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Pension Management Center. VSO outreach presentation. September 2013. Agenda. What’s New In The PMC Fully Developed Claim (FDC) presentation Assisted living versus Independent living Relaxed Dependency evidence requirements for surviving spouses

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Pension Management Center

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Pension management center

Pension Management Center

VSO outreach presentation

September 2013


Agenda

Agenda

  • What’s New In The PMC

  • Fully Developed Claim (FDC) presentation

  • Assisted living versus Independent living

  • Relaxed Dependency evidence requirements for surviving spouses

  • Changes in rules for paying service-connected burial benefits

  • Eligibility Verification Report program termination


Pension organization changes

Pension Organization Changes:

  • Rating & Maintenance Processing Teams

    • Teams now process the same terminal digit range but six exclusively process original claims (Veteran and survivor) and four exclusively processes maintenance claims.

    • There is also a dedicated Burial/Fiduciary Team.


Pension organization changes1

Pension Organization Changes:

  • Advocacy Team

    • Formerly each team processed “special” claims internally along with general claims work.

    • Now the advocacy team processes “special” claims from start to finish.

    • Special Inquiry Phone Queue – the dedicated phone line has been expanded and is now staffed by the employees who process the special claims.

    • Went into effect July 20, 2012.


Enhanced screening procedures

Enhanced Screening Procedures

  • Now Veteran’s AND survivor’s claims are being pre-screened.

    • More “quick decisions” where development is not required to grant or deny the claim.

    • More “directed development” to ask for the necessary information the first time.

    • Less time waiting for claims folders when they are needed to make a final decision.


Objectives for fully developed claim presentation

Objectives for Fully Developed Claim Presentation

  • Describe the contents of the VA Form 21-527 EZ and VA Form 21-534 EZ

  • Define the criteria to qualify for participation in the FDC program

  • Define the criteria for subsequent exclusion from the FDC program


Pension management center

VA Form 21-527EZ

  • A new version of the VA Form 21-527EZ (dated August 2011) is divided into two parts:

    • The Veteran notice

      • This explains requirements for Pension benefits that would have previously been in any initial development letter

    • The FDC Application

      • This is a 5-page form

    • Note: There is no longer a requirement to submit a separate certification. You simply need to sign the application, which authorizes consideration in the FDC program


Pension management center

FDC Criteria – 21-527EZ

  • To participate the Veteran must submit the completed 21-527EZ along with all relevant and pertinent evidence to “fully develop” the claim, that is:

    • For special monthly pension claims,

      • a completed VA Form 21-2680, Examination for Housebound Status or Permanent Need For Regular Aid And Attendance

      • or a completed VA Form, 21-0779, Request For Nursing Home Information in Connection With Claim For Aid And Attendance.

  • The Veteran must also be available to report for a VA examination, if required.


Pension management center

VA Form 21-534EZ

  • The VA Form 21-534EZ was released in 2012 and is also divided into two parts:

    • The claimant notice

      • This explains requirements for Pension, DIC and accrued benefits that would have previously been in any initial development letter

    • The FDC Application

      • This is a 5-page form


Pension management center

FDC Criteria – 21-534EZ

  • To participate, the claimant must submit the completed 21-534EZ along with:

    • All relevant and pertinent evidence to “fully develop” the claim, that is:

      • A copy of the Veteran’s death certificate

      • If claiming pension All necessary income and net-worth information

    • If claiming aid and attendance or housebound benefits for either DIC or Death Pension

      • A completed VA Form 21-2680, Examination for Housebound Status or Permanent Need For Regular Aid And Attendance, or, if claiming this benefit based on nursing home attendance, a VA Form, 21-0779, Request For Nursing Home Information in Connection With Claim For Aid And Attendance.


Pension management center

FDC Exclusions

  • A claim is no longer considered an FDC if the:

    • Claim did not meet FDC criteria upon receipt or is found to require additional development such as requesting private medical evidence, or further evidence from the claimant

    • The claimant fails to report for an examination (unless VA is at fault)

    • The claimant submits a supplemental claim or evidence after receipt of the FDC Claim

  • Note: A claim will not be excluded from this program due to normal delays built into development for evidence in Federal custody


Objectives for fully developed claim presentation1

Objectives for Fully Developed Claim Presentation

  • Describe the contents of the VA Form 21-527 EZ

  • Define the criteria to qualify for participation in the FDC program

  • Define the criteria for subsequent exclusion from the FDC program

    Questions?


Objectives for residential living fees presentation

Objectives for Residential living fees presentation:

  • Overview of history.

  • Overview of definitions.

  • Outline of recent changes implemented.

Press release 12/20/12


Residential facility fees

Residential facility fees

  • There are more and more facilities which cater to an aging or elderly population.

  • Many facilities provide differing levels of care.

  • The deductibility of these fees has been something we have questioned.

  • VA Fast Letter 12-23 was released in October 2012 and provided some clarification.


Assisted living vs independent senior living

Assisted living vs. Independent/Senior living

  • Traditionally, VA defined an assisted living facility as a facility which did provide medical and/or nursing care to a resident.

  • A RLF generally provides less care than an ALF, and normally does not provide any medical or nursing home type care.

  • Fees from RLFs are generally for room and board only.

  • New guidance on using fees from RLF as deductible medical expenses.


Accepting independent living fees

Accepting Independent Living Fees

  • Room and Board expenses from an Independent/Senior living facility are now acceptable only if:

    • The individual’s physician states in writing that the claimant must reside in that facility in order to separately contract for custodial care with a third-party provider (and contract for that care).Or…

    • The facility provides the individual with custodial care in the form of assistance with two or more activities of daily living.


What are custodial care and activities of daily living

What are Custodial Care and Activities of daily living?

