Transcript Group 5 – Non-Service Connected.

VA Montana Health Care System
Overview of Eligibility & Services
John “Johnny” F. Ginnity, FACHE
Director (Acting)
December 8, 2014
NATIONAL OVERVIEW
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5.3 Million Veterans enrolled in health care
152 Medical Centers
971 Community Based Outreach Clinics (CBOC)
133 Community Living Centers
98 Domiciliary Rehabilitation Treatment Programs
300 Readjustment Counseling Centers
140 Comprehensive home-care programs
VETERANS HEALTH ADMINISTRATION
LOCAL OVERVIEW
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VA Montana serves nearly 40,000 Veterans state wide
Fort Harrison is only VA Hospital in Montana
12 Community Based Outreach Clinics (CBOC)
Billings VA Health Care Center
Miles City Community Living Center
State Veteran Homes – Glendive and Columbia Falls
VA – Indian Health Service Collaboration
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Increase connectivity between agencies increasing access
Renewing MOU between VISN19 and Billings area to increase
services to local IHS service units boosting Tribal Health access to
care and program availability
VETERANS HEALTH ADMINISTRATION
SERVICES PROVIDED*
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Internal Medicine
Gastroenterology
Neurology
Dental
Cardiology
Palliative Care
Physical Therapy
Medical Oncology
Surgery
Urology
Orthopedics
Ophthalmology/Optometry
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VETERANS HEALTH ADMINISTRATION
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Podiatry
Gynecology
Chiropractic Care
Psychiatry
Ambulatory Care (Primary Care)
Sleep Medicine
Prosthetic and Sensory Aids
Emergency Room
Long Term Care
Inpatient Care
Radiology
Medical Foster Home
Home Based Primary Care
*Services are not at all VA facilities
ELIGIBILITY
ACTIVE DUTY SERVICE MEMBERS
• Must serve 24 months of consecutive service after Sept.
7th, 1980. Combat tour is not required.
• Must have an Honorable Discharge as noted on the
DD214
• Have a Service Connected Disability or separated from
the Armed Forces due to a disability
• If service time is less than 24 months, separation must be
for convenience of the government or force reduction,
and this must be specifically stated on the DD214.
VETERANS HEALTH ADMINISTRATION
RESERVE/NATIONAL GUARD
• Must have been federally ordered to Active Duty
• Must have been deployed to a Combat Theater or
deployed in support of Combat Operations
• Must be Honorably Discharged as noted on DD214
VETERANS HEALTH ADMINISTRATION
SERVICE CONNECTED
DISABILITY
Definition – Any injury, illness or disease, that
was incurred or aggravated while on Active
Duty.
• Disability does not have to be Combat related
• Disability is annotated in 10% increments, starting with 0%.
• Disability claims are adjudicated through the Veterans
Benefits Administration (VBA).
VETERANS HEALTH ADMINISTRATION
ENROLLMENT PRIORITY GROUPS
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Group 1 – Service Connected 50% to 100%. Free health care and travel pay.
Group 2 – Service Connected 30% or 40%. Free health care and travel pay.
Possibility of medication copayment for Non-Service Connected medications.
Group 3 – Service Connected 10% or 20%. Free health care, travel pay paid for
service connected visits, otherwise based on income. Possibility of medication
copayment for Non-Service Connected medications.
Group 4 – Aid and Attendance or Catastrophically Disabled. Free health care
including medications. Travel Pay based on income.
Group 5 – Non-Service Connected. Free health care, medications copay status and
Travel Pay based on income.
Group 6 – Combat Veterans. Copay for services and visits
Group 7 - Asset Based Enrollment. Threshold is $80,000. Copay for services and
visits.
Group 8 (a,c,d,e,g) – Income Based Enrollment. Income exceeds thresholds
associated with Group 5. Copay for services and visits. 8e and 8g – Not Eligible.
