navigating the complex but amazing journey benefits ...helminthiasis, malnutrition (including optic...

3/9/2020

1

Navigating the Complex but Amazing Journey through VA Benefits

Derenda Lovelace , MSN, RN-BC, CM Sandra Filiault, BSN, RN, CCM

Hematology/Oncology Care Coordinator National CMSA Dod/VA Advisor VAMC WRJ, VT

Navigating the Complex but Amazing Journey through VA Benefits

Derenda Lovelace , MSN, RN‐BC, CMPresident CVC CMSA & National CMSA DoD/VA AdvisorCVC CMSA Spring ConferenceMarch 19, 2020

Identifying your Veteran and understanding how Veterans qualify for VA benefits

Identify Veteran groups that may qualify for “presumptive” disability benefits

Describe the Mission Act and how it improves Veterans access to healthcare

Discuss additional VA programs and benefits that assist case managers and Social Workers in directing Veterans healthcare.

Objectives

DisclosuresThere are no conflicts of interestNo financial relationships or partneringNo commercial support or sponsorship

Non‐endorsement of products discussed/displayed in conjunction with this activity (disclosure applicable when products present)

Disclaimer

The views presented here belong to the presenter and do not represent the views of the US Government or the VA.

Disclosures and Disclaimer

1

2

3

3/9/2020

2

There are three components:

Veterans Health Administration (VHA)

Veterans Benefits Administration (VBA)

National Cemetery Administration (NCA)

Department of Veteran Affairs

“A Veteran is a person who wrote a blank check payable to: ‘The United States of America’ for an amount of: ‘up to and including my life’.”

I earned this distinction

My service speaks of courage and sacrifice in the face of mortal danger

My service speaks of compassion and heartbreak in the wake of the terrible cost of war

My service speaks of love of country and of a belief in America.

I am a Veteran

4

5

6

3/9/2020

3

“Have you served in the U.S. Military? Army, Navy, Air Force, Marines, or Coast Guard?”

“Where has your Veteran served?”

“Do you receive healthcare services in the Veterans HealthcareSystem?”

Identifying Your Veterans

Discharged or released under conditions other than dishonorable

Served on active status with the military, naval, or air service may qualify for VA health care benefits including qualifying Reserve or National Guard

Veteran Eligibility

Service‐connected (SC)Veteran: A Veteran who has an illness or injury incurred in or aggravated by military service as determined by VA

Non‐service connected (NSC) Veteran: A Veteran who has been discharged from active military duty and does not have a VA adjudicated illness or injury incurred in or aggravated by military service.

Service‐Connected vs Non‐Service Connected

7

8

9

3/9/2020

4

Apply online for VA health care. https://www.1010ez.med.va.gov

Local VA Medical Center eligibility office

Forms may be mailed to Veteran

If the Veteran does not have a copy of their DD214 (proof of service)

http://www.archives.gov/veterans/military‐service‐records/

Applying for VA Healthcare

Veterans are not automatically enrolled in the VHA system

The categories of Veterans who can be enrolled in VHA programs are determined by the amount of money Congress gives VA each year

Due to limited funds, VA set up Priority Groups to make sure that certain groups of Veterans can be enrolled before others

VHA Enrollment

Enrollment Priority Groups (1‐8) with 1 being the highest priority

Based on the level of a veteran’s needs and how much it will cost the VA to treat them

The veteran is placed in the highest group that they qualify for

The copay will change depending on what priority group the veteran is assigned to

Priority Group Assignment Based on SC/NSC

10

11

12

3/9/2020

5

Assigned to a Primary Care Team (PACT)

Providers

Nurses

SW & CM

Medical support assistants

Mental Health

Gateway to Care and Services

“Presumptive” Service Connection

VA presumes that certain disabilities were caused by military service. If a presumed condition is diagnosed in a veteran in a certain group, they can be awarded disability compensation

“Presumptive” Conditions

Veterans diagnosed with a chronic disease (ex., arthritis, diabetes or hypertension) within one year of active duty release, should apply for disability compensation

If a veteran served continuously for at least 90 days and was diagnosed with amyotrophic lateral sclerosis (ALS) after discharge, they can establish service connection for the disease

