Presentation on theme: "Pension Management Center"— Presentation transcript:
1 Pension Management Center VSO outreach presentationSeptember 2013
2 Agenda What’s New In The PMC Fully Developed Claim (FDC) presentation Assisted living versus Independent livingRelaxed Dependency evidence requirements for surviving spousesChanges in rules for paying service- connected burial benefitsEligibility Verification Report program termination
3 Pension Organization Changes: Rating & Maintenance Processing TeamsTeams now process the same terminal digit range but six exclusively process original claims (Veteran and survivor) and four exclusively processes maintenance claims.There is also a dedicated Burial/Fiduciary Team.
4 Pension Organization Changes: Advocacy TeamFormerly each team processed “special” claims internally along with general claims work.Now the advocacy team processes “special” claims from start to finish.Special Inquiry Phone Queue – the dedicated phone line has been expanded and is now staffed by the employees who process the special claims.Went into effect July 20, 2012.
5 Enhanced Screening Procedures Now Veteran’s AND survivor’s claims are being pre-screened.More “quick decisions” where development is not required to grant or deny the claim.More “directed development” to ask for the necessary information the first time.Less time waiting for claims folders when they are needed to make a final decision.
6 Objectives for Fully Developed Claim Presentation Describe the contents of the VA Form EZ and VA Form EZDefine the criteria to qualify for participation in the FDC programDefine the criteria for subsequent exclusion from the FDC program
7 VA Form EZA new version of the VA Form EZ (dated August 2011) is divided into two parts:The Veteran noticeThis explains requirements for Pension benefits that would have previously been in any initial development letterThe FDC ApplicationThis is a 5-page formNote: There is no longer a requirement to submit a separate certification. You simply need to sign the application, which authorizes consideration in the FDC program
8 FDC Criteria – EZTo participate the Veteran must submit the completed EZ along with all relevant and pertinent evidence to “fully develop” the claim, that is:For special monthly pension claims,a completed VA Form , Examination for Housebound Status or Permanent Need For Regular Aid And Attendanceor a completed VA Form, , Request For Nursing Home Information in Connection With Claim For Aid And Attendance.The Veteran must also be available to report for a VA examination, if required.
9 VA Form EZThe VA Form EZ was released in 2012 and is also divided into two parts:The claimant noticeThis explains requirements for Pension, DIC and accrued benefits that would have previously been in any initial development letterThe FDC ApplicationThis is a 5-page form
10 FDC Criteria – EZTo participate, the claimant must submit the completed EZ along with:All relevant and pertinent evidence to “fully develop” the claim, that is:A copy of the Veteran’s death certificateIf claiming pension All necessary income and net-worth informationIf claiming aid and attendance or housebound benefits for either DIC or Death PensionA completed VA Form , Examination for Housebound Status or Permanent Need For Regular Aid And Attendance, or, if claiming this benefit based on nursing home attendance, a VA Form, , Request For Nursing Home Information in Connection With Claim For Aid And Attendance.
11 FDC Exclusions A claim is no longer considered an FDC if the: Claim did not meet FDC criteria upon receipt or is found to require additional development such as requesting private medical evidence, or further evidence from the claimantThe claimant fails to report for an examination (unless VA is at fault)The claimant submits a supplemental claim or evidence after receipt of the FDC ClaimNote: A claim will not be excluded from this program due to normal delays built into development for evidence in Federal custody
12 Objectives for Fully Developed Claim Presentation Describe the contents of the VA Form EZDefine the criteria to qualify for participation in the FDC programDefine the criteria for subsequent exclusion from the FDC programQuestions?
13 Objectives for Residential living fees presentation: Overview of history.Overview of definitions.Outline of recent changes implemented.Press release 12/20/12
14 Residential facility fees There are more and more facilities which cater to an aging or elderly population.Many facilities provide differing levels of care.The deductibility of these fees has been something we have questioned.VA Fast Letter was released in October and provided some clarification.
15 Assisted living vs. Independent/Senior living Traditionally, VA defined an assisted living facility as a facility which did provide medical and/or nursing care to a resident.A RLF generally provides less care than an ALF, and normally does not provide any medical or nursing home type care.Fees from RLFs are generally for room and board only.New guidance on using fees from RLF as deductible medical expenses.
16 Accepting Independent Living Fees Room and Board expenses from an Independent/Senior living facility are now acceptable only if:The individual’s physician states in writing that the claimant must reside in that facility in order to separately contract for custodial care with a third- party provider (and contract for that care) Or…The facility provides the individual with custodial care in the form of assistance with two or more activities of daily living.
