Pension Management Center

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 • Changes in rules for paying service-connected burial benefits • Eligibility Verification Report program termination

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 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 • 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 • 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

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 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: • Overview of history. • Overview of definitions. • Outline of recent changes implemented. Press release 12/20/12

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 • 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 • 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? • 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 • 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 • 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: • Overview of history. • Outline of recent changes implemented.

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 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. • .

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: • Overview of history. • Outline of recent changes implemented.

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 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.

Objectivesfor S/C burial changes : • Overview of history. • Outline of recent changes implemented. Questions?

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 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?

Special Access to:Philadelphia PMC Advocacy Team Special Inquiry Phone Queue: 215-381-3762 E-mail Addresses: PensionCtrVSO.VBAPHI@va.gov

Thank you!

Monthly Receipts FY 12 FY12 Receipts: 309,861

Monthly Completions FY 12 FY12 Completions: 281,999

Monthly Receipts FY 13 FYTD Receipts: 113,632

Monthly Completions FY 13 FYTD Completions: 101,239

Receipts Vs. Completions

Receipts Vs. CompletionsTheoretical forecast

Philadelphia PMC Timeliness

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 • 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

Pension Management Center