Presumptive Disability Benefits

Former prisoners of war

Vietnam Veterans to include Blue Water Navy

Atomic Veterans

Gulf War Veterans

Camp Lejeune Water Contamination

Presumptive Disability Groups

13

14

15

3/9/2020

6

Condition that is at least 10 percent disabling

Imprisoned for any length of time: Mental health disorder, organic residuals of frostbite, post‐traumatic osteoarthritis, heart disease or hypertensive vascular disease, stroke and residual effects

Imprisoned for at least 30 days: beriberi, chronic dysentery, helminthiasis, malnutrition (including optic atrophy), pellagra, other nutritional deficiencies, IBS, PUD, peripheral neuropathy, cirrhosis of the liver

Former Prisoners of War

Exposed to Agent Orange

Served in the Republic of Vietnam between Jan. 9, 1962, and May 7, 1975

Conditions: AL amyloidosis‐cell leukemia, CLL, Type 2 DM, Hodgkin’s disease, non‐Hodgkin’s lymphoma, IHD, Parkinson’s disease, prostate CA, respiratory Cas, soft tissue sarcoma (not including osteosarcoma, chondrosarcoma, Kaposi’s sarcoma or mesothelioma)

The following if they become greater than 10% disabling w/in year of exposure to herbicide agent: acute and subacute peripheral neuropathy, chloracne or other similar acneiform disease, porphyria cutanea tarda

Vietnam Veterans

Exposed to ionizing radiation and experienced one of the following:

Participated in atmospheric nuclear testing

Occupied or were prisoners of war in Hiroshima or Nagasaki

Served before Feb. 1, 1992, at a diffusion plant in Paducah, Kentucky, Portsmouth, Ohio or Oak Ridge, Tennessee

Served before Jan. 1, 1974, at Amchitka Island, Alaska

Conditions: all leukemias except CLL, multiple cancers, multiple myeloma, lymphomas other than Hodgkin’s disease

Atomic Veterans

16

17

18

3/9/2020

7

Served in the Southwest Asia Theater of Operations

Have a condition that is at least 10 percent disabling by Dec. 31, 2021

Conditions: medical unexplained chronic multiple symptoms that exist for six months or more (chronic fatigue syndrome, fibromyalgia, IBS and others as determined by Secretary of VA Affairs

Signs or symptoms of undiagnosed illness (fatigue, skin symptoms, headaches muscle pain, joint pain, neurological symptoms, sleep disturbance, GI symptoms

Gulf War Veterans

SMs, Reserve & National Guard members stationed at Camp Lejeune from Aug. 1, 1953 to Dec. 31, 1987

Served a minimum of 30 days (simultaneous or cumulative) during the above time period

Suffering from 8 “presumptive illnesses”: adult leukemia, bladder, liver or kidney CA, multiple myeloma, non‐Hodgkin’s lymphoma, Parkinson’s disease

Camp Lejeune Water Contamination

Examples of Two Veteran’s with Presumptive Conditions and Presumptive Connections

Eligibility: SERVICE CONNECTED 50% to 100% Status: VERIFIEDS/C %: 100

S/C Disabilities: IMPAIRED HEARING 0% SCTINNITUS 10% SCHODGKINS DISEASE 100% SCNEOPLASM, MALIGNANT, GENITOURINARY 80% SC

Eligibility: SERVICE CONNECTED 50% to 100% Status: VERIFIEDS/C %: 100

S/C Disabilities: IMPAIRED HEARING 10% SCPOST-TRAUMATIC STRESS DISORDER 100% SC

19

20

21

3/9/2020

8

153 VA Medical Centers

820 Outpatient sites*

*Includes Community Based, Mobile, and Independent Outpatient Clinics

Nation’s Largest Integrated Health Care System

Readjustment Counseling Centers (Vet Centers)

Domiciliary Residential Rehabilitation Treatment Programs

Community Living Centers

Veterans Integrated Service Networks (VISNs)

VISN 6: Mid‐Atlantic Health Care Network

22

23

24

3/9/2020

9

Historically there has always been a community care benefit for those Veterans who qualify for VA to pay for their care in the community

Fee Program (Prior to Choice to pay for Veterans who qualified for care that VA could not provide such as a service‐connected condition)

