Entitlement to Basic VA Medical Care VFW Basic

Veterans must enroll into the VA Health Care System as a condition for receiving the medical benefits package by submitting an application
(VA Form 10-10EZ)
Establishes eligibility and Priority Group assignment
Veterans can be placed in Priority Group categories 1-8 (category 1 is the highest)
38 C.F.R. 17.36 ENROLLMENT<br>

PRIORITY GROUP CATEGORIES<br>

PRIORITY GROUP CATEGORIES<br>

Is designed to:

Promote good health

Preserve your current health

Restore you to better health

38 C.F.R 17.38 COMPREHENSIVE “MEDICAL BENEFITS PACKAGE"<br>

Primary Care
Health Promotion
Disease Prevention
Diagnosis
Palliative Care
Surgery
Prescriptions for Medications
Prosthetics
Critical Care
Mental Health Care
Women’s Health Care
Orthopedics
Radiology
Physical Therapy
Rehabilitation
Emergency Care
Transplants
Dental Care *
Preventive Care
Inpatient Care
Ancillary
Specialty Care
Pharmacy
Home Based Primary Care*
Geriatric and Extended Care*
Prosthetics and Sensory Aids MEDICAL BENEFITS PACKAGE https://www.va.gov/GERIATRICS/Guide/LongTermCare/index.asp Medically necessary services include:<br>

Provides support/assistance to eligible caregivers of qualifying veterans
VA Mission Act of 2018 expands the eligibility and benefit of the Comprehensive Caregiver Program for caregivers of all eras.
As of October 1, 2020, VA implemented the new Program of Comprehensive Assistance for Family Caregivers (PCAFC) which includes a stipend and other benefits for caregivers. www.caregiver.va.gov
38 C.F.R 71.10 - 71.50 FAMILY CAREGIVER PROGRAM<br>

Health Registries related to environmental and occupational exposure during military service

Exposure Categories
Environmental/Toxic Hazards (burn pit smoke, dust…)
Chemicals (Agent Orange, contaminated water…)
Occupational Hazards (Asbestos, lead…)
Radiation (nuclear weapons, X-rays…)
Warfare Agents (Chemical, biological weapons) HEALTH REGISTRIES<br>

Agent Orange Review
Gulf War Review
Operation Iraqi/Enduring Freedom Review
Ionizing Radiation Review

https://www.publichealth.va.gov/exposures/meyh/publications/index.asp NEWSLETTERS, PUBLICATIONS, FACT SHEETS<br>

Veteran and/or family members must have resided at Camp Lejeune for 30 days or more between August 1, 1953 to December 31, 1987 to receive care under the new law (no requirement for consecutive days).

The VA recognizes a total of 15 qualifying health conditions

Eight conditions eligible for presumptive service connection for Veterans

38 CFR 17.129 and 38 CFR 17.400 (Health Care)
38 CFR 3.309(f) (Service Connection) CAMP LEJEUNE WATER CONTAMINATION BENEFITS<br>

The Sergeant First Class (SFC) Heath Robinson Honoring our Promise to Address Comprehensive Toxics (PACT) Act was signed into law August 8, 2022.

Expands and extends eligibility for VA health care for Veterans with toxic exposures and Veterans of the Vietnam, Gulf War, and post-9/11 eras
Adds more than 20 new presumptive conditions for burn pits and other toxic exposures
Adds more presumptive-exposure locations for Agent Orange and radiation
Requires VA to provide a toxic exposure screening to every Veteran enrolled in VA health care
Helps us improve research, staff education, and treatment related to toxic exposures
PACTActinfo.org for information, eligibility and referral to VSO 2022 Pact Act<br>

Based on access standards for average
Drive time: 30 minute drive time for primary care, mental health and non-institutional care services
Drive time: 60 minute drive time for specialty care
Appointment wait time: 20 days for primary care, mental health and non-institutional care services
Appointment wait time: 28 days for specialty care
38 C.F.R 17.4000 – 17.4040 COMMUNITY CARE PROGRAM<br>

