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Appendix A VHA'S BENEFICIARY TRAVEL PROGRAM: FREQUENTLY ASKED QUESTIONS48 Who is eligible for travel? Veterans rated 30 percent or more SC for travel relating to any condition Veterans rated less than 30 percent for travel relating to their SC condition Veterans receiving VA pension benefits for all conditions Veterans with annual income below the maximum applicable annual rate of pension for all conditions Veterans who can present clear evidence that they are unable to defray the cost of travel Veterans traveling in relation to a Compensation and Pension (C&P) Examination Certain veterans in certain emergency situations Certain nonveterans when related to care of a veteran (attendants and donors) Beneficiaries of other Federal agencies (when authorized by that agency) Allied Beneficiaries (when authorized by appropriate foreign government agency) Are OEF/OIF veterans, combat veterans, spinal cord injury (SCI) or any other "special" group of veterans eligible for travel based upon their inclusion in that group? With the exception of veterans traveling to a VA or VA authorized transplant center in relation to VA transplant care, veterans in a "special" group are not eligible for VA travel benefits based solely on their inclusion that group. "Special" group" veterans must meet travel eligibility criteria in the same manner as any other veteran. 48This section, reproduced from the Veterans Health Administration's web site, describes the medical transportation services and assistance provided by VHA to veterans and provides links to authorizing legislation and regulations. The title of this web page is "VA Health Care Eligibility & Enrollment: Beneficiary Travel Frequently Asked Questions (FAQs)." See http://www4.va.gov/healtheligibility/Library/FAQs/BeneTravelFAQ.asp, accessed December 9, 2009. A-1

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What travel can the Department of Veterans Affairs (VA) provide? VA has authority to provide eligible beneficiaries reimbursement for mileage, special mode of transportation (when medically justified by a VA health care provider), and in certain circumstances, taxi or hired car. What are current mileage rates for travel? Why are rates different for veterans and VA employees? Effective November 17, 2008 VA reimburses 41.5 cents per mile for ALL veteran travel, including C&P exams and when VA has determined that a deficiency lab, EKG, x-ray etc. exists in relation to a C&P exam ("Convenience of the Government"). Mileage rates for veterans and VA employees are determined under separate authorities and take different criteria under account. Title 38 United States Code (U.S.C.) 111 and 38 Code of Federal Regulations (C.F.R.) 70.1 70.50 are the authorities for Beneficiary Travel. 41 C.F.R. Chapter 301 provides guidance for employee travel. Can mileage reimbursement or special mode transport be withheld from a travel eligible veteran? Travel benefits may be withheld when it is clinically determined that travel allowance would be counterproductive to care, treatment, or therapy being provided and such determination is recorded in the patient's medical record. In addition, the chief of the service or a designee must review and approve the determination in writing in the patient's medical record. What are the deductible amounts? Is the monthly deductible cap for each facility or is it for travel to all VA facilities for health care? Who is required to pay the deductible? Public Law 110-387 required VA to reduce (and freeze) the deductible amounts to those originally specified in 38 U.S.C. 111(c)(5). Therefore, effective January 9, 2009 the Beneficiary Travel deductible was reduced to $3.00 per one way trip; $6.00 for a round trip; with a maximum deductible of $18.00 per calendar month. The $18.00 is the total monthly deductible amount for travel to all VA facilities. Regardless of the deductible amount withheld per trip, deductible requirements end after 6 one-way (3 round) trips in a calendar month. Should a veteran be going to multiple VA A-2

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facilities, and the veteran notes this when applying for Travel reimbursement, it is incumbent upon the facility providing the care and travel to contact any other VA facilities to determine if the deductible has been met. The only exemptions to the deductible are: Veterans traveling in conjunction with a C&P examination, Nonveteran donors, Veterans requiring a special mode of transportation, and When it is determined that the imposition of the deductible would cause a severe financial hardship (see "Waivers"). All other eligible veterans, including those receiving care for service connected conditions, are required to have the deductible applied. Who is eligible for a waiver? How do you determine if a veteran is eligible for the waiver? Waivers of the deductible can be made when the deductible causes a "severe financial hardship" to the veteran. Per 38 CFR 70.31(c), a severe financial hardship occurs when the veteran is in receipt of a VA pension; his or her income for the year prior to application, or projected income for the year of application (current year) does not exceed the appropriate VA pension level; or in the case of an SC veteran, income is at or below the appropriate "Means Test" thresholds for the year prior to application or projected for the year of application. How is it determined that a veteran requires "Special Mode" transportation? What eligibility requirements must be met? Special mode of transportation includes ambulance, ambulette, air ambulance, wheelchair van, and other modes which are specially designed to transport certain disabled individuals. Special mode DOES NOT include public transportation such as taxi, bus, subway, train, airplane, or privately owned conveyance with special adaptive equipment and/or capable of transporting disabled persons. A-3

