Pension Management Center

Transcription

1 Pension Management Center Heidi Schweitzer-Taavao, Assistant Pension Center Manager September 2014

2 Excellent Year! End of FY13 September 19, ,266 claims pending 113 ADP (all end products) 20,503 claims pending, down 43% 53 ADP (all end products), down 53% *The PMC began brokering in 500 Rating EPs and EPs from the Philadelphia PMC since April. We have continued to broker claims from Philly at the same rate, along with some of their Notice of Death messages, and we will continue until further notice. *The Milwaukee PMC sent a Help Team to the Philadelphia PMC for 5 weeks (2/24/14 3/28/14) to assist with claims processing. 1

3 Contact Information The Milwaukee PMC has a direct line and address FOR VSOs to inquire about the current status of expedited claims. We consider the following to be Priority One Claims requiring expedited processing: Medal of Honor Homeless Terminal Illness POW, GWOT, Seriously Injured (SI)/Very Seriously Injured (VSI) Severe Financial hardship The number is: and PMCVSO.VBAMIW@va.gov This number and are answered by employees on our Advocacy Team who also process these priority claims. 2

4 Submitting a Claim Milwaukee PMC Address Department of Veterans Affairs Pension Management Center PO Box Milwaukee, WI OR Virtual VA Fax number Reminder: Please do not fax in multiple claimants at once. Send them in as separate faxes because splitting documents is time consuming and can delay claims processing. 3

5 Virtual VA Fax On Virtual VA Homepage, go to Fax Coversheet Generator Fax Number: Total Pages: x Sender Information User Name: Representative User Name Full Name: Representative Name Phone Number: Fax Date: 09/23/2014 Document Information VA File Number: Veteran Name: Example Veteran Date of Receipt: 09/23/2014 Document Type: Select from drop down 4

6 Virtual VA Fax Click generate coversheet button Click print icon at the bottom of the page Place printed coversheet on top of the documents and fax to fax number Note: There is an instructional video on the Virtual VA homepage You can fax it to the new VVA number without the fax cover sheet it will take a day to get in 5

7 How can you help us? Please be careful when submitting claims. Please ensure that the claim contains sufficient information to identify the Veteran. A VA file number, SSN, and service number helps us associate the claim with the proper Veteran s record Remind claimants that they need to report income to us immediately. This is especially important because we no longer require submission of an annual Eligibility Verification Report, and we only receive FTI currently on original claims. When filing a claim, please have the claimant only report what they are actually paying for attendant fees, not the amount they would be paying if VA pension was granted. This will generate an improper increased rate if the claimant does not pay the reported amount. The claimant can submit paid unreimbursed medical expenses at any time for an increase to their VA pension rate. 6

8 Fully Developed Claims (FDC) Program Over 50% of original claims received are Fully Developed Thank you! 7

9 Fully Developed Claims (FDC) Program 8

10 Fully Developed Claims (FDC) Program 9

11 Fully Developed Claims (FDC) Program The Fully Developed Claims Program is a voluntary program that enables Veterans and their families to: Submit all evidence and medical records (both private treatment records and records available at a Federal facility) at the time of claim submission, and Certify he or she has no further evidence to submit. When an FDC is filed, VA is able to expedite the claim which: Benefits Veterans, Decreases the amount of time VA spends developing a claim, and Contributes to reducing the claims backlog. 10

12 FDC Forms VA Form EZ: Veteran s Pension claim VA Form EZ: Survivor s Dependency and Indemnity Compensation (DIC), Death Pension, and/or Accrued Benefits claim. The updated VA Forms are comprised of two main parts: The Notice The Application Please note: The application part of the new forms needs to be completely filled out and submitted to the Pension Management Center. 11

13 Helpful Hints The claimant should have access to the following information to apply: Discharge or separation papers (DD214 or equivalent), AND Private medical evidence relevant to the claim and treatment dates, AND Dependency records **The Veteran must also identify any relevant treatment records held at a federal facility, such as a VA medical center. VA will still complete the following development on an FDC: Request any identified federal records that the Veteran identified and authorized (service treatment records, VAMC records, personnel records, Social Security records) Request a VA exam and opinion, if necessary to decide the claim. Please note: Submitting original or certified DD 214s with application may help expedite processing of claim because there is a delay in receiving a response from PIES. 12

14 FDC: Non-Service Connected Pension VA Form EZ, Application for Pension Necessary to apply: Submit claim on a signed and completed VA Form EZ All necessary income and net-worth information; AND All, if any, relevant, private medical treatment records Identification of any relevant treatment records available at a Federal facility, such as a VA medical center Report for any VA medical examinations VA determines are necessary to decide claim 13

15 FDC: Non-Service Connected Pension VA Form EZ, Page 3 14

16 FDC: Non-Service Connected Pension VA Form EZ, Page 3 15

17 Income and Net Worth VA Form EZ, Page 7 16

18 Additional Forms VA Form EZ, Page 1 17

19 FDC: Dependency and Indemnity Compensation (DIC) VA Form EZ, Application for DIC, Death Pension, and/or Accrued Necessary to apply: Submit claim on a signed and completed VA Form EZ A copy of the Veteran's Death Certificate All, if any, relevant, private medical treatment records Identification of any relevant treatment records available at a Federal facility, such as a VA medical center, that support claim Any and all Service Treatment and Personnel Records 18

