Special thanks to the following individuals who prepared this guide:
The Department of Veterans Affairs (VA) provides many health services for United States veterans, including hospice and palliative care services, under the Veterans Health Administration (VHA). Created in 1946 as the Department of Medicine & Surgery, the VHA today serves more than 6.8 million veterans.
The VHA provides health care through 21 Veterans Integrated Service Networks (VISNs) that are organized geographically. Their purpose is to pool and align resources to better meet local health care needs and provide greater access to care. In addition, VHA also conducts research and education, and provides emergency medical preparedness.
Each VISN contains VA medical centers (VAMCs), which are hospital systems that serve veterans. These systems include some or all of the following services: inpatient hospital care; ambulatory care and out-patient clinics; nursing home care programs; home care programs; and long-term care domiciliaries. As of this time, there are 163 VAMCs, more than 850 ambulatory care and outpatient clinics, 137 nursing home care programs, 73 home care programs, and 43 domiciliaries.
VISNs also oversee Vet Centers, which provide psychological counseling for war-related trauma, counseling for veterans sexually assaulted or harassed while on active duty, case management services, and social services for veterans and family members. There are 206 Vet Centers in the United States.
The Veterans Heath Care Eligibility Reform Act of 1996 established the Medical Benefits Package for enrolled veterans. An enrolled veteran is someone who has successfully completed the application process, has had eligibility verified, and has been assigned to a VA facility.
Veterans can initiate the enrollment process by completing VA form 10-10EZ. The 10-10EZ may be obtained by visiting, calling, or writing to any VA health care facility or veterans' benefits office. Veterans can also call toll-free at 1-877-222-VETS (1-877-222-8387) or access the form on the internet at http://www.va.gov/1010ez.htm. Hospice staff at VA facilities may be available to facilitate the enrollment process.
In general, veterans who have been honorably discharged from active service are eligible for benefits. Active service is defined as full-time service as a member of the Army, Navy, Air Force, Marine Corps, or Coast Guard, or as a commissioned officer in the Public Health Service, the Environmental Services Administration, or the National Oceanic and Atmospheric Administration. Additional special groups and those dishonorably discharged, imprisoned, or paroled may be eligible for benefits and should contact a VA regional office to verify eligibility.
Although most veterans must enroll to receive health care benefits, some veterans under specific circumstances are exempt from enrollment. The exceptions are as follows:
Are there any costs associated with receiving health care benefits from the VA?
Once eligibility has been determined and enrollment complete, veterans are assigned a priority group. Services are provided to enrolled veterans regardless of priority group, but some veterans may be charged a co-payment for services depending on their annual household income. Veterans in Priority Groups four, six, and seven (See Priority Groups listed below) may be required to pay a co-pay, as they did not have a service-connected disability or their disability did not qualify for compensation.
The VA utilizes a Geographic Means Test to determine whether or not veterans will be charged a co-payment for services received. The annually adjusted Geographic Means Test performed by the Department of Housing and Urban Development (HUD) is used in combination with figures for Standard Metropolitan Statistical Areas (SMSAs), which is adjusted periodically to reflect changes in local economies. This combination is used to adjust the Federal standard for maximum household income for benefits to reflect local cost of living for veterans.
What are the Priority Groups?
The priority groups range from one to eight, with one being the highest priority for enrollment. Under the Medical Benefits Package, the same services are generally available to all enrolled veterans. As of January 17, 2003, the VA is not accepting new Priority Group 8 veterans for enrollment (veterans falling into Priority Groups 8e and 8g.)
What benefits are contained within the Medical Benefits Package?
The following services are available through the VA:
Basic Care
Preventive care services provided include periodic medical exams, heath education, drug use monitoring and education, and mental heath and substance abuse services.
What services are not provided under the Medical Benefits Package?
Services NOT provided include:
For a detailed list of all services and specific requirements, go to http://www.va.gov/health_benefits.
The Veterans Millennium Health Care and Benefits Act of 1999 (Public Law 106-117) contained provisions for providing hospice and palliative care services to eligible veterans. Hospice and palliative care are covered services on equal priority with any other medical care service as authorized in the Medical Benefits Package, and must be appropriately provided in any outpatient setting and in any inpatient bed location.
Who is eligible for what?
Veterans enrolled in VA health services (see eligibility requirements outlined earlier) may receive hospice and palliative care services through VA health care facilities. This might include consultation by a palliative care consult team, placement in a defined hospice unit within a VA facility, hospice care provided in a VA nursing facility, and home care services directed toward palliative care of the patient in the home. While most VA facilities have inpatient palliative care services and home care, they rarely have home hospice programs. If a veteran elects home hospice care-and does not have Medicare or other insurance-the VA can pay for that care by contracting with a non-VA community hospice agency.
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This toolkit is provided by the Department of Veterans Affairs National Hospice-Veteran Partnership (HVP) Program. Development of the toolkit was made possible through support by Rallying Points, the National Hospice and Palliative Care Organization, the Center for Advanced Illness Coordinated Care, and other end-of-life care advocates. Information about VAHPC initiatives is made available for use within the Inter-Institutional Collaborating Network on End-of-life Care (IICN) with the assistance of Growth House, Inc.