Division: Office of Veterans Advocacy

Idaho Women Veterans Day is October 22nd
In conjunction with the 2016 Women Veterans Conference, Governor C.L. “Butch” Otter has proclaimed October 22, 2016 to be Idaho Women Veterans Day. The theme for this year’s Idaho Women Veterans Conference is Women Veterans Past and Present Healthy Living, Healing and Informing. The schedule is full of speakers that will cover health, history, personal stories, and information-plus a raffle. For more information and to register to attend the Women Veterans Conference click here.
DOCUMENTS
Idaho Governor’s Proclamation for Idaho Women Veterans Day

VA News Release: VA Schedules 2 Million Appointments Using Veterans Choice Program
Recently the VA authorized its two millionth appointment under the Veterans Choice Program (VCP). While that is a milestone for a less than two year old program, the VA is ultimately asking that Congress authorize the VA to simplify and streamline the care received under the VCP.

Among Secretary Bob McDonald’s five MyVA objectives are improving the Veteran experience, improving the employee experience so the VA can better serve Veterans; and establishing a culture of continuous improvement. In the VA’s view the consolidation of community care programs could greatly benefit not only Veterans, but also VA employees and care providers.

However, this consolidation care plan must be enacted by Congressional legislation. The potential positive impacts has been presented by Deputy Secretary Gibson in November 2015 and Secretary McDonald in January 2016.

The Plan is available online at http://www.blogs.va.gov/VAntage/resources/myva-initiative/.

DOCUMENTS
VA Press Release VCP Reached 2 Million Appointments 07142016

VA Announces Call Center to Help Veterans with Choice Program Billing Issues
Veterans can now work directly with the Department of Veterans Affairs (VA) to resolve debt collection issues resulting from inappropriate or delayed Choice Program billing. In step with MyVA’s efforts to modernize the VA’s customer-focused, veteran-centered services capabilities, a Community Care Call Center has been set up for veterans experiencing adverse credit reporting or debt collection resulting from inappropriately billed Choice Program claims. Veterans experiencing these problems can call (877) 881-7618 from 9:00 a.m. to 5:00 p.m. EST for assistance. “As a result of the Veterans Choice Program, community providers have seen thousands of veterans. We continue to work to make the program more veteran- friendly,” said Dr. David Shulkin, Under Secretary for Health. “There should be no bureaucratic burden that stands in the way of veterans getting care.”

The new call center will work to resolve instances of improper veteran billing and assist community care medical providers with delayed payments. VA staff are also trained and ready to work with the medical providers to expunge adverse credit reporting on veterans resulting from delayed payments to providers. The VA is urging veterans to continue working with their VA primary care team to obtain necessary health care services regardless of adverse credit reporting or debt collection activity. The VA acknowledges that delayed payments and inappropriately billed claims are unacceptable and have caused stress for veterans and providers alike. The new call center is the first step in addressing these issues. The VA presented The Plan to Consolidate Community Care in October of 2015 that outlines additional solutions to streamline processes and improve timely provider payment.

For more details about the Veterans Choice Program and the VA’s progress, visit: www.va.gov/opa/choiceact. Veterans seeking to use the Veterans Choice Program can call (866) 606-8198 from 9:00 a.m. to 5:00 p.m. EST to find out more about the program, confirm their eligibility, and schedule an appointment.

Veterans with Incomplete Health Care Applications Receive Additional Year to Enroll
The Department of Veterans Affairs (VA) announced it will extend the healthcare enrollment application period for one year to approximately 545,000 living veterans that have pending incomplete enrollment applications. “Fixing the veterans enrollment system is a top priority for VA. This is an important step forward to regain veterans’ trust and improve access to care as we continue the MyVA transformation,” said VA Deputy Secretary Sloan D. Gibson. “We’ve got a lot of work left to do, but this is a big step in the right direction to restore the data integrity of our enrollment system,” Gibson said.

The National Enrollment Improvement team conducted a detailed analysis of the pending applications in the VA’s enrollment system and identified approximately 545,000 living veterans whose applications were incomplete and in a pending status. The team also validated that approximately 288,000 pending enrollment system records were for deceased veterans. The VA has segregated deceased records from living veteran records and, as part of the Veteran Enrollment Rework Project (VERP), will review each incomplete application to determine if any should have been enrolled in VA health care. The VA is required by law to provide notice to veterans of incomplete applications. The VERP team could not verify whether the VA’s mailing system used to contact veterans about their incomplete applications was able to notify the 545,000 veterans identified above. The VA will contact living veterans to confirm their continued interest in enrolling in VA health care and ask them for the necessary information to complete their application. Veterans will have one year from the notice to provide this information. After a year, the VA will close the record. A veteran may reapply for enrollment at any time.