20 FDC: Dependency and Indemnity Compensation (DIC) VA Form EZ, Page 3 19

21 FDC: Dependency and Indemnity Compensation (DIC) VA Form EZ, Page 1 20

22 FDC: Dependency and Indemnity Compensation (DIC) VA Form EZ, Page 7 21

23 Complete Marital Information VA Form EZ, Page 8 22

24 Exclusions from FDC A claimant can be excluded from the FDC Program for various reasons, including: Further evidence is needed from the claimant or an identified private medical provider. The claim requires any development except: Records in the custody of the Federal government Claimant-identified Federal treatment records such as VAMC treatment records The Veteran fails to report for a VA exam. VA receives any of the following after receipt of the FDC: supplemental claim, additional evidence, Notice of Disagreement (NOD) on any claim If you request VA assistance in gathering medical evidence by completing VA Form , Authorization and Consent to Release Information to the Department of Veterans Affairs, the claim will not be processed as an FDC. 23

25 IRS & SSA 24

26 Reference & Explanation FL Upfront Verification of Income Using Internal Revenue Service and Social Security Administration Records (October 30, 2013) This new upfront verification process involves using Federal Tax Information (FTI) obtained from IRS and SSA to process a claim. The fast letter requires a three year look-back period for all newly established claims coming in for initial benefits (187 and 197 End Products). We now will also use the FTI on reopened claims if it was considered on the original claims. This is to help verify potential income and reduce the amount of improper payments made due to a claimants failure to report income and net worth. Hardship, Terminal, Homeless and POW claims can be expedited without waiting for FTI data. However, we are required to use the FTI if it becomes available any time prior to authorization (this includes sending development if required). 25

27 Income Scenarios If pension can be granted using the countable income reported by IRS, that income will be used on the award, and the claimant will be notified. If pension cannot be granted using the income reported by IRS, and the claimant did not report that income, the PMC will initiate further development. If development is necessary, the claimant needs to submit a document or statement showing they are no longer in receipt of the income. If no response is received, we will deny for failure to respond. FTI may prompt net worth development. 26

28 FTI examples 27

29 Burial Benefits 28

30 Burial Allowance Eligibility Effective July 7, 2014, burial payments of $ or $2, for SC death are paid automatically if the surviving spouse was on the Veteran s award at the time of death. Spouse may apply for plot or transportation with a 21P-530 form. Other claimants will need to fill out a 21P-530, and will be paid on a first to file basis. 29

31 Non-Service Connected (NSC) Burial Allowance Determination of Eligibility In receipt of VA pension or compensation. Entitled to compensation but waived benefit in lieu of Military Retired Pay (MRP). Veteran died in VA hospital, VA contract nursing home, state nursing home. Veteran died traveling from VA medical center (VAMC) for authorized travel. Veteran had active service. Other than dishonorable discharge. 30

32 Burial Allowance Evidence Signed VA Form 21P-530. Acceptable proof of death. We no longer require an itemized statement from provider of services unless transportation fees are claimed. Special conditions governing payments. Medical evidence for service connected burial. 31

33 Service Connected (SC) Burial Allowance Determination of Eligibility Cause of death was related to, or aggravated by, a service-connected condition. Related to a disease or injury that existed during the active military service. Additional evidence needed: Medical evidence Presumptive conditions (38 CFR 3.309): Veteran had at least one service related connected condition rated 50% or higher Agent Orange (Vietnam) Asbestos Mustard Gas Radiation 32

34 Plot-Internment Allowance Plot is the final disposal site of the Veteran s remains. Examples: Grave, Mausoleum, Vault. Plot allowance is payable under the same eligibility requirements as burial allowance. Plot is not payable when: The Veteran was buried in a National Cemetery. There is no final resting place for the body. If it was at no cost to the claimant. 33

35 Transportation Allowance NSC death incurred: En route for VA authorized examination, treatment, or care. Properly hospitalized at a medical center, domiciliary, or nursing home under the direct jurisdiction of VA. Receiving authorized nursing home care in a non-va facility, or As a patient at an approved State nursing home and death occurred on or after October 9,

36 Transportation Allowance Service Connected: Veteran is buried in a national cemetery and either: Died of a SC condition Has a SC condition at the time of death for which s/he was receiving disability compensation, or Was receiving MRP or VA pension at the time of death in lieu of disability compensation. 35

37 Entitlement Allowances NSC Burial Death on or after 12/01/01 Death on or after 10/01/11 Death on or after 10/01/13 Burial allowance up to $ Burial allowance up to $ Burial allowance up to $ when properly hospitalized *$ COLA rate SC Burial $2, (plus transportation if buried in a National Cemetery) Plot Death on or after 12/01/01 Death on or after 10/01/11 Death on or after 10/01/2013 Plot allowance up to $ Plot allowance up to $ *$ COLA rate 36

38 Memorialization Benefits include: Presidential Memorial Certifications (VA Form ) Flags (VA Form ), and Headstones and markers (VA Form ) Memorial Programs Service (41A1) Department of Veteran Affairs 5109 Russell Road Quantico, VA

39 References 38 CFR CFR Fast Letter

40 Liberalizing Law 39

41 Liberalizing Law and Pension Public Law (sections ), enacted on 9/17/01, changed the disability requirement for pension. The law allowed pension to be granted presumptively, without a rating, if: The Veteran is 65 or older, or The Veteran is recognized as disabled by the Social Security Administration, or The Veteran is a patient in a nursing home.

