Rao bulletin 15 April 2016 html edition this bulletin contains the following articles
VA Vet Choice Program Update 38 ►
Download 0.88 Mb.
|
- Navigate this page:
- VA Structure ► Understanding the Divisions Services
- VA Health Care
- Veterans Benefits Administration .
- Burial and Cemeteries .
- Agent Orange Diseases Update 03 ► 3 Under Review for Presumptive Status
- VA Caregiver Program Update 33 ► Blindness Not Considered a Disability
- Arizona Vet Cemetery Update 02 ► Marana Site Opening
VA Vet Choice Program Update 38 ► Behind $878M in Vet Care Payments 
When news broke in 2014 that the Department of Veterans Affairs (VA) was covering up dangerously long wait times at VA clinics, the administration was quickly buried in an avalanche of bad press. Congress responded by creating the Choice Card program, which allows veterans facing long wait times to seek care from private doctors. Now that program, too, has encountered a serious problem. The VA reportedly hasn’t been paying these out-of-network doctors. Despite the program’s $10 billion budget, the VA is behind on $878 million in payments for emergency services rendered at non-VA hospitals throughout the nation, according to testimony delivered to Congress by Vince Leist on behalf of the American Hospital Association (AHA). That’s giving these hospitals pause when it comes to working with the VA to treat veterans. “While we are very dedicated to serving the veterans in our community, and we accept each and every one who walks through our doors, we have decided against contracting with the VA due to slow or no payment for claims and the bureaucracy involved with getting claims through the payment process,” Leist, the chief executive officer of an Arkansas healthcare system, told Congress last June. Some have reported being hounded by bill collectors, while many others find the program too confusing to navigate. Part of the problem is the speed with which the program was introduced, according to the private companies contracted by the VA to handle referrals and process payments. The program began on Nov. 5, 2014, just a few months after President Obama signed the Choice Act into law. “Within record time, we created the infrastructure, hired and trained hundreds of staff, and mailed Choice Cards to the four million veterans in our area of responsibility,” a public relations team from Triwest, the firm that administers the program in the West and parts of the South, told Healthline in an email. “We continue to work alongside the VA to refine the program to help improve upon its original structure as the program is matured,” they wrote. Since its inception, the Choice Card program has been adjusted in several ways in response to user complaints. Originally, veterans were eligible to use the program if they had to wait more than 30 days past the time a doctor recommended they be treated, or if they lived more than 40 miles from the nearest VA clinic as measured by a straight line. Now, veterans are eligible if they have to wait any amount of time longer than what the doctor recommends, or if they live more than 40 miles away in terms of driving distance. Most recently, the VA eliminated the requirement that veterans’ medical records must be received in order to process claims. The move was meant to streamline payments, and was applauded by Triwest and Health Net, the other health insurance company contracted by the VA. But Carlos Fuentes, a policy advisor with the Veterans of Foreign Wars (VFW), is skeptical that decoupling medical records from payments is the right approach. “We’re actually supportive of tying payment and medical documentation and we don’t completely agree that that was what was causing the delay,” he told Healthline. One of the benefits of the VA system is that it provides “integrated care,” he said, meaning that doctors can track a patient’s medical history and progress even if different doctors at different places saw that patient. Keeping track of medical records is an important part of such care, he said. Indeed, of the recommendations that Leist made to Congress last year, removing the medical records requirement was not among them. He suggested that the VA commit to accepting or denying a claim within seven days and paying approved claims within 30 days. The administration should also be clear about why it denies claims. Fuentes also cited poor communication as a major roadblock to processing claims, as well as an outdated paperwork system that relies heavily on actual paper rather than electronic records. In a press release, the VA said it “is moving forward on two paths to further improve timely payment.” First, VA officials are working toward a single community care program that is easy to understand, simple to administer, and meets the needs of veterans, community providers, and VA staff. Secondly, VA officials plan to pursue a claims solution that moves to a more