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In order to be eligible for special mode of transportation, two criteria must be met. The veteran first has to be administratively eligible for transport at VA expense. This includes meeting the basic criteria, as well as being "unable to defray the expenses of travel" as defined in 38 CFR 70.10 (c). Unless these criteria are met the veteran is not eligible for special mode of transportation. Once administrative eligibility is established, a VA clinician must then determine that a special mode of transportation is medically required to transport the veteran for VA health care. Unless one of the forms of special mode of transportation is required and documented as such, this method of transportation is inappropriate. Should it be clinically determined at one VA facility that such transportation is required, this should be accepted at all VA facilities, unless there is reason to think a veteran's condition may have changed. Local procedures should be established to determine special mode requirements, as well as communication guidelines to other VA facilities when it is necessary to send veterans with this requirement to Tertiary Care, other VA facilities, or non-VA providers for treatment. How much discretion does a facility have if a veteran does not meet eligibility standards and extenuating circumstances exist? There is no authority to provide transportation at VA expense for veterans who do not meet eligibility requirements, except in the case of Organ Transplants (VHA Directive 2001-027). Is there anything we can do to obtain travel for ineligible beneficiaries? When a veteran does not meet eligibility for Beneficiary Travel, other sources, including the DAV network, family and community should be aggressively pursued. VA Form 3068, "Reduced Rate transportation" is also available for field use. This form can be presented to transportation carriers for possible reduced rates for veterans needing to travel in relation to VA health care. It is mainly used for bus transportation; however it may be accepted by other carriers. In addition, VA facilities should be pro-active in assisting the veteran explore possible VA options that would give him/her eligibility for Beneficiary Travel. A-4

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These include: Service Connection Is the veteran potentially eligible? Refer to the Directory of Veterans Service Organizations, a VBA Representative, your Regional Office, or the VA web site. A&A/Housebound For veterans not receiving these benefits, is their income at or below the income thresholds for these benefits? VHA Directive 2004-026, "Income Thresholds Used in Identifying Veterans Exempt from Extended Care Service and Outpatient Medication Copayment and in Determining Eligibility for Beneficiary Travel" provides details on how veterans not receiving A&A/housebound may still be determined eligible for Beneficiary Travel. "Hardship" review Is veteran unable to pay the cost of their transportation? Has veteran lost their job? Does it appear that their future income will be less? Does VA have authority to provide transportation for Fee Basis or visits when an eligible veteran chooses to use private health insurance to pay for care? VA has authority to pay for transportation of veterans traveling to VA authorized non-VA health care when a deductible (if applicable) is met. If VA is not paying for the care, travel at VA expense will not be provided. What if a veteran chooses to go to his "preferred" facility instead of the closest VA facility that can provide the care? Veterans have the choice to go to any VA facility they choose for care. However, travel can only be authorized to the nearest facility that can provide the needed care. Therefore, should a veteran choose to go to another facility than that closest to his home, they are responsible for any costs beyond that for transportation to the nearest facility. This includes mileage and special mode of transportation. A-5

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How do we determine mileage for reimbursement purposes? VA has not established use of a single reference. Mileage can be determined using authoritative guidance such as Rand McNally or MapQuest; or zip code to zip code as determined at the local VA health care facility, whichever gives the greater benefit to the veteran. What if a veteran has a PO Box and physically lives elsewhere? Beneficiary Travel is intended to assist veterans with transportation from their place of residence to the VA health care facility that can provide the needed care. With the implementation of the Health Insurance Portability and Accountability Act of 1996 (HIPAA) veterans now have the option of having their official mail sent to any place they choose. However, this does not imply that Travel should be paid from that point. Similarly, a veteran's home address could be in another state but he or she is currently staying in the area. Therefore, travel should not necessarily be paid from the distant address. In order to determine appropriate travel reimbursement it is necessary that a veteran establish a current place of residence. A veteran may be asked to provide documentation establishing their address. Should a veteran refuse to provide this information, they are only authorized travel to the nearest VA facility that can provide the required care, not necessarily where the veteran chooses to seek care or treatment. If another VA facility is closer to the veteran's actual residence and that VA facility can provide the care, then Travel reimbursement will only be to that point. Which facility is responsible for travel when a veteran is referred to a Tertiary Care facility, or another facility that can provide the needed care on an outpatient basis? For inpatient treatment? What about veterans who do not meet eligibility criteria? For outpatient treatment, the VA facility that is providing the care, or in the case of non-VA care, the facility that authorizes the care is responsible for arranging and providing travel to eligible veterans. Therefore, should a VA facility refer a veteran to another VA facility for care, the second facility is responsible for providing travel, as they will be providing the care (as well as authorizing it). For non-VA (FEE Basis) care, the VA facility that authorizes and pays for the treatment is responsible for travel. When it is necessary to transport an inpatient between VA facilities (Interfacility Travel), the releasing VA facility is responsible for travel. Therefore, the initial transportation will be the A-6