VETERANS HEALTH ADMINISTRATION
DENTAL ELIGIBILTY
• Service Connected 100% with Permanent and
Total clause
• Be Service Connected for a Dental issue
• Service Connected 60% or greater with an
Individual Un-employability clause.
• Enrolled in a VA sponsored Vocational
Rehabilitation program
• Homeless
VETERANS HEALTH ADMINISTRATION
MATERNITY CARE
• Requires enrollment in VA Healthcare
• Complete Maternity care to include pre-natal and
post-natal care
• Includes new born enrollment for 7 days
• Most services are Fee Based to private sector
providers
VETERANS HEALTH ADMINISTRATION
TRAVEL PAY
Eligibility is based on the following criteria:
1. Available for Groups 1 and 2
OR
2. Veterans with income below the Non-Service Connected
Pension threshold.
3. Available when attending Compensation and Pension
medical appointments
4. Paid at per diem rate of $.415 cents per mile
5. Electronic Funds Transfer or Debit Card will be only form of
payment in the near future
VETERANS HEALTH ADMINISTRATION
VETERANS HEALTH IDENTIFICATION
CARD (VHIC)
• VHIC is a Health Care Card.
• Must be enrolled in VA Health Care to receive the card
• Cards can be processed at every clinic
• Several businesses are giving discounts when in
possession of the card (Home Depot, Lowe’s, Applebee’s,
etc…)
VETERANS HEALTH ADMINISTRATION
AFFORDABLE CARE ACT (ACA)
• Enrollment in VA Health Care meets the minimum essential
coverage requirements as established with the ACA.
• Enrollment in Medicare, Medicaid, Tricare, Tricare for Life,
ChampVA, or Spina Bifida program meets the minimum essential
coverage requirements as well.
• 4 levels of plans, ranging in coverage and varying payment ratios.
– Platinum – 90% Insurance, 10% policy holder
– Gold – 80% Insurance, 20% policy holder
– Silver – 70% Insurance, 30% policy holder
– Bronze – 60% Insurance, 40% policy holder
VETERANS HEALTH ADMINISTRATION
ACA OVERVIEW
• ACA, also known as the health care law, was
created to expand access to affordable health
care coverage to all Americans, lower costs, and
improve quality and care coordination.
• ACA became effective January 1st, 2014
• Marketplace and Open Season began
October 1st, 2013
VETERANS HEALTH ADMINISTRATION
ACA REQUIREMENTS
• All US Citizens must meet minimum essential
coverage by Jan. 1, 2014
• Includes Spouse and Children, regardless of age
• VA Healthcare, Medicare, Medicaid, Tricare,
ChampVA, and Spina Bifida programs meet the
minimum essential coverage.
VETERANS HEALTH ADMINISTRATION
VETERANS ACCESS, CHOICE, AND
ACCOUNTABILITY ACT OF 2014 (VACAA)
Background:
• Major element of Public Law 113-146, passed Aug. 7,
2014
• Funded at $10 billion
• Temporary 3-year program to bridge gap while VA
expands capacity, access
• Approximately 600,000 Veterans immediately eligible: 40
miles / 30 days
• 9 million enrolled Veterans to receive a Choice Card
• Program to be run by a contracted third party
administrator
VETERANS HEALTH ADMINISTRATION
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ELIGIBILITY FOR VACAA
40 + Miles
• Third Party Administrator (TPA) is provided list of eligible Veterans that
reside more than 40 miles from VA facility
– Distance is calculated by address in VistA
– This list is updated monthly
• Veterans is notified of their eligibility through mailings
30 + Days
• If patient is scheduled 30+ days within the VA, patient is eligible for
Choice.
• Patient will keep VA appointment and has the option to call the TPA at
their 800# (patient must call if they would like to participate in Choice)
• TPA will coordinate appointment within the community if possible
VETERANS HEALTH ADMINISTRATION
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INFORMATION
http://www.montana.va.gov
www.va.gov
www.healthcare.gov
www.myhealth.va.gov
VA Montana Public Affairs Officer
406.447.7303
VETERANS HEALTH ADMINISTRATION