people would qualify under the definition above but we suspect they will.
All reasonable fees paid to the licensed health professional for personal care of the disabled person and maintenance of the disabled person’s immediate environment may be allowed. This includes such services as cooking for the disabled person and housecleaning for the disabled person. It is not necessary to distinguish between “medical” and “nonmedical” services. However, services which are beyond the scope of personal care of the disabled person and maintenance of the disabled person’s immediate environment may not be allowed.
Services beyond the scope might be services such as driving the veteran’s spouse to appointments, paying bills, answering the phone, providing shopping errands for the household, and so on. If an hourly rate is being paid to the home care provider, a portion of this rate may be disallowed for services beyond the scope of personal care.
Care Recipient Is Rated for “Aid and Attendance” or “Housebound”
If the disabled care recipient has been rated “housebound” or in need of “aid and attendance” by VA, all fees paid to an in-home attendant will be allowed as long as the attendant provides some medical or nursing services for the disabled person. The attendant does not have to be a licensed health professional.
All reasonable fees paid to the individual for personal care of the disabled person and maintenance of the disabled person’s immediate environment may be allowed. This includes such services as cooking for the disabled person and housecleaning for the disabled person. It is not necessary to distinguish between “medical” and “nonmedical” services. However, as with an unrated beneficiary, services which are beyond the scope of personal care of the disabled person and maintenance of the disabled person’s immediate environment may not be allowed.
For a disabled person who has been rated, a family member may be considered an in-home attendant, but that family member has to be paid for services duly rendered. There is potential for fraud here where a family member may move into the home and ostensibly receive payment as a caregiver but not actually provide the level of care paid for. Documentation for this care must be provided to VA, and it is reasonable for VA to question whether the services being purchased from someone living in the household are legitimate.
Whether this type of care is eligible for annualization is also questionable. The family member who is living in the home can certainly request consideration of this care as a recurring monthly cost, but our guess is, if VA allows it, the relationship will be scrutinized very carefully month-to-month.
We suspect the service representative is more likely to grant a request for annualization for a family member who is not living in the home. In either case, evidence must be submitted that this care will be required month-to-month and that the cost and the amount of care will remain fairly constant. Otherwise prospective annualization of the expenses is unlikely. We also suggest drawing up a contract between the family member and the person receiving the care and a copy of this furnished to VAalong with actual evidence of payment.
Documentation of Home Care Expenses
If the fees for an in-home attendant are an allowable expense, receipts or other documentation of this expense are required. Documentation includes any of the following:
1. a receipt bill
2. statement on the provider’s letterhead
3. computer summary
4. ledger, or
5. bank statement.
The evidence submitted must include:
1. the amount paid
2. the date payment was made
3. the purpose of the payment (the nature of the product or service provided)
4. the name of the person to or for whom the product or service was provided
5. identification of the provider to whom payment was made.
Courtesy of Tom Day- NCPC