This two-part article explains transportation and travel expenses related to VA medical care for veterans with spinal-cord injury/dysfunction (SCI/D). Part One (February 2001) covered basic guidelines, transportation for outpatient treatment, and "deductible provisions."
Hospital, Domiciliary, and Nursing-home Care
The regulation governing transportation incident to hospital, domiciliary, and nursing-home care is quite specific. But one part is more useful and interesting than the others:
"Eligible spinal-cord-injury patients will be paid or reimbursed for necessary travel expenses to obtain admission to the following VA healthcare facilities:
* The closest [one] with an available bed.
* The closest [one] having an available bed on an appropriate SCI service. If the patient requests admission to a more distant VA healthcare facility, necessary travel can be authorized; however, reimbursement will be limited to the amount equal to the cost of travel to the closer hospital with SCI service."
Eligible SCI/D veterans falling under VA's Nursing Home Care Program also are eligible for reimbursement for necessary care-related travel expenses. This would include eligible SCI/D veterans who reside in community nursing homes. An example of this allowance would be if transportation is needed for obtaining prosthetics services on an outpatient basis.
This could also be for travel expenses to a community nursing home in a patient's permanent residential area when he or she must be there to qualify for community assistance (financial) if VA-authorized nursing-home care is discontinued.
Also, transportation will be authorized if required for admission of a patient already in a community nursing home but transferring to a VA healthcare facility.
Interfacility transfer refers to transportation to take a patient from one healthcare institution to another. Such transfers will be considered only under three conditions:
* Both facilities must agree to furnish the treatment at VA expense.
* The transfer must be necessary for continuation of such VA treatment.
* The transferring facility can't provide the necessary services.
Interfacility transfers can be from any VAMC, nursing home, domiciliary or outpatient clinic, and even from any healthcare facility if VA has contracted with them for care.
These transfers can take place when veterans need inpatient or outpatient treatment. However, this applies to transfers from outpatient facilities to other facilities only if the patient's condition is acute and it would be medically inappropriate to send him or her home before to the other medical facility. Interfacility transfers do not apply when veterans are simply referred to other facilities for ongoing treatment or if they would normally be sent home to wait admission or care.
According to VA regs, travel expenses and related accommodations necessary are the responsibility of the releasing facility.
Another important VA-manual provision says, "Under no circumstances will an outpatient be admitted solely for the purpose of speeding up a transfer from one facility to another facility for inpatient care." Patients often ask physicians to admit them for this purpose and, as you can see, doctors are not able to accommodate that request.
A word to the wise: It is in your best interest to make every effort to never do anything without VA's authorization! Do not anticipate VA will understand your circumstances if your situation does not meet department criteria. Pre-approval will almost always minimize--if not eliminate--your problems.
Always get the name of any VA person with whom you speak! Regardless of whether you talked to someone who granted or denied something for you, having a name to start with will be extremely valuable if any problems arise.
What if a problem develops? Sometimes administrative mistakes may prevent veterans from securing VA reimbursement for beneficiary travel. In some instances the local PVA national service officer (NSO) can perfect an appeal, and favorable findings may result in reimbursement for the veteran. The crux of the entire beneficiary-transportation issue is to contact the local PVA NSO for assistance as quickly as possible.
A good rule of thumb is to always let your PVA NSO know what you are applying or asking for beforehand. This way you can benefit from his or her knowledge and guidance and, in most cases, actually avoid a problem. NSOs are here to serve you!
Bobbie Suresch Holloway is a PVA NSO in Waco, Tex.
If you have a question you would like answered, send it to Veteran Advisor, Veterans Benefits Department, 801 Eighteenth Street, NW, Washington, DC 20006. All inquiries will be answered, but only those of general interest to our readers will be published.
Question: I am the widow of a veteran who died almost two years ago. My neighbor, who is also a veteran's widow, says she receives medical care through the Department of Veterans Affairs (VA). How do I obtain medical treatment through VA?
Answer: Your neighbor is referring to VA Civilian Health and Medical Programs (CHAMPVA). Not all surviving spouses or beneficiaries are eligible for CHAMPVA benefits. This program is closed to people eligible for TRICARE (formerly CHAMPUS) or Medicare Part A (age 65).
CHAMPVA's benefit doors are open to the following individuals:
* Dependents of a veteran VA rated as having a total and permanent service-connected disability
* Surviving spouse or child of a veteran who died as a result of a VA-rated service-connected condition, or who at time of death was rated permanently and totally disabled from a service-connected condition
* Surviving spouse or child of a veteran who died in line of duty and whose death was not due to misconduct
To be eligible for CHAMPVA benefits, a veteran's dependents or surviving spouse or child must establish their legal relationship to the veteran (sponsor) with the VA Regional Office (VARO). This usually occurs when the VARO approves a claim for survivor benefits. A spouse/surviving spouse's divorce or remarriage does not affect children's eligibility, except for stepchildren whose relationship ceases when they leave the sponsor's household. Students aged 18-23 are eligible for CHAMPVA benefits only if the school submits a certification of full-time enrollment each school term. Full-time enrollment is 12 credit hours per semester or the equivalent number of credit hours on any academic calendar. CHAMPVA does not accept pre-enrollment letters, because it considers them as letters of intent rather than certification of attendance.
