Pension Management Center

VSO outreach presentation

September 2013

Agenda

What’s New In The PMCFully Developed Claim (FDC) presentationAssisted living versus Independent livingRelaxed Dependency evidence requirements for surviving spousesChanges in rules for paying service-connected burial benefitsEligibility Verification Report program termination

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 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.

Pension Organization Changes:

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.

Enhanced Screening Procedures

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 programDefine the criteria for subsequent exclusion from the FDC program

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

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.

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

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.

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 Presentation

Describe the contents of the VA Form 21-527 EZDefine the criteria to qualify for participation in the FDC programDefine the criteria for subsequent exclusion from the FDC program

Questions?

Overview of history. Overview of definitions. Outline of recent changes implemented.

Objectives for Residential living fees presentation:

Press release 12/20/12

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.

Residential facility fees

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.

Assisted living vs. Independent/Senior living

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.

Accepting Independent Living Fees

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.

What are Custodial Care and Activities of daily living?

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.

Non-medical related services

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

Independent Living allowances

Overview of history. Outline of recent changes implemented.

Objectives for relaxed dependency evidence requirements presentation:

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 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 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. .

Death claim dependency requirements

Overview of history. Outline of recent changes implemented.

Questions?

Objectives for relaxed dependency evidence requirements presentation :

Overview of history. Outline of recent changes implemented.

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

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 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.

S/C Burial requirements

Overview of history. Outline of recent changes implemented.

Questions?

Objectives for S/C burial changes :

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 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 program:

Questions?

Termination of the Eligibility Verification Report program:

Special Inquiry Phone Queue:215-381-3762

E-mail Addresses:PensionCtrVSO.VBAPHI@va.gov

Special Access to:Philadelphia PMC Advocacy Team

Thank you!

Oct

-11

No

v-1

1

De

c-1

1

Jan

-12

Feb

-12

Ma

r-1

2

Ap

r-1

2

Ma

y-1

2

Jun

-12

Jul-

12

Au

g-1

2

Se

p-1

2

0

10,000

20,000

30,000

40,000

50,000

60,000

Rating ReceiptsDeath ReceiptsMaintenance ReceiptsTotal

Monthly Receipts FY 12

FY12 Receipts:309,861

Oct

-11

No

v-1

1

De

c-1

1

Jan

-12

Feb

-12

Ma

r-1

2

Ap

r-1

2

Ma

y-1

2

Jun

-12

Jul-

12

Au

g-1

2

Se

p-1

2

-

10,000

20,000

30,000

40,000

50,000

60,000

Rating CompletionsDeath CompletionsMaintenance CompletionsTotal

Monthly Completions FY 12

FY12 Completions:281,999

Oct

-12

No

v-1

2

De

c-1

2

Jan

-13

Feb

-13

Ma

r-1

3

Ap

r-1

3

Ma

y-1

3

Jun

-13

Jul-

13

Au

g-1

3

Se

p-1

3

0

10,000

20,000

30,000

40,000

50,000

60,000

Rating ReceiptsDeath ReceiptsMaintenance ReceiptsTotal

IVM Autocest

Monthly Receipts FY 13

FYTD Receipts:113,632

Oct

-12

No

v-1

2

De

c-1

2

Jan

-13

Feb

-13

Ma

r-1

3

Ap

r-1

3

Ma

y-1

3

Jun

-13

Jul-

13

Au

g-1

3

Se

p-1

3

-

10,000

20,000

30,000

40,000

50,000

60,000

Rating CompletionsDeath CompletionsMaintenance CompletionsTotal

Monthly Completions FY 13

FYTD Completions:101,239

FY11 FY12250,000

260,000

270,000

280,000

290,000

300,000

310,000

320,000

Completions Receipts

FY 11 Gap:43,772

FY 12 Gap:27,826

36% Reduction!

Receipts Vs. Completions

FY 11 FY 12 EOFY 13 EOFY 14250,000

260,000

270,000

280,000

290,000

300,000

310,000

320,000

330,000

Completions ReceiptsForecast completions Forecast Receipts

Receipts Vs. CompletionsTheoretical forecast

Rating Death Maintenance0

50

100

150

200

250

300

Average Days Pending

Philadelphia PMC Timeliness

Rating Death Maintenance0

50

100

150

200

250

300

350

Average Days To Complete

EOFY 11EOFY 12FY 13 FYTD

Pre-Consolidation

FY 03 EOFY 12

Less than 50%(Authorization Nationally)

74% (Authorization) 97.24% (Authorization)96.65% (Rating)

Quality

• National STAR Review• Local Quality Review• Individual Performance Quality Review• Quality Team• All findings are used to develop annual

refresher training.

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

National Pension Call Center(NPCC) FY 12