As veterans choose to enroll, the VA offers an enhancement to their enrollment experience through “Welcome to VA” (W2VA). Veterans enrolled since July 1, 2015, have received a personal introduction to VA health care services, programs, and resources to help them become more familiar with the VA’s services. In addition, the VA sends each new enrollee an introductory letter and personalized handbook in the mail. W2VA enhances communication by reaching out to newly enrolled veterans through personal phone calls upon enrollment, providing assistance with health care inquiries, and assisting with their initial appointment at their preferred VA healthcare facility.

VA Proposes, Takes Action on Leaders at the Veterans Benefits Administration
The Department of Veterans Affairs (VA) announced actions against four leaders at the Veterans Benefits Administration (VBA) and close-out of an Administrative Investigation Board (AIB) review of the Denver Hospital Replacement project.

Based on results of investigations, the VA proposed three actions and issued one action. These actions include:

Danny Pummill, Acting Undersecretary for Benefits, received a proposed 15-day suspension. This action is based on his alleged lack of oversight regarding Ms. Rubens’ and Ms. Graves’ actions in connection with their relocations.
Diana Rubens, Director, Philadelphia Regional Office, received a reprimand and a proposed 10% salary reduction. This action is based on her failure to exercise sound judgement by creating the appearance of impropriety in connection with her relocation.
Kimberly Graves, Director, Minneapolis/St. Paul Regional Office, received a reprimand and a proposed 10% salary reduction. This action is based on her failure to exercise sound judgement by creating the appearance of impropriety in connection with her relocation.
Additionally, Beth McCoy, Director, Field Operations, received a reprimand, based on her failure to exercise sound judgment by creating the appearance of impropriety in connection with her involvement in vacating the position to which she was then permanently assigned.
Mr. Pummill’s action, if sustained, is appealable to a third party. Ms. Rubens’ and Ms. Graves’ pay reductions, if sustained, may be reviewed by the VA Secretary but may not be appealed to outside third parties. Reprimands may be grieved administratively but may not be appealed to outside third parties. “When I learned that other evidence was available following the decisions of the Merit Systems Protection Board, I made a commitment to review all of the facts and take any additional accountability actions that I believed to be in the best interest of veterans and taxpayers. That meant looking through an enormous amount of additional evidence,” said Deputy Secretary Sloan Gibson. “After my review of that evidence, I believe that, within the scope and intent of the law, additional accountability actions were warranted. We have already reinstated Diana Rubens and Kim Graves to their positions as Regional Office Directors and I have been encouraged by their immediate effort to get back to work. Ultimately, that is what these decisions are about getting back to the work of serving America’s veterans.” The VA also announced that no additional adverse personnel actions will be taken as a result of the Administrative Investigative Board (AIB) review of the Denver Hospital Replacement project. If additional information comes to light when the Office of Inspector General completes its investigation regarding potential wrongdoing on the Denver replacement project, the VA will look to take appropriate action at that time. The AIB determined that responsibility for the decisions that resulted in delays and cost overruns fort the Denver replacement facility rested with executives who had departed from the VA prior to the AIB’s completion. Also prior to the AIB’s completion, the Department made personnel changes in other key positions for the project:

The previous Project Executive was moved to a staff resident engineer position–a reassignment that resulted in a loss of grade and pay. The individual is no longer employed by VA.
The previous Senior Resident Engineer was reassigned to non-supervisory work as a design manager–two new Senior Resident Engineers were hired in October 2014. The individual is also no longer employed by VA.
The previous Senior Contracting Officer for Denver was removed from the project and reassigned to non-supervisory duties.
“We know that errors were made in the construction of the Denver replacement facility,” said Gibson, who has visited the replacement facility site at least 10 times in the past year and a half. “We have owned those challenges and taken action to get the project back on track. We know that earning back the trust of veterans in Colorado and across the nation means constructing a facility they will be proud of and making sure that these errors do not occur again. After reviewing thousands of pages of documentation, I determined that the evidence does not support accountability action against any individual still employed by VA. We have made many changes in the way we design, bid and construct facilities. We have appointed a new Principle Executive Director of the Office of Acquisition, Logistics, and Construction, Mr. Greg Giddens, and we are working more closely with the Army Corps of Engineers than ever before. All of these process and personnel changes have made major reforms to the way we build, lease, and buy space to best serve our veterans and taxpayers.”