automated process for payment. Marilyn Park, a lobbyist with the American Federation of Government Employees (AFGE), a union that includes VA employees, says the Choice Program took resources away from the already underfunded and understaffed VA hospital network. We want the veterans to get the care they prefer and we want veterans to get the comprehensive and integrated care that they were promised. “It’s simple physics,” Park told Healthline. “Demand’s going up and resources for staff are not meeting it at all.” Veterans themselves prefer the VA, she said, citing polling commissioned by the Vet Voice Foundation, a nonprofit. That poll found that 64 percent of veterans oppose privatizing their healthcare. “We want the veterans to get the care they prefer and we want veterans to get the comprehensive and integrated care that they were promised,” she said. When the Choice Card program expires in 2017, it will likely be folded into a new program consolidating the eight private payer programs administered by the VA. The union supports that plan, Park said. Payment woes are “another example of why the VA needs to reassert control and do a smart version of contract care,” she said. [Source: Healthline News | Rose Rimler | April 11, 2016 ++] ****************************** VA Structure ► Understanding the Divisions & Services The Veterans Administration is a branch in the federal government, and like most federal organizations it can be quite confusing. Most people do not understand the structure of the Department of Veterans Affairs (DVA). It is made up of three divisions that are responsible for specific activities — VA Health Care, Veterans Benefits Administration (VBA), and Burial and Cemeteries. Each division is independent and are like stove pipes where communication does not necessarily exist. VA Health Care. The Veterans Health Administration (VHA) handles all health care for veterans. It is responsible for the medical centers, outpatient clinics, community based outpatient clinics, and the vet centers. They provide care, medications, and prosthetic devices as needed. They are responsible for setting the veteran’s health care priority and eligibility based on information provided by the benefits section. To enroll and receive treatment, the veteran must fill out VA Form 10-10EZ, enclose their DD 214, and send them to the nearest VA facility. There are certain basic eligibility requirements.
After the veteran is enrolled, he/she will be assigned to a priority group, scheduled for a blood test, assigned a primary care person and required to attend an orientation class. Veterans are encouraged to keep their private insurance plans if they can afford to do so. The VA will bill the insurance companies for their care and the veteran can continue to use the services of private doctors or hospitals if they choose. However, in order to stay enrolled in the system, the veterans must use the VA facilities at least once a year. Veterans Benefits Administration. The VBA is responsible for the payment of all VA gratuitous benefits. It handles claims for compensation, pension, and education, including vocational rehabilitation, burials, home loans, life insurance and just about any other monetary benefit that comes from the VA. The VBA field operations are located in regional offices (VAROs) where all benefits claims are handled. Each state has at least one regional office (except Wyoming), plus offices in San Juan, Washington D.C., and Manila. Each office varies greatly in size depending on the population served. Each office is guided by a director. The functions are then split among the divisions. The largest division in each office is the Veterans Service Center. This division handles all compensation and pension claims from receipt of the claim to the decision. There are three Pension Maintenance Centers located at Milwaukee, St. Paul, and Philadelphia regional offices. Education claims are handled in Regional Processing offices in four locations. Every regional office has the capability of handling public contact for their area, both for walk-in clients and telephone calls. When a veteran is not satisfied with the decision made on his claim, he has the right to file an appeal. Appeals are decided on questions regarding all veteran’s benefits by the Board of Veteran Appeals (BVA), which is completely independent from the VBA. As with most bureaucracies, there are contingencies and qualifications in filing claims for compensation. The veteran must have a service connected disability. As an example, if a Vietnam veteran has type II diabetes, the VA recognizes that type II diabetes could be a direct result of being exposed to Agent Orange in Vietnam and therefore could be compensated. Each county has a trained Veteran Service Officer (VSO) to help veterans to file claims. Burial and Cemeteries. The National Cemetery Association operates the National Cemetery