VA Spina Bifida Benefits
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- Jonas Reynolds
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1 Spina Bifida
2 VA Spina Bifida Benefits Overview The Department of Veterans Affairs (VA) provides monetary allowances, vocational training and rehabilitation and VA-financed health care benefits to certain Korea and Vietnam Veterans birth children who have been diagnosed with spina bifida. For the purpose of this program, spina bifida is defined as all forms or manifestations of spina bifida (except spina bifida occulta). Effective October 10, 2008, there was a change to Public Law , Section 408, which outlines the benefits available under the Spina Bifida Program. As a result of this change, medical services and supplies for spina bifida beneficiaries are no longer limited to the spina bifida condition. This program now covers comprehensive health care considered medically necessary and appropriate. The VA s Health Administration Center in Denver, Colorado, manages the Spina Bifida Health Care Program, including the authorization of benefits and the subsequent processing and payment of claims. Contact us if you have questions. Monthly Monetary Allowance Spina bifida benefits are based on eligibility determinations made by the
3 Denver VA Regional Office. VA will determine the current level of disability upon receipt of both medical and lay evidence and a completed Application for Spina Bifida Benefits (VA Form ). The completed form and competent medical evidence should be returned to: Department of Veterans Affairs Veterans Service Center (339/21) Box Denver CO Vocational Training VA s Vocational Rehabilitation and Employment Service is available if it is reasonably feasible for the eligible child to achieve a vocational goal. The applicant must be a child: To whom VA has awarded a monthly allowance and For whom VA has determined that achievement of a vocational goal is feasible.
4 Medical Benefits Eligibility for VA spina bifida health care benefits are limited to: A birth child of a Korea Veteran, regardless of age or marital status, who was conceived after the date on which the Korea Veteran first served in or near the Korean demilitarized zone during the period beginning on April 1, 1968, and ending on August 31, A birth child of a Vietnam Veteran, regardless of age or marital status, who was conceived after the date on which the Vietnam Veteran first entered the Republic of Vietnam during the period beginning on January 9, 1962, and ending on May 7, Detailed program material addressing covered and non-covered services and supplies, preauthorization requirements and claim filing instructions will be automatically furnished to all program beneficiaries after the Denver VA Regional Office awards benefits.
5 Provider Options Beneficiaries may select the provider of their choice as long as the provider is an approved health care provider. The provider must be approved by the Centers for Medicare and Medicaid Services, Department of Defense TRICARE program, CHAMPVA, JCAHO or may be a health care provider approved for providing services pursuant to a state license or certificate. A provider is not required to contract with the HAC; the HAC does not maintain a list of providers. In addition to approved private providers, some services may also be obtained from VA health care facilities. Contact the VA in your area to see if they have space available to provide treatment. It s up to the local VA health care facility to decide if they can provide the care you need. Preauthorization Requirements Although most health care services and supplies do not require approval in advance (preauthorization), some do. Preauthorization is NOT required for routine health care services and supplies.
6 Preauthorization IS required for: Attendants Dental services Durable medical equipment with a total rental or purchase price in excess of $2,000 Mental health services Hospice care Substance abuse treatment Training of family members Transplantation services Travel (other than mileage for privately owned automobiles for local travel) Note: When in doubt, contact the HAC.
7 Assistance Eligibility & Application Information Telephone Please go to and follow the directions for submitting via IRIS Web site and select Spina Bifida Health Care Benefits Information Telephone Please go to and follow the directions for submitting via IRIS FAX Web Site Mail Spina Bifida Health Care Benefits PO Box Denver CO
8 Department of Veterans Affairs Health Administration Center Spina Bifida Health Care Benefits PO Box Denver CO
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