Combat Veterans Get Telephonic Health Care Application Option
The Department of Veterans Affairs (VA) announced it has amended its enrollment regulations to allow veterans to complete applications for enrollment in VA health care by telephone without the need for a signed paper application. The change is effective immediately for combat veterans and will be effective July 5, 2016, for all veterans. This phased implementation accelerates the VA’s effort to enroll all combat veterans with pending applications as part of its ongoing Veterans Enrollment Rework Project. The VA is working to complete the review and rework of all pending health enrollment records for living and deceased veterans this summer. “This improvement to our veterans’ experience is one we can implement now, and it’s the right thing to do for veterans,” said VA Deputy Secretary Sloan D. Gibson, “Enrolling all 31,000 combat veterans with pending applications is the top priority in our effort to fix our enrollment system. Our analysis of our current application process convinced me we could enroll veterans more quickly using this method, particularly combat veterans and those who are transitioning from active duty to veteran status,” Gibson said.

By adding this telephone application option to the VA’s regulations, the VA will now offer three ways to enroll. This change provides veterans an even more convenient way to apply for enrollment, in addition to the paper VA Form 10-10 EZ and online enrollment application process. With publication in the Federal Register today, combat veterans may now apply by phone. All other veterans may apply by phone starting on July 5, 2016. When veterans choose to enroll, the VA offers an enhancement to their enrollment experience through “Welcome to VA” (W2VA). Veterans enrolled since July 1, 2015, have received a personal introduction to VA health care services, programs, and resources to help them become more familiar with the VA’s services. In addition, the VA sends each new enrollee an introductory letter and personalized handbook in the mail. W2VA enhances communication by reaching out to newly enrolled veterans through personal phone calls upon enrollment, providing assistance with health care inquiries, and assisting with their initial appointment at their preferred VA healthcare facility. For more information, veterans can contact the Health Eligibility Center Enrollment and Eligibility Division toll free at (855) 488-8440.

VA Announces Additional Steps to Reduce Veteran Suicide
The Department of Veterans Affairs (VA) announced new steps it is taking to reduce veteran suicide. The steps follow a February 2nd summit, “Preventing Veteran Suicide – A Call to Action,” that brought together stakeholders and thought leaders to discuss current research, approaches, and best practices to address this important subject. “We know that every day, approximately 22 veterans take their lives and that is too many,” said VA Under Secretary for Health, Dr. David Shulkin. “We take this issue seriously. While no one knows the subject of veteran suicide better than VA, we also realize that caring for our veterans is a shared responsibility. We all have an obligation to help veterans suffering from the invisible wounds of military service that lead them to think suicide is their only option. We must and will do more, and this summit, coupled with recent announcements about improvements to enhance and accelerate progress at the Veterans Crisis Line, shows that our work and

commitment must continue.”

Several changes and initiatives are being announced that strengthen the VA’s approach to suicide prevention. They include:

Elevating the VA’s Suicide Prevention Program with additional resources to manage and strengthen current programs and initiatives;

Meeting urgent mental health needs by providing veterans with the goal of same-day evaluations and access by the end of calendar year 2016;

Establishing a new standard of care by using measures of veteran-reported symptoms to tailor mental health treatments to individual needs;

Launching a new study, “Coming Home from Afghanistan and Iraq,” to look at the impact of deployment and combat as it relates to suicide, mental health, and well-being;

Using predictive modeling to guide early interventions for suicide prevention;

Using data on suicide attempts and overdoses for surveillance to guide strategies to prevent suicide;

Increasing the availability of naloxone rescue kits throughout the VA to prevent deaths from opioid overdoses;

Enhancing Veteran Mental Health access by establishing three regional tele-mental health hubs; and

Continuing to partner with the Department of Defense on suicide prevention and other efforts for a seamless transition from military service to civilian life.

For information about the VA initiatives to prevent veteran suicide, visit

www.mentalhealth.va.gov/suicide_prevention.

VA Improves Timeliness of Provider Payments
To enhance veterans’ access to care and eliminate delays in Choice provider payment, the Department of Veterans Affairs (VA) is eliminating administrative burdens placed on VA community providers. Previously, payments to Choice providers were not allowed until a copy of the veteran’s medical record was submitted. Now, community providers, under the Choice program, will no longer be required to submit medical records prior to payment being made. To facilitate the change, the VA has modified the Choice Program contract, making it easier for Health Net and TriWest to promptly pay providers. The VA continues to require pertinent medical information be returned to ensure continuity of care, but it is no longer tied to payment. The VA is taking these steps to more closely align with industry standards. This administrative step just makes sense,” said VA Under Secretary for Health Dr. David J. Shulkin. “It ensures veteran access, timely payments, and strengthens our partnerships with our Choice providers. We know that providing veterans access to high-quality, timely healthcare would be impossible without collaboration with our community providers.”