  • Custodial Care: “assisting a person with activities of daily living”

  • Activities of Daily living: “items of basic self-care which include; bathing or showering, dressing, eating, getting in or out of bed or a chair, and toileting”

  • To accept fees facility must provide at least 2 of the above activities of daily living.


Non medical related services

Non-medical related services

  • Meal preparation,

  • Shopping or traveling with the individual

  • Providing security monitoring

  • Housework, other chores, etc.

  • Are NOT considered basic self-care activities of daily living

    Services such as these would not make the facility fees deductible.


Independent living allowances

Independent Living allowances

  • Prior to this guidance, there may have been situations where a deduction was allowed for a facility which would no longer meet the criteria for deductibility, with this new guidance.

  • We will not be removing from consideration previously allowed fees, as this guidance is not intended to displace beneficiaries.

  • However, if a beneficiary changed facilities, the new rules would apply


Objectives for relaxed dependency evidence requirements presentation

Objectives for relaxed dependency evidence requirements presentation:

  • Overview of history.

  • Outline of recent changes implemented.


Death claim dependency requirements

Death claim dependency requirements

  • 21-534 variations

  • Until recently, our processing guidelines stated that a surviving spouse must submit acceptable evidence establishing themselves as the surviving spouse, even if that claimant was previously established on the Veteran’s award

  • VA Fast Letter 13-04 was released in March 2013 and relaxed this guidance.


Death claim dependency requirements1

Death claim dependency requirements

  • Concede dependency when the evidence in VA records as of the date of the Veteran's death establishes the survivor's relationship with the deceased Veteran.

  • Therefore, if the spouse was on the Veteran’s award at the time of the Vet’s passing, we only need:

    • a statement: regarding continuous cohabitation and,

    • a statement indicating whether they have remarried since the Vet’s passing.

  • If the spouse was not recognized at the time of death, normal evidence requirements apply.


Death claim dependency requirements2

Death claim dependency requirements

  • Normal evidence requirements

  • A complete marital history of both the Veteran and surviving spouse, which would include

    • Names of all prior marriage partners

    • How each prior marriage ended (divorce, death, etc.)

    • Where each prior marriage ended (city, state)

    • When each prior marriage ended (month, year)

    • How, Where, and When the marriage to the Veteran started

    • A statement regarding continuous cohabitation and,

    • A statement indicating whether the surviving spouse has remarried since the Vet’s passing.

  • .


Objectives for relaxed dependency evidence requirements presentation1

Objectives for relaxed dependency evidence requirements presentation :

  • Overview of history.

  • Outline of recent changes implemented.

    Questions?


Objectives for service connected s c burial changes presentation

Objectives for Service-connected (S/C) burial changes presentation:

  • Overview of history.

  • Outline of recent changes implemented.


S c burial requirements

S/C Burial requirements

  • 21-534 variations

  • Until recently, our processing guidelines stated that we could only pay the service connected burial allowance if the Veteran’s death was in fact determined to be service-connected. If a surviving spouse was granted DIC under 1318 (10 years of 100% disability), then SC burial benefits would not be payable.

  • VA Fast Letter 13-04 was released in March 2013 and relaxed this guidance.


S c burial requirements1

S/C Burial requirements

  • Now, a claimant, who is entitled to DIC under section 1318 as if the Veteran’s death was service-connected, is also entitled to service-connected burial benefits. Do not develop for service connection for the cause of death in these cases for purposes of granting service-connected burial.

  • Pay burial benefits (if otherwise in order) at the service-connected rate.


Objectives for s c burial changes

Objectivesfor S/C burial changes :

  • Overview of history.

  • Outline of recent changes implemented.

    Questions?


Termination of the eligibility verification report program

Termination of the Eligibility Verification Report program:

  • In January 2013, a decision was made to terminate the Eligibility Verification Report program, which means that no claimants are required to submit an annual report to maintain their Pension benefits.

  • Beneficiaries were notified soon thereafter.


Termination of the eligibility verification report program1

Termination of the Eligibility Verification Report program:

  • Beneficiaries must still report income and medical expense changes.

  • Beneficiaries can still claim additional unreimbursed medical expenses for recalculation of benefits.

  • Matching programs will be expanded to ensure that beneficiaries are properly reporting their income.


Termination of the eligibility verification report program2

Termination of the Eligibility Verification Report program:

Questions?


Special access to philadelphia pmc advocacy team

Special Access to:Philadelphia PMC Advocacy Team

Special Inquiry Phone Queue:

215-381-3762

E-mail Addresses:

[email protected]


Thank you

Thank you!


Monthly receipts fy 12

Monthly Receipts FY 12

FY12 Receipts:

309,861


Monthly completions fy 12

Monthly Completions FY 12

FY12 Completions:

281,999


Monthly receipts fy 13

Monthly Receipts FY 13

FYTD Receipts:

113,632


Monthly completions fy 13

Monthly Completions FY 13

FYTD Completions:

101,239


Receipts vs completions

Receipts Vs. Completions


Receipts vs completions theoretical forecast

Receipts Vs. CompletionsTheoretical forecast


Philadelphia pmc timeliness

Philadelphia PMC Timeliness


Quality

Quality

  • National STAR Review

  • Local Quality Review

  • Individual Performance Quality Review

  • Quality Team

  • All findings are used to develop annual refresher training.


National pension call center npcc fy 12

National Pension Call Center(NPCC) FY 12

  • Philadelphia Pension Call Center answered an average of 37,000 calls per month

  • Average speed of answer:6 minutes, 21 seconds

  • Virtual Hold System:

    • 50% acceptance rate

    • 93% successful reconnect rate

  • Abandoned call rate is 15.4%

  • Average length of call 10 min 30 sec


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