Presentation is loading. Please wait.

Presentation is loading. Please wait.

VSO outreach presentation September 2013.  What’s New In The PMC  Fully Developed Claim (FDC) presentation  Assisted living versus Independent living.

Similar presentations


Presentation on theme: "VSO outreach presentation September 2013.  What’s New In The PMC  Fully Developed Claim (FDC) presentation  Assisted living versus Independent living."— Presentation transcript:

1 VSO outreach presentation September 2013

2  What’s New In The PMC  Fully Developed Claim (FDC) presentation  Assisted living versus Independent living  Relaxed Dependency evidence requirements for surviving spouses  Changes in rules for paying service- connected burial benefits  Eligibility Verification Report program termination

3  Rating & Maintenance Processing Teams ◦ Teams 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  Advocacy Team ◦ Formerly 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  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  Describe the contents of the VA Form EZ and VA Form EZ  Define the criteria to qualify for participation in the FDC program  Define the criteria for subsequent exclusion from the FDC program

7 VA Form EZ  A new version of the VA Form EZ (dated August 2011) is divided into two parts:  The Veteran notice  This explains requirements for Pension benefits that would have previously been in any initial development letter  The FDC Application  This is a 5-page form Note: 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 – EZ  To 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 Attendance  or 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 EZ  The VA Form EZ was released in 2012 and is also divided into two parts:  The claimant notice  This explains requirements for Pension, DIC and accrued benefits that would have previously been in any initial development letter  The FDC Application  This is a 5-page form

10 FDC Criteria – EZ  To 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 certificate  If claiming pension All necessary income and net- worth information  If claiming aid and attendance or housebound benefits for either DIC or Death Pension  A 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 claimant  The 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 Claim  Note: A claim will not be excluded from this program due to normal delays built into development for evidence in Federal custody

12  Describe the contents of the VA Form EZ  Define the criteria to qualify for participation in the FDC program  Define the criteria for subsequent exclusion from the FDC program Questions?

13  Overview of history.  Overview of definitions.  Outline of recent changes implemented. Press release 12/20/12

14  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 2012 and provided some clarification.

15  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  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  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  Meal preparation,  Shopping or traveling with the individual  Providing security monitoring  Housework, other chores, etc.  Are NOT considered basic self-care activities of daily living Services such as these would not make the facility fees deductible.

19  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  Overview of history.  Outline of recent changes implemented.

21  variations  Until 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 award  VA Fast Letter was released in March 2013 and relaxed this guidance.

22  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  Normal evidence requirements  A complete marital history of both the Veteran and surviving spouse, which would include ◦ Names of all prior marriage partners ◦ How 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 started ◦ A statement regarding continuous cohabitation and, ◦ A statement indicating whether the surviving spouse has remarried since the Vet’s passing. .

24  Overview of history.  Outline of recent changes implemented. Questions?

25  Overview of history.  Outline of recent changes implemented.

26  variations  Until 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 2013 and relaxed this guidance.

27  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  Overview of history.  Outline of recent changes implemented. Questions?

29  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  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 Questions?

32 Special Inquiry Phone Queue: Special Inquiry Phone Queue: Addresses: Addresses:

33

34 FY12 Receipts: 309,861

35 FY12 Completions: 281,999

36 FYTD Receipts: 113,632

37 FYTD Completions: 101,239

38

39

40

41 Pre-ConsolidationFY 03EOFY 12 Less than 50% (Authorization Nationally) 74% (Authorization)97.24% (Authorization) 96.65% (Rating) National STAR Review Local Quality Review Individual Performance Quality Review Quality Team All findings are used to develop annual refresher training.

42  Philadelphia Pension Call Center answered an average of 37,000 calls per month  Average speed of answer: 6 minutes, 21 seconds  Virtual Hold System: ◦ 50% acceptance rate ◦ 93% successful reconnect rate  Abandoned call rate is 15.4%  Average length of call 10 min 30 sec


Download ppt "VSO outreach presentation September 2013.  What’s New In The PMC  Fully Developed Claim (FDC) presentation  Assisted living versus Independent living."

Similar presentations


Ads by Google