The VA’s Plan to Consolidate Community Care Programs outlines additional solutions to improving timely provider payment. The VA is moving forward on two paths to further improve timely payment. First, the VA is 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, the VA plans to pursue a claims solution that moves to a more automated process for payment. The VA envisions a future state where it is able to auto-adjudicate or process a high percentage of claims, enabling the Department to pay community providers promptly and correctly, while adopting a standardized regional fee schedule to promote consistency in reimbursement.

Veterans seeking to use the Veterans Choice Program or wanting to know more about it, can call (866) 606-8198 to confirm their eligibility and to schedule an appointment. For more details about the Veterans Choice Program and the VA’s progress, visit www.va.gov/opa/choiceact.

Veteran’s Copayment Responsibility for VA Health Care
What are your options if you are unable to pay your full copay charges? There are multiple options available to help make paying your current copay charges more affordable, or to eliminate them. You have the right to establish a monthly repayment plan at any time during your enrollment in VA health care if you cannot pay your debt in full. To do so, submit a completed Agreement to Pay Indebtedness (VA Form 1100). Indicate your proposed monthly payment amount in paragraph 1A. Include your first payment with the completed form, making a check or money order payable to “VA” and include the account number and payment stub. You also have the right to request a waiver of part or all of your debt. If the waiver is granted you will not be required to pay the amount waived. To do so, submit an explanation and a completed Financial Status Report (VA Form 5655). Your explanation should include why you are not responsible for the debt and any undue hardship the payment of the debt would cause you. You have the right to request a hearing in connection with your request for a waiver. To do so, submit a written request for hearing with your waiver request. The VA will notify you of the date, time, and place where the hearing will be held. You also have the right to request a compromise. A compromise means you propose a lesser amount as full settlement of the debt. To request a compromise, submit your request in writing to the VA, specifying the dollar amount you are proposing the VA should accept as payment in full, and a completed Financial Status Report (VA Form 5655).

What are your options if your household income has decreased and you will be unable to pay future copay charges? If your gross household income has decreased from the previous income year, you may be eligible for a Hardship Determination which provides future exemption from medical and hospital care copays for a determined period of time. To request a hardship determination, send a letter explaining any financial hardship these charges will cause you and a completed Request for Hardship Determination (VA Form 10-10HS). If your gross household income has decreased, you may be eligible for enrollment in a higher Priority Group which may qualify you for copayment exemption. Submit a completed Health Benefits Renewal (VA Form 10-10EZR).

When does your debt become delinquent? Your balance is considered delinquent if it remains unpaid after the balance due date on your initial billing statement, which is typically thirty (30) days after the statement date. What happens once your bill becomes delinquent? If your bill remains delinquent for ninety (90) days, any current or future VA benefit payments you are entitled to will be reduced or “offset” in order to satisfy the overdue debt. If you fail to make a payment on your debt before it reaches one hundred twenty (120) days delinquent, (150 days from initial billing statement date), accounts without VA benefits available for offset will automatically transfer to the Department of the Treasury Cross-Servicing Program. Once your bill has been referred to Treasury, the VA can no longer accept payments on the debt. You can continue to make payments on any bill that has not been referred to Treasury. If you make a payment online it will be applied to any outstanding balance not at Treasury. If no additional debt exists with the VA, the payment will be applied as a credit balance and refunded after 60 days, unless a refund is requested sooner. To pay a bill that has been referred to Treasury, contact Debt Management Services toll free at (888) 826-3127 between 8:00 a.m. to 10:00 p.m. EST, Monday through Friday to speak with a representative.

Will you be able to continue receiving health care services if your bill is referred to Treasury? Yes. Your health care services will continue without interruption regardless of whether your bill is referred to Treasury. What happens once your bill is referred to Treasury? The Treasury Cross-Servicing Program consists of a standard collection process, including Treasury Debt Collection, which issues the official Treasury collection letter and attempts to contact you by searching various databases, making telephone calls and sending additional collection letters; Treasury Offset Program (TOP), which identifies debtors in the federal database and will offset (reduce or withhold) any federal payments to pay the debt, including tax refunds, Social Security benefits, military pay, retirement pay, and other federal payments that are not exempt by law or by action of the Secretary of the Treasury; Administrative Wage Garnishment (AWG), which Treasury identifies eligible debtors who have been employed for at least 12 months and will provide appropriate due process and issue notice to the employer to deduct up to 15% of disposable pay each pay period until the debt, including all interest, penalties and costs, is paid in full; and Private Collection Agency (PCA), which once Treasury has exhausted efforts to collect debts internally, accounts are referred to contracted PCAs to make additional attempts to find and contact you by searching various databases, making telephone calls, and sending collection letters.