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responsibility of the first facility, and return transport is the responsibility of the second facility. The only exceptions to these rules are for transportation in relation to VA transplant care and for transportation to a VA Parkinson's Disease, Research, Education and Clinical Centers (PADRECCs). In such cases, the referring facility is responsible for round-trip transportation for either inpatient or outpatient care. Who is responsible for transport of veterans in a community nursing home (CNH)? For veterans in a CNH at VA expense, the placing VA facility is responsible for travel. Should a CNH veteran be placed in another VA Clinic of Jurisdiction (COJ), the initial placing facility will be responsible for travel (and CNH payment) for the first 90 days. After that time, the receiving COJ will be responsible for costs incurred, including travel for VA placement of the veteran. Veterans in a CNH at private expense must meet eligibility requirements for VA payment of non-VA emergency care as well as Beneficiary Travel in order to receive transport at VA expense. What authority does VA have to transport veterans in emergency situations? Transport from a VA facility to a community facility for emergency treatment: When a veteran develops an emergency while receiving care at a VA facility and the facility cannot provide the needed care, transport to a community provider and back to the VA facility can be authorized at VA expense in accordance with 38 U.S.C. 1703(a)(3), regardless of the veteran's Beneficiary Travel eligibility. Transport from any point other than a VA facility to a community facility for emergency treatment: If the emergency episode of care is approved for VA payment, then transport from the point of emergency to the non-VA facility can be authorized at VA expense. However, once medically stabilized at the community provider, the veteran must meet Beneficiary Travel and medical eligibility criteria for further transportation at VA expense. A-7

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Can VA pay for transport of an attendant, donor, or other non-veteran? VA has the authority to pay for transportation and associated incidental costs (lodging, food, etc.) at VA expense of certain non-veterans when: It is clinically determined by a VA provider that due to the veterans mental or physical condition that an attendant is required when transporting the veteran, or The nonveteran is the donor or potential donor of tissue, organ, or parts to a veteran receiving VA, or VA authorized non-VA health care, or In the case of an Allied Beneficiary, travel and reimbursement has been authorized by the appropriate foreign government agency, or Travel and reimbursement is authorized by another Federal agency when VA care is provided to a beneficiary of that agency. Is VA required to pay for lodging and meals associated with VA travel? VA may provide reimbursement for the actual cost up to 50 percent of the government employee rate for meals and/or lodging, when appropriate. The need for such costs should be determined on a case-by-case basis and based upon the veteran's medical condition, distance required to travel, and any other extenuating circumstances. Such items should be requested and authorized in advance of travel. Reimbursement should not be provided solely because the veteran chooses to stop or take a less direct route to the VA facility. Does VA have authority to pay ferry fares; bridge, road, and tunnel tolls; luggage fares; or parking in association with VA travel? Reimbursement for these and/or other accessories of travel may be provided upon presentation of an appropriate receipt. The beneficiary should be informed prior to their travel to save their receipts. They should also be informed of any travel restrictions (e.g., amount of luggage authorized). Reimbursement is based on a case-by-case basis and the individual needs and condition of the beneficiary. A-8

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Does VA have authority to transfer veterans to where they "grew up", or where their family resides? VA has limited authority to provide travel for such requests. Such transport may be approved for travel eligible veterans if the cost to the government is less than to the originating home of record. Otherwise, only veterans receiving inpatient care at a VA facility, or non-VA facility at VA expense, in a terminal condition (estimated less than 6months to live) can be transferred to a suitable health care facility in area other than where they lived upon entering the VA facility. In addition, such transfer can occur only from one VA facility to another, or when VA is paying for care at a non-VA facility, and future care will be at VA expense. Veterans receiving care on an outpatient basis are not eligible for such transportation. How should travel be determined if a veteran changes residence while undergoing VA health care, especially if they are an inpatient? If the beneficiary's residence changed while receiving care or services, payment for the return trip will be for travel to the new residence except that payment may not exceed the amount that would be allowed from the facility where the care or services could have been provided that is nearest to the new residence. For example, if during a period of care or services in Baltimore, a beneficiary changed his or her address to Detroit, payment for the return trip would be limited to that allowed for traveling to the new residence from the nearest facility to the new residence in Detroit where the care or services could have been provided. How should Beneficiary Travel at CBOCs or other outlying VA facilities be handled when there isn't a Travel Office or agent cashier agent cashier on station? Each "parent" facility must develop local guidelines in order to provide Beneficiary Travel benefits to eligible veterans at remote facilities under their jurisdiction. These must include procedures to capture appropriate documents and signatures in order to meet the requirements of the program as well as those of other involved services (e.g., Fiscal). A-9