system. It is responsible for the establishment and construction of new cemeteries and the care and maintenance of existing cemeteries. It provides flags for burials of veterans and issues the Presidential Memorial Certificates. [Source: Churubusco News Indiana | Richard Eckert | April 05, 2016 ++] ****************************** Agent Orange Diseases Update 03 ► 3 Under Review for Presumptive Status The Veterans Affairs Department is weighing whether to add several diseases to the list of health conditions presumed in Vietnam veterans to be caused by exposure to Agent Orange. A VA working group is studying a report issued in March by the Institute of Medicine to determine whether bladder cancer, hypothyroidism and Parkinson’s-like symptoms — illnesses the IOM said may be more strongly linked to exposure than previously thought — should automatically make a Vietnam veteran eligible for VA disability benefits and health care. According to Dr. Ralph Erickson, VA's chief consultant for post-deployment health services, the group will make a recommendations to VA Secretary Robert McDonald on whether the diseases should be added to a list of 15 already in place. “We are in the midst of a deliberative process, carefully looking at all the IOM committee put in the report and additional information that has come out since,” Erickson said. “We will be putting tougher a VA response that will be brought before senior leaders and ultimately brought before the secretary.” The process could take up to two years, a VA spokeswoman added. Roughly 1 million Vietnam veterans are enrolled in the VA health system, according to the department. Based on a review of data for one year, 5,484 of these veterans have been diagnosed with bladder cancer, 15,983 suffer from hypothyroidism and an estimated 1,833 have Parkinson’s-like symptoms. The working group also is looking into the role, if any, Agent Orange exposure has played in the development of hypertension in Vietnam veterans. According to VA, 307,324 Vietnam veterans in the Veterans Health Administration have high blood pressure. “Hypertension has been a question that has been asked,” Erickson said. “The cohort of men and women who heroically served their country in uniform and went to Vietnam are in their 60s, 70s and 80s, and these individuals, merely because of their age, are starting to accrue chronic diseases that come with aging. It’s a delicate matter to tease out whether someone has hypertension because of their age or whether it would be related to an exposure to Agent Orange.” VA began recognizing diseases associated with herbicide exposure in Vietnam beginning in 1991, naming 15 diseases as presumed to be related, including Hodgkin’s disease, multiple myeloma, non-Hodgkin’s lymphoma, early-onset peripheral neuropathy, porphyria cutanea tarda, prostate cancer, respiratory cancers, soft-tissue sarcoma, chloracne, type-2 diabetes mellitus, light chain amyloidosis, ischemic heart disease, chronic B-cell leukemias, Parkinson’s disease, and spina bifida in offspring of veterans. The most recent IOM report actually downgraded spina bifida in the children of Vietnam veterans, saying research does not support a previously held belief that the disease occurred in offspring of exposed veterans at higher rates. But the change of spina bifida from "limited or suggestive evidence" it is related to exposure to “inadequate or insufficient” evidence should not affect disability payments to the 1,153 descendants of Vietnam veterans who receive them, Veterans Benefits Administration senior adviser for compensation services Brad Flohr said. VA recommends that veterans who have an illness they believe is related to Agent Orange exposure file a claim; they are considered on a case-by-case basis if the illness is not on the presumptive condition list. Should new diseases be added to the list, the regulation would go into effect 30 days after it is published in the Federal Register. If a veteran dies of a condition determined to be a presumptive condition after the veteran’s death, VA will provide dependency and indemnity compensation benefits to eligible spouses, children and parents of that veteran. [Source: Military Times | Patricia Kime | April 8, 2016 ++] ****************************** VA Caregiver Program Update 33 ► Blindness Not Considered a Disability Army Sergeant Major Jesse Acosta has received notification from the VA that his benefits for a caregiver are ending in 90 days, at the end of May 2016. The letter he received from the VA states “he is no longer appropriate for the Program of Comprehensive Assistance for Family Caregivers.” They say they are pleased to inform him of this. According to the VA, even though Acosta, blinded by a mortar attack in Iraq, is still blind, they are excited (with an exclamation point to prove it) to let him know they have determined he’s “graduated,” and no longer needs a caregiver. 