Why is the VA referring your delinquent debt to the Department of the Treasury? In 1996, due to a steady increase in the amount of delinquent non-tax debt owed to the United States, Congress passed the Debt Collection Improvement Act (DCIA) of 1996. This law centralized the government wide collection of delinquent non-tax debt and gave the Department of the Treasury significant new responsibilities in this area. If Federal agencies are not successful at collecting a debt, they are required under the Digital Accountability and Transparency Act (DATA) of 2014 to refer eligible delinquent non-tax debt to TOP for debt collection action within 120 days.

Will you pay additional fees if your bill is referred to Treasury? Yes. You will incur collection fees from Treasury based upon a percentage of your outstanding bill(s) and length of time outstanding. Treasury charges a 28% fee for debts less than 2 years delinquent and a 30% fee for debts over 2 years delinquent. Treasury collects the fees from each payment made and applies the remaining amount to the debt balance. In the event the debt is recovered through TOP, a fee is charged per transaction. TOP has a tiered fee schedule based on the type of offset e.g. salary, social security.

DoD & VA Kick off New Interagency Coordination of Complex Care Effort
The Departments of Defense (DoD) and Veterans Affairs (VA) announced its ongoing effort to ease the transition for service members who require complex care management as they transition from the DoD system of health care to the VA or within each system. The effort is designed to ease the burden for service members and veterans, who have suffered illnesses or injuries so severe as to require the expertise provided by multiple care specialties throughout both Departments. “More than a decade of combat has placed enormous demands on a generation of service members and veterans–particularly those who have suffered wounds, injuries, or illnesses which require a complex plan of care,” said Dr. Karen Guice, Principal Deputy Assistant Secretary of Defense for Health Affairs, and Co-chair of the DoD-VA Interagency Care Coordination Committee (IC3). “These individuals require the complex coordination of medical and rehabilitative care, benefits, and other services to successfully transition from active duty to veteran status, and to optimally recover from their illnesses or injuries.”

“Our collaborative efforts with DOD have improved and enhanced the process of caring for our military members with serious illness, injuries, or disabilities as they recover and return to their communities. Great attention has been made to developing a system which focuses on continuity of care, holistic support services, and a ‘warm handoff’ for service members and veterans as they move from and between the military, the VA, and community health care systems. Our care coordinators now have at their fingertips tools and processes that improve and simplify the lines of communication for our wounded, ill, and injured service members and veterans who require complex care coordination, their families, and those who provide their care in both Departments,” said Dr. Linda Spoonster Schwartz, Assistant Secretary for Policy and Planning for the Department of Veterans Affairs, and Co-chair of the DoD-VA Interagency Care Coordination Committee (IC3). “This process will enhance and improve the quality of care and services for these veterans and their families now and in the future.”

The hallmark of the effort is the implementation of the role of Lead Coordinator. The Lead Coordinator will be a designated member of a service member’s care management team who will serve as the primary coordinator for that individual. The Lead Coordinator will offer personal guidance and assist the service member and their families in understanding the benefits and services to which they are entitled. Service members, veterans, and their families, working with their Lead Coordinator, will have someone to whom they can turn when they have a question or issue as they actively participate in their care. The first phase of Lead Coordinator Training was completed in November. It is expected a total of 1,500 DoD staff and 1,200 VA staff will serve as Lead Coordinators.

This effort comes as a result of the work of the DoD-VA IC3, established in 2012 to implement a joint, standard model of collaboration for the most complex cases of care that will require a warm handoff from the DoD to the VA system of care, as well as within the Departments, and is based on many of the best practices of collaboration that have been created over the last decade. This effort was enacted as policy by both departments in 2015, aligning more than 250 sub-policies to one, overarching policy that will govern the coordination of complex care cases that transition between the two departments. Coordination efforts are synchronized through the IC3 Community of Practice (CoP), a group representing more than 50 DoD and VA programs that provide specialty care, including rehabilitation services for the visually impaired and polytrauma centers. It will be the job of the Lead Coordinator to guide service members through the system, ensuring that they receive the care, benefits, and services they both require and to which they are entitled.