Under CHAMPVA, VA shares the cost of most healthcare services and supplies that are medically necessary. CHAMPVA is always the secondary payer, except when it is coupled with Medicaid or policies purchased as supplements to CHAMPVA. People eligible for CHAMPVA should contact the local VA medical center (VAMC) to see if it is offering selective healthcare services under the CHAMPVA In-house Treatment Initiative (CITI). Not all VAMCs have sufficient staff to provide treatment to CHAMPVA beneficiaries.
As with any health insurance policy, CHAMPVA has detailed requirements for eligibility, preauthorizations, selection of healthcare providers, inpatient and outpatient coverage, and filing of claims. An excellent Web site, www.va.gov/hac/champva /champva.htm, gives a comprehensive overview on CHAMPVA and provides access to a list of frequently asked questions and a copy of the CHAMPVA Handbook.
Beneficiaries may apply for CHAMPVA benefits by using VA Form 10-10D, a copy of which is at www.va.gov/forms/medical; type in "CHAMPVA" as the key search word. You may also obtain the form via a telephone or written request at the following source:
VA Health Administration Center, CHAMPVA
P. O. Box 65023 Denver, CO 80206-9023 (800) 733-8387 (toll-free) / (303) 331-7804 (fax)
We have forwarded your letter to your local PVA national service officer (NSO). Do not hesitate to contact your NSO to discuss this--or any other --benefit issue.
RICHARD GLOTFELTY Associate Executive Director, Veterans Benefits
Effective October 1, 2001, military retirees and their dependents are eligible for lifetime participation in TRICARE Extra and TRICARE Standard. In the future, the Department of Defense (DOD) may allocate lifetime coverage to TRICARE Prime.
Until now, beneficiaries lost TRICARE eligibility at age 65 and had to transition into Medicare ("Tricare: What's in it for You?"-April 1997). The one exception has been the Uniform Services Family Health Plan (USFHP) version of TRICARE Prime, which allows lifetime coverage ("Uniform Services Family Health Plan," Veterans Benefits, PVA in Action, December 1999).
"TRICARE-for-Life" has three important considerations:
* Enrollment is not effective until October 1, 2001
* Participants must have Medicare Part B coverage for primary insurance coverage and use TRICARE for remaining medical expenses that Medicare does not cover
* Participants' current address must be on file with the Defense Enrollment Eligibility Reporting System (DEERS)
Several avenues exist for updating DEERS address information:
* MHS/TRICARE Web site at www.tricare.osd.mil/DEERSAddress/
* Nearest military personnel office with an ID-card facility
* Local military treatment facility
* The Defense Manpower Data Center Support Office (DSO) telephone center, (800) 538-9552 (the best time is between 9:00 a.m. and 3:00 p.m. [Pacific Time], Wednesday through Friday)
* Mail address change to DSO, Attn: COA, 400 Gigling Road, Seaside, CA 93955-6771
* Fax address change to DSO, Attn: COA at (831) 655-8317
* Send an e-mail message to addrinfo@osd.Pentagon.Mil
Messages should be lower-case only and include sponsor's name, Social Security and telephone numbers, name(s) of beneficiaries affected by address change, and effective date for the change.
To update DEERS information other than address changes, contact the nearest military ID-card issuing facility to determine required documentation. You may also mail or fax appropriate documentation to the DSO (see above), and include an attention line, Attn: R&A. Requests received without the required documentation are returned unprocessed.
Although participants 65 and older will have no annual enrollment fees for TRICARE Extra or Standard, they will be responsible for Medicare's monthly premium. If you do not have Medicare Part B coverage and miss Medicare's open-enrollment period this year, you will not be eligible for "TRICARE-for-Life" until July 1, 2002. Medicare's open enrollment period for 2001 will end March 31, 2001. Except in special cases, your Medicare Part B premium will increase by 10% for each 12-month period that you were eligible for Medicare Part B but chose not to participate.
For information on Medicare enrollment, beneficiaries may contact the Social Security Administration (SSA), (800) 772-1213 (toll-free)/(800) 325-0778 (TTY/TDD). Additional information is available on www.medicare.gov / www.ssa.gov / www.tricare.osd.mil.
If you have questions about this or any benefit issue, contact your local PVA Service Office.
The Veterans Benefits Department provides this section to update readers on significant benefit changes or resources. These brief updates are intended only to familiarize you with topics appearing in this section. Your local national service officer (NSO) is available to provide more in-depth information.
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|Title Annotation:||part two; Who picks up the tab?|
|Author:||Holloway, Bobbie Suresch|
|Publication:||PN - Paraplegia News|
|Date:||Mar 1, 2001|
|Previous Article:||Research & Education.|
|Next Article:||Service Office Roster.|