Based on Veteran’s assigned Priority Group and required copayment
Priority Group 1-5 – $30 copay charged for fourth visit and all subsequent visits in calendar year.
Priority Group 6 – Visits related to specialty authority or exposure, then $30 copay for all unrelated conditions and subsequent visits in calendar year.
Priority Groups 7-8 – $30 copay per visit
38 C.F.R 17.105, 17.108 and 17.4600

https://www.va.gov/find-locations/ URGENT CARE PROGRAM<br>

The EMCP has 2 important parts that must be understood and considered when related to emergency care
Medical emergency for service connected verses non-service connected conditions
Emergency Transportation (Ambulance)

https://ia801406.us.archive.org/10/items/www.va.gov/www.va.gov/PURCHASEDCARE/docs/pubfiles/factsheets/FactSheet_20-02.pdf (Emergency Medical Care)

https://ia801406.us.archive.org/10/items/www.va.gov/www.va.gov/PURCHASEDCARE/docs/pubfiles/factsheets/FactSheet_20-05.pdf (Emergency Transportation) EMERGENCY MEDICAL CARE PROGRAM (EMCP)<br>

Abortions/Birth Termination/Counseling
Non-FDA approved drugs/devices
Cosmetic Surgery
Health Club/Spa Membership
Veterans housed in institutions (incarcerated in state or government facility), the legal obligation to provide services and care is the responsibility of the agency with a veteran inmate.

38 C.F.R 17.38 (c) EXCLUSIONS OF THE VA MEDICAL BENEFITS PACKAGE<br>

Initiated at the Agency of Original Jurisdiction (AOJ)

*If an appeal that is benefit related is not resolved at the AOJ level to the appellant’s satisfaction, the appellant may formally continue appeal to the Board of Veterans Appeal (BVA) for a BVA de novo review and issuance of a final decision.

38 CFR 19.25 and 38 CFR 19.26 MEDICAL APPEALS<br>

Patient Advocates – VA employee specifically designated to manage feedback received from Veterans and their family members.

*Complaints, suggestions and/or concerns should always be addressed with the care team first, and if the disagreement or concern continues, speak with the individual’s supervisor or Chief of Service. If still unresolved, contact the Patient Advocate and request assistance filing an appeal for a review of the concern. PATIENT ADVOCATE PROGRAM<br>

Ambulance Services
Eyeglasses
Hearing Aids
Home Health Care
Dental Care
Certain Counseling Services LIMITED BENEFITS<br>

VA’s Foreign Medical Program (FMP) furnishes care to veterans residing outside the US if:

Treatment is for a service-connected disability, or a disability determined as aggravating the service-connected disability.
The veteran is a participant in a Chapter 31 rehabilitation program with specific determining eligibility.


38 CFR 17.35 VETERANS CARE OUTSIDE THE UNITED STATES<br>

If you are working with a veteran who needs assistance with their healthcare needs, first try to resolve the issue using local resources such as the patient advocate or Chief of Service.
If unsuccessful, the VFW Healthcare Team may be able to help.

James Moss
Assistant Director,
Veterans Health Policy
(202) 608-8371
Jmoss@vfw.org WHO TO CONTACT FOR HELP Julie Holt Marion Fera
Special Assistant for Health Consultant
Veteran Health Policy (202) 608-8349
(202) 608-8346 Mfera@vfw.org
JHolt@vfw.org<br>

www.caregiver.va.gov
www.publichealth.va.gov
https://www.va.gov/find-locations/
PACTActinfo.org
38 U.S.C. 1151
38 U.S.C. 1710 (e), (f), and (g)
38 U.S.C. 1712
38 U.S.C. 1722 (a)
U.S. Public Law 114-2 (Clay Hunt Act) REFERENCES<br>

Questions? 24<br>