Choice program started in 2014 to quickly expand access to care for Veterans s/p identifying long wait times within some VAMC

Office of Community Care was developed at the time of the Choice Program

Mission Act went into effect on June 6th, 2019. Improves and expands the services provided under the Choice program

Veterans Community Carenow the Mission Act

Veteran needs to be enrolled in VA Health Care to use Community Care Benefits

In most instances VA must authorize your care before you receive it

Six different eligibility criteria for community care

Meeting any one of these criteria for the specific care you need means you are eligible to elect to receive that care either through direct VA care or a community provider in VA’s network

Mission Act

1: Veteran needs a service that is not available at VA (e.g., Maternity care, IVF)

2: Veteran resides in a U.S. state or territory without a full‐service VAmedical facility (AK, HI, NH, and the US territories of Quam, AmericanSamoa, Northern Mariana Islands, and the U.S. Virgin Islands)

3: Veteran was eligible under the distance criteria under the Veterans Choice Program on the day before the VA MISSION Act was enactedinto law (06/6/2018), lives in one of the five states with the lowestpopulation (ND, SD, MT. AK, WY)or continues to meet the distancecriteria, received care between 06/6/2017, and 06/06/2018, andrequires care before 06/06/2020

Mission Act Eligibility

25

26

27

3/9/2020

10

4: Veteran meets specific access standards for average drive time or appointment wait‐times (Important: Access standards are not yet final)

Average Drive time to a specific VA Medical Facility:

– 20 min Average drive time for PCP, MH, and non‐institutional extended care services

– 60 min average drive time for specialty care

Appointment wait time at a specific VA medical facility:

– 20 days for PC, MH, and non‐institutional extended care services, unless the Veteran agrees to a later date in consultation with their VA health care provider

– 28 days for specialty care from the date of request, unless the Veteran agrees to a later date in consultation with their VA health care provider


5: Veteran and their referring clinician agree that it is in the Veteran’s best medical interest to be referred to a community provider

6: Veteran needs care from a VA medical service line that VA determines is not providing care that complies with VA’s quality standards


Collaboration and Communication

28

29

30

3/9/2020

11

BenefitsWhere Do We Begin and Is There an End?

DisabilityEducation and training

Pensions

Service Connected

Non‐Service ConnectedFamily and Caregiver

VisionDental

Disability Housing and Home Modification Grants

Fiduciary Services

VA Nursing homes

Assisted Living

Home Health Care

Durable Medical Equipment

Vocational Rehabilitation and Employment

Aid and AttendanceVA Home Loans

Survivor and dependent Compensation

Transportation

Catastrophically Disabled

Long Term CareRehabilitation

HISA Grant

Vehicle Modification

Driver evaluation

Extensive Mental Health Services

Surgeries

Medical treatments

Kidney dialysis

Acute care (short‐term treatment for a severe illness or injury or after surgery)

Specialized care (including organ transplants, intensive care for mental and physical conditions, and care for traumatic injuries)

Inpatient Hospital Services

Health exams (including gender‐specific exams)

Women’s Comprehensive Care

Health education (including nutrition education)

Immunization against infectious diseases (like flu shots)

Counseling on genetic diseases (diseases that run‐in families)

Preventive Care Services

Basic Health Care Services Through the VAfor SC and NSC Veterans

Urgent and emergency care in a VA hospital, outpatient clinic, or Vet Center

Emergency care in a non‐VA hospital, clinic, or other medical setting

Urgent care for minor injuries and illnesses, like pink eye or ear infections in non‐VA urgent care clinics

Mental health services to treat certain issues like posttraumatic stress disorder (PTSD), military sexual trauma (MST), depression, and substance use problems


31

32

33

3/9/2020

12

Specialty Care: All routine specialty care such as cardiac, nephrology, oncology, hematology, vascular, orthopedics etc., as well as polytrauma and spinal cord injury

Prescriptions written by a VA doctor or CommunityCare provider through the MISSION Act


Home Based Primary Care

Transitional Care Program

Respite Care

Telehealth

Hospice/Palliative Care

Adult Day Health Care

Homemaker Home Health Aide

Skilled Nursing

SCI Bowel & Bladder Home Care

Veteran‐Directed Care

Home and Community Based Care

Nursing Homes

Community Living Centers (CLC)