42 Applying Liberalizing Law When we apply liberalizing law: The Veteran is granted pension (presumptively or by rating), and The Veteran met one of the presumptive requirements on the date of the law change (9/17/01)* through the present date of claim, and The Veteran has never received pension, and The Veteran was never denied for excessive net worth. *If we are considering this based on age 65, this means the Veteran s DOB must be 9/17/36 or earlier.

43 Liberalizing Law Claims The new initial year will begin one year prior to the original entitlement. Although the Veteran must have been presumptively entitled to pension from the date of the law, in order to grant SMP from an earlier effective date, the evidence only needs to show entitlement to SMP from one year prior to the current entitlement date.

44 Independent / Senior Living: How do I report these medical expenses? 43

45 Goals Be able to identify what is Independent Living Understand the differences between Activities of Daily Living and Instrumental Activities of Daily Living Know what forms are needed and how to report medical expenses Understand Fast Letter 12-23, Room and Board as a Deductible Medical Expense 44

46 Definitions Aid and Attendance Independent/Senior Living Custodial Care Activities of Daily Living (ADL) Instrumental Activities of Daily Living (IADL) 45

47 Aid and Attendance Veteran/Surviving Spouse must be rated for Aid and Attendance Submit VA Form , Examination for Housebound Status or Permanent Need for Regular Aid and Attendance Submit a VA Form , Statement in Support of Claim signed by the claimant requesting this increased benefit 46

48 What are ADL and IADL? ADL Bathing or showering Dressing Eating Getting in and out of bed or chair Using the toilet IADL Meal preparation Doing housework and other chores Shopping Traveling Doing laundry Using a telephone 47

49 Independent/Senior Living Custodial Care Two or More ADLs Statement from Physician Paid Third Party Caregiver Not a Medical/Nursing Service Emergency Pull Cords 24 Hour Staffing Locked Exterior Doors 48

50 Reporting Medical Expenses VA Form , Medical Expense Report Care Provider Statement from Facility 3 rd Party Caregiver statement Statement from Physician 49

51 Scenario 1 Joe Veteran is entitled to pension at the aid and attendance rate and requests that VA deduct unreimbursed medical expenses paid to an independent living facility for assistance with meal preparation. The facility provides the Veteran with assistance in transferring and bathing, as well as regular blood tests. Mr. Veteran submits the following forms. Care Expense Statement from this facility showing the care they are providing VA Form , Medical Expense Report reporting room and board expenses Can the VA count room and board as a medical expense? 50

52 Scenario 1 (answer) YES The Veteran has been rated for Aid and Attendance The Veteran submitted all forms necessary for us to count medical expenses The facility provides assistance with 2 ADLs, and therefore we can count the cost of room and board as a medical expense. 51

53 Scenario , Medical Expense Report completely filled out 52

54 Scenario 2 (cont) We received a Medical Expense Report for calendar year 2012, showing the Veteran lives in an independent living facility, and he/she is claiming medical expenses for room and board to this facility. The Veteran is rated for Aid and Attendance. We receive a letter from the care facility stating they provide meal preparation, housekeeping, emergency pull cords, 24 hour staff, and locked exterior doors. Does the VA count room and board from this facility as a medical expense? 53

55 Scenario 2 (answer) NO. The VA cannot consider the costs paid to this independent living facility because they do not provide custodial care (assistance with ADLs) 54

56 Scenario 3 The Veteran is receiving pension with aid and attendance. He/she writes in and states that they moved to an Independent Living Facility, and that they are receiving care from a 3 rd party caregiver. What forms/information do we need? 55

57 Caregiver Statement showing the care they provide to the Veteran/Surviving Spouse 56

58 Scenario 3 (cont) Statement received from physician 57

59 Scenario 3 (cont) Statement received from facility To Department of Veterans Affairs Mr/Mrs. Veteran moved into FACILITY NAME on MO/DA/YY. He/She pays $AMOUNT for the care provided by our facility. He/She has the option of contracting with a Third Party Provider for assistance with his/her activities of daily living. Thank you, Facility Representative 58

60 References 38 CFR M21-1MR.V.iii.1.G.43 and 44 M21-1MR.V.iii.1.G.43.h 38 CFR 4.124a note 3 38 CFR (g) Fast Letter 12-23; Room and Board as a Deductible Medical Expense 59

61 Questions? 60