Acosta served with distinction from 1975 until his retirement in 2010. In 2003 he joined the Individual Ready Reserve program until he was recalled to active duty in 2005. He deployed to Iraq in August. Everything changed on January 16, 2006 when he was struck by a mortar. His injuries included the loss of both eyes, injury to the frontal and temporal lobes of his brain, loss of part of his jaw and teeth, a back injury, a herniated calf muscle that won’t heal and loss of a kneecap so that one knee is bone on bone. He was not expected to survive when he arrived at the military hospital in Landstuhl, Germany. But survive he did. Over the course of forty surgeries his jaw and eye sockets were reconstructed but his vision was lost forever. Today he’s a fine-looking man. In good shape, fit, his service dog by his side. You wouldn’t know looking at him that he’s been rated, in addition to his blindness, 70% disability from PTSD and 100% disability from TBI. Jesse Acosta returned to his employer after Iraq, but he needs some assistance to do his job. Likewise, at home he needs some help. That’s what the caregiver provides: help getting to medical appointments, managing medication refills, help with paperwork and shopping. The daily things that sighted people take for granted. His service dog helps both with mobility and with PTSD. But the caregiver fills an essential need. Whether or not the VA agrees. When National Veterans Foundation representatives Shad Meshad spoke with Jesse, he was told, “When the VA representative called to tell us the caregiver benefit had been canceled, we were told verbally that ‘the VA does not consider blindness a disability’.” You can understand how the VA might look at him...he’s employed, he has a service dog...and think his blindness does not completely disable him. But how humane is it not to take into consideration the effects of PTSD and TBI? The VA has treated him for both and they have complete records. He can appeal his case, of course. Based on a 2012 VA report that will take about two and a half years. The eligibility criteria from the Caregivers and Veterans Omnibus Health Services Act,” Public Law 111-163 Section 1720G (a) (2) states: “(2) For purposes of this subsection, an eligible veteran is any individual who— (A) is a veteran or member of the Armed Forces undergoing medical discharge from the Armed Forces; (B) has a serious injury (including traumatic brain injury, psychological trauma, or other mental disorder) incurred or aggravated in the line of duty in the active military, naval, or air service on or after September 11, 2001; and C) is in need of personal care services because of— (i) an inability to perform one or more activities of daily living; (ii) a need for supervision or protection based on symptoms or residuals of neurological or other impairment or injury...” The Caregivers and Veterans Omnibus Health Services Act, was intended, among other things, to assist members of veterans’ families who have left careers to care for veterans with catastrophic disabilities. However, the Department of Veterans Affairs (VA) is failing to implement the law (Public Law 111-163) as Congress intended. Paralyzed Veterans of America testified on this point on 11 MAR before the House Committee on Veterans’ Affairs Subcommittee on Health. Carl Blake, Legislative Program Director for Paralyzed Veterans of America, said, “(VA) said the only way a caregiver will be eligible for this is if the veteran would have otherwise been institutionalized. Blake explained that such an interpretation would lower the number of families eligible for these benefits, such as monthly stipends and health-care benefits through the Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), to about 840. According to Blake that number is less than 25 percent of what Congress intended. An article in the Illinois Statesman on Feb. 23, 2016 states that about 7,000 veterans who were receiving caregiver benefits are no longer getting them. “About a third were cut because VA staff members determined that they did not meet medical criteria for the support.” The program, passed into law in 2010, was never intended to be a permanent benefit. Only last year did the VA publish an official rule on how the program should be run. Stipends were to be provided to families as long as the veteran’s health met certain criteria. If the situation improved, the VA might remove patients from the financial part of the program. Based on his experience, Jesse says, “I have never been VA friendly, and because I question and challenge the VA process, I truly believe I have been targeted in having this benefit canceled.” He was also quick to say he’s not the only one receiving this kind of treatment by the VA, and he launched into a story about another vet in the LA area whose VA care came from six different VA facilities (i.e. Long Beach, West