Community Nursing Homes

State Veterans Homes

Residential

Assisted Living Facilities (ALF)

Residential Care (CRC)

Medical Foster Homes (MFH)

Home and Community Based Care

34

35

36

3/9/2020

13

Population Specific Programs

LGBTQ programs

Traveling Veteran Coordinated Care

Transition and Care Management

VIST programs for the Visually Impaired

Women’s Comprehensive Care Clinic

Tobacco Cessation

Recreational Therapy Programs

–Golden Games (This year in Anchorage Alaska)

–Sports Clinics such as skiing, skating, Rolfing, Fly fishing

Healthy Lifestyle Programs

MOVE programs for weight loss

Farmers Markets

Lodge program

Fitness Centers

Other Specialty Programs

The VHA Transportation Network

Mileage benefit for Veterans traveling to VA appointments independently

Links eligible Veterans with special needs to VHA medical services and benefits

Wide variety of vehicles Veterans eligible for VHA travel should contact their VAMC travel office

37

38

39

3/9/2020

14

DAV Transportation Network provides free transportation for Veterans to get to VA appointments

DAV donates vans where needed

Volunteers drive Veterans to and from VA hospitals and clinics

802‐274‐6395

“Honor America’s Veterans by providing exceptional health care that improves their health and well‐being.”

Thank your for joining us today. We look forward to working together for the Veterans in our community.

Contact information

Derenda Lovelace, MSN, RN‐BS, CM

President CVC CMSA

National CMSA DoD/VA Advisor

Phone: 804‐928‐2360

Email: [email protected]

40

41

42

3/9/2020

15

Apply online: https://www.1010ez.med.va.gov

DD214 (proof of Service): http://www.archives.gov/veterans/military‐service‐records/

Enrollment: http://www.va.gov/healthbenefits/resources/priority_groups.asp

National Cemetery Association: http://www.cem.va.gov/about/

Veteran Benefits: http://www.va.gov/healthbenefits/apply/veterans.asp &

http://www.benefits.va.gov/BENEFITS/about.asp

Veterans Health Administration: http://www.va.gov/health/aboutVHA.asp &

http://www.va.gov/directory/guide/division.asp?dnum=1 &

https://www.va.gov/health‐care/about‐va‐health‐benefits/

Bibliography/References

Veteran and VA Statistics:

http://www.va.gov/vetdata/docs/Quickfacts/Stats_at_a_glance_06_30_14.pdf &

http://www.va.gov/vetdata/docs/pocketcards/fy2014q4.pdf

Unique Veteran Users Report FY 2014 Prepared by the National Center for Veterans Analysis and Statistics March 2016:

http://www.va.gov/vetdata/Utilization.asp

Transitioning the Continuum of Care: www.NTOCC.org


Priority Groups: https://militarybenefits.info/va‐priority‐groups/#ixzz5rOTsqqbo

Presumptive Disability Benefits: https://www.benefits.va.gov/BENEFITS/factsheets/serviceconnected/presumption.pdf

Presumptive Conditions for Camp Lejeune Veterans: https://www.publichealth.va.gov/exposures/publications/gulf‐war/gulf‐war‐winter‐2017/camp‐lejeune.asp

VA Facility Directory: https://www.va.gov/directory/guide/home.asp

VISN 6: Mid‐Atlantic HCN: https://www.visn6.va.gov/about/index.asp

Services Offered by the VA: http://www.va.gov/opa/publications/benefits_book.asp


43

44

45

3/9/2020

16

Mission Act: https://www.va.gov/directory/guide/home.asp

Home and Community Based Care:

https://www.va.gov/GERIATRICS/guide/longtermcare/Home_and_Community_Based_Services.asp

Transportation:

DAV:www.dav.org/veterans/i‐need‐a‐ride

Veterans Transportation Program: www.va.gov/HEALTHBENEFITS/vtp

Pictures: www.emsoutdoors.com , https://www.nps.gov/appa/index.htm&

Illustration by Jacob Thomas – https://www.backpacker.com/skills/passfail‐off‐trail‐hiking


46

navigating the complex but amazing journey benefits ...helminthiasis, malnutrition (including optic...

Documents