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How long do beneficiaries have to submit a claim for travel? Without a Special Mode of Transportation: A claimant must apply either in person or in writing for payment of Beneficiary Travel within 30 calendar days after completing travel that does not include a special mode of transportation. With a Special Mode of Transportation: For Beneficiary Travel that includes a special mode of transportation, a claimant must apply for payment of Beneficiary Travel and obtain approval from VA prior to travel. Emergency treatment: If there has been an emergency treatment and the claimant applies for payment of Beneficiary Travel (without prior approval) within 30 calendar days after the travel is completed, the application will be considered timely submitted. Eligible within 30 days of travel: If a person becomes eligible for Beneficiary Travel after the travel takes place, payment may be made if the person applies for travel benefits within 30 days of the date when the person became eligible for travel benefits. NOTE: The date of an application for Beneficiary Travel is the postmark date, if mailed; or the date of submission if hand delivered. What are the VA authorities for Beneficiary Travel, and where can copies be obtained? The following are current legislative, regulatory and VHA Manual guidelines for VA Beneficiary Travel: United States Code (USC) Payments or allowances for Beneficiary Travel 38 U.S.C. 111 A-10

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Code of Federal Regulations (CFR) Purpose and Scope 38 C.F.R. 70.1 Definitions 38 C.F.R. 70.2 Determination of Secretary 38 C.F.R. 70.3 Criteria for Approval 38 C.F.R. 70.4 Eligible persons 38 C.F.R. 70.10 Application 38 C.F.R. 70.20 Where to Apply 38 C.F.R. 70.21 Payment Principles 38 C.F.R. 70.30 Deductibles 38 C.F.R. 70.31 Reimbursement or Prior Payment 38 C.F.R. 70.32 Administrative Procedures 38 C.F.R. 70.40 Recovery of Payments 38 C.F.R. 70.41 False Statements 38 C.F.R. 70.42 Reduced fare requests 38 C.F.R. 70.50 Are veterans who work at a VA facility and receive their care there eligible for Beneficiary Travel reimbursement when they have a medical appointment? What about volunteers? Eligible employee veterans and Compensated Work Therapy (CWT) patients shall be provided mileage reimbursement in the same manner as other travel eligible veterans when they have a scheduled health care appointment on the same day they are working. As always, in order to qualify the veteran must meet Beneficiary Travel eligibility. In the case of an employee, sick or annual leave should be used to cover the period of the appointment if the appointment is during their tour of duty. CWT patients should have appropriate approval for absence from their CWT program. In cases of unscheduled visits, if the employee or CWT patient is seen as a veteran (vs. employee), then A-11

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they may be reimbursed for one-way travel the same as other veterans. The following must be met in order to be eligible for such reimbursement: The purpose for which the veteran reported is one for which travel at VA expense would have been normally authorized, and The visit is satisfactorily completed. Volunteers are not employees and are therefore eligible for Beneficiary Travel reimbursement whether or not they volunteer on the same day as their appointment. Are veterans who travel together all entitled to Beneficiary Travel reimbursement? What about those veterans who take the DAV system or other "free" transportation? In order to be eligible for travel benefits when transporting to VA care or treatment, a veteran must actually be incurring an expense. Should one or more veterans travel together in a private vehicle, only the owner of the vehicle is actually incurring expenses and therefore is the only person entitled to travel reimbursement. However, should multiple veterans share a vehicle where passengers must pay for their transport such as a taxi or where one veteran pays another veteran for transport, then all are entitled to travel reimbursement either at the mileage reimbursement rate or actual expense, whichever is less. Such persons must provide a receipt to indicate an incurred expense and to receive reimbursement. Veterans who take non-pay transportation such as DAV transportation, VA Network transportation systems or other no-cost city, state, or area systems are not incurring cost and therefore are not entitled to Beneficiary Travel reimbursement. A-12