Los Angeles, San Diego, Loma Linda, East Los Angeles and downtown LA). This is Southern California. That’s miles and miles of driving, not to mention hours of car time because of traffic, and then the expense on top of that. It’s no wonder that so many vets suffering from PTSD and TBI also have anger management problems. Meshad can’t help but think the run-around treatment, some of it looking like harassment, that these vets experience from the VA is a factor in the 22 veteran suicides a day. Sergeant Major Acosta served with distinction in the U.S. Army from 1975 until 2010. Among his many awards are The Legion of Merit, The Bronze Star, The Purple Heart, the Meritorious Service Medal and six Army Commendation Medals. The VA’s budget for fiscal year 2016 is $163 billion. The proposed 2017 budget includes an increase for VA funding. Maybe money isn’t the problem. Maybe it’s the structure of the VA, how large and unwieldy it is. Maybe it’s the entrenched culture of no accountability. Meshad grants that changes are being made. But how do you explain to the Jesse Acostas who served this country that it’s just too much trouble to take their cases individually? That in order to get through the number of cases, there’s more investment in blocking treatment than in authorizing it? Because that’s how it looks. The National Veterans Foundation personnel wish that Acosta’s case was out of the ordinary. Unfortunately, it’s not. If you know a vet who needs help, their LifeLine for Vets is 888.777.4443. It’s vet-to-vet, the only one of its kind. [Source: HuffPost Impact | The Blog | March 30, 2016 ++] ****************************** Arizona Vet Cemetery Update 02 ► Marana Site Opening The Department of Veterans Affairs (VA) announced the opening of the 100th VA grant funded Veterans cemetery. An $8.9 million grant from the VA funded the new Arizona Veterans’ Memorial Cemetery in Marana, Arizona. The cemetery is the 100th Veterans cemetery funded with a VA grant awarded to a State or Tribal organization. “This significant milestone underscores the importance of our partnerships with State and Tribal organizations to increase Veterans access to benefits, said Secretary of Veterans Affairs Robert A. McDonald. “This grant helps VA fulfill its goal of providing at least 95 percent of Veterans and spouses with access to an open national, state or tribal cemetery within 75 miles of their home,” McDonald said 
VA’s Veterans Cemetery Grants Program complements VA’s 134 National Cemeteries across the country. Since 1980, the Veterans Cemetery Grants Program has awarded grants totaling more than $665 million to establish, expand, and improve 100 Veterans cemeteries in 47 states and territories including tribal trust lands, Guam, and Saipan. These VA-funded Veterans cemeteries provided more than 35,000 burials in 2015. The new cemetery opened on March 14, 2016 and was dedicated on March 26, 2016 with a public ceremony with remarks by George D. Eisenbach Jr., Director, Veterans Cemetery Grants program. The cemetery, on approximately 20 acres, includes 1,802 pre-placed crypts, 1,638 cremains gravesites and 1,920 columbarium niches and will help serve the needs of approximately 105,000 Arizona Veterans and their families. Veterans with a discharge issued under conditions other than dishonorable who have completed a period of active duty service as required by law, their spouses and eligible dependent children may be buried in the Arizona Veterans’ Memorial Cemetery at Marana. The closest VA national cemetery to the new Arizona cemetery is VA’s National Memorial Cemetery of Arizona in Phoenix, approximately 91 miles away. The nearest VA grant-funded state Veterans cemetery is Southern Arizona Veterans’ Memorial Cemetery in Sierra Vista, which is located at a distance of about 107 miles from the new site. For more information on VA’s Veterans Cemetery Grants Program, visit: www.cem.va.gov/cem/grants. For more information on Arizona's Veterans Memorial at Marana, visit: https://dvs.az.gov/arizona-veterans-memorial-cemetery-marana. [Source: VA News Release | April 07, 2016 ++] ****************************** Directory: wp-content -> uploads -> 2016 2016 -> 2017 afoCo Landmark Scholarship Program 2016 -> Instructions for the Preparation of Camera-Ready Contributions to the Conference Proceedings 2016 -> Step student Scholarships for Year 10-13 2016 -> The united church of canada 2016 -> Idan raichel biography – May 2016 Brief Producer, keyboardist, Lyricist, composer and Performer Idan Raichel 2016 -> An introduction to centre’s interventions expanding access to justice 2016 -> Sanchar Shakti 2016 -> Unit analysis should help here. We want number of bananas 2016 -> The Autobiography of Elder Joseph Bates 2016 -> The Great Heat and the Rhode Island Deep Water Bay Scallop (Argopecten irradians) Fishery 1875-1905 Download 0.88 Mb. Share with your friends:
|