17 What are Custodial Care and Activities of daily living? Custodial Care: “assisting a person with activities of daily living”Activities of Daily living: “items of basic self- care which include; bathing or showering, dressing, eating, getting in or out of bed or a chair, and toileting”To accept fees facility must provide at least 2 of the above activities of daily living.
18 Non-medical related services Meal preparation,Shopping or traveling with the individualProviding security monitoringHousework, other chores, etc.Are NOT considered basic self-care activities of daily livingServices such as these would not make the facility fees deductible.
19 Independent Living allowances Prior to this guidance, there may have been situations where a deduction was allowed for a facility which would no longer meet the criteria for deductibility, with this new guidance.We will not be removing from consideration previously allowed fees, as this guidance is not intended to displace beneficiaries.However, if a beneficiary changed facilities, the new rules would apply
20 Objectives for relaxed dependency evidence requirements presentation: Overview of history.Outline of recent changes implemented.
21 Death claim dependency requirements variationsUntil recently, our processing guidelines stated that a surviving spouse must submit acceptable evidence establishing themselves as the surviving spouse, even if that claimant was previously established on the Veteran’s awardVA Fast Letter was released in March and relaxed this guidance.
22 Death claim dependency requirements Concede dependency when the evidence in VA records as of the date of the Veteran's death establishes the survivor's relationship with the deceased Veteran.Therefore, if the spouse was on the Veteran’s award at the time of the Vet’s passing, we only need:a statement: regarding continuous cohabitation and,a statement indicating whether they have remarried since the Vet’s passing.If the spouse was not recognized at the time of death, normal evidence requirements apply.
23 Death claim dependency requirements Normal evidence requirementsA complete marital history of both the Veteran and surviving spouse, which would includeNames of all prior marriage partnersHow each prior marriage ended (divorce, death, etc.)Where each prior marriage ended (city, state)When each prior marriage ended (month, year)How, Where, and When the marriage to the Veteran startedA statement regarding continuous cohabitation and,A statement indicating whether the surviving spouse has remarried since the Vet’s passing..
24 Objectives for relaxed dependency evidence requirements presentation : Overview of history.Outline of recent changes implemented.Questions?
25 Objectives for Service-connected (S/C) burial changes presentation: Overview of history.Outline of recent changes implemented.
26 S/C Burial requirements variationsUntil recently, our processing guidelines stated that we could only pay the service connected burial allowance if the Veteran’s death was in fact determined to be service- connected. If a surviving spouse was granted DIC under 1318 (10 years of 100% disability), then SC burial benefits would not be payable.VA Fast Letter was released in March and relaxed this guidance.
27 S/C Burial requirements Now, a claimant, who is entitled to DIC under section 1318 as if the Veteran’s death was service- connected, is also entitled to service-connected burial benefits. Do not develop for service connection for the cause of death in these cases for purposes of granting service-connected burial.Pay burial benefits (if otherwise in order) at the service-connected rate.
28 Objectives for S/C burial changes : Overview of history.Outline of recent changes implemented.Questions?
29 Termination of the Eligibility Verification Report program: In January 2013, a decision was made to terminate the Eligibility Verification Report program, which means that no claimants are required to submit an annual report to maintain their Pension benefits.Beneficiaries were notified soon thereafter.
30 Termination of the Eligibility Verification Report program: Beneficiaries must still report income and medical expense changes.Beneficiaries can still claim additional unreimbursed medical expenses for recalculation of benefits.Matching programs will be expanded to ensure that beneficiaries are properly reporting their income.
31 Termination of the Eligibility Verification Report program: Questions?
32 Special Access to: Philadelphia PMC Advocacy Team Special Inquiry Phone Queue:Addresses:
41 Quality National STAR Review Local Quality Review Pre-ConsolidationFY 03EOFY 12Less than 50%(Authorization Nationally)74% (Authorization)97.24% (Authorization)96.65% (Rating)National STAR ReviewLocal Quality ReviewIndividual Performance Quality ReviewQuality TeamAll findings are used to develop annual refresher training.
42 National Pension Call Center (NPCC) FY 12 Philadelphia Pension Call Center answered an average of 37,000 calls per monthAverage speed of answer: 6 minutes, 21 secondsVirtual Hold System:50% acceptance rate93% successful reconnect rateAbandoned call rate is 15.4%Average length of call 10 min 30 sec