Update on federal veterans programs
by Thomas Crisp Contributing Columnist
The Department of Veterans Affairs announced Aug. 1 that veterans filing an original fully developed claim (FDC) for service-connected disability compensation may be entitled to up to one year of retroactive disability benefits. The retroactive benefits, which are in effect Aug. 6 through Aug. 5, 2015, are a result of a comprehensive legislative package passed by Congress and signed into law by President Barack Obama last year.
“VA strongly encourages veterans to work with veterans service organizations to file fully developed claims and participate in this initiative, since it means more money in eligible veterans’ pockets simply by providing VA the information it needs up front,” said Allison A. Hickey, Undersecretary for Benefits. “At the same time, it helps reduce the inventory of pending claims by speeding the process.”
Filing an FDC is typically the fastest way for veterans to receive a decision on their claims because fully developed claims require veterans to provide all supporting evidence in their possession when they submit their claims. Often, this is evidence that VA legally must attempt to collect on the veteran’s behalf, which is already in the veteran’s possession, or is evidence the veteran could easily obtain, like private treatment records.
When veterans submit such evidence with their claims, it significantly reduces the amount of time VA spends gathering evidence from them or other sources — often the longest part of the claims process. While VA will still make efforts to obtain federal records on the veterans’ behalf, the submittal of non-federal records (and any federal records the veteran may have) with the claim allows VA to issue a decision to the veteran more quickly.
Typically, VA processes FDCs in half the time it takes for a traditionally filed claim. FDCs can be filed digitally through the joint DOD-VA online portal eBenefits. VA encourages veterans who cannot file online to work with an accredited veterans service organization that can file claims digitally on veterans’ behalf.
While submitting an FDC provides a faster decision for any compensation or pension claim, only veterans who are submitting their very first compensation claim as an FDC are potentially eligible for up to one year of retroactive disability benefits under the newly implemented law.
FDCs help eliminate VA’s claims backlog because they increase production of claims decisions and decrease waiting times. Also, VA assigns FDCs a higher priority than other claims which means veterans receive decisions to their claim faster than traditional claims.
VA continues to prioritize other specific categories of claims, including those of seriously wounded, terminally ill, Medal of Honor recipients, former prisoners of war, the homeless and those experiencing extreme financial hardship. As part of its drive to eliminate the claims backlog in 2015, VA also gives a priority to claims more than a year old.
In May, VA announced a new partnership with veterans service organizations and others known as the “Community of Practice,” an effort that seeks to reduce the compensation claims backlog for veterans by increasing the number of FDCs filed by veterans and their advocates.
VA is continuing to implement several initiatives to meet the Department’s goal to eliminate the claims backlog in 2015. In May, VA announced that it was mandating overtime for claims processors in its 56 regional benefits offices to increase production of compensation claims decisions through the end of fiscal year 2013.
In April, VA launched an initiative to expedite disability compensation claims decisions for veterans who have a waited a year or longer. As a result of these initiatives, VA’s total claims inventory remains at lower levels not seen since August 2011.
The number of claims in the VA backlog — claims pending over 125 days — has been reduced by 17 percent compared to the highest point in March 2013. [Source: VA News Release 1 Aug 2013]
Tricare prime update
The Defense Department will reduce the number of TRICARE Prime service areas in the United States beginning Oct. 1, affecting about 171,000 retirees and their family members. Those beneficiaries, who mostly reside more than 40 miles from a military clinic or hospital, received a letter earlier this year explaining their options. They will receive a second letter later this month.
TRICARE Management Activity officials said changing the location of Prime service areas has been planned since 2007 as part of the move to the third-generation of managed care support contracts and will allow them to continue their commitment to making high-quality health care available while supporting DOD efforts to control the rising cost of health care for 9.6 million beneficiaries.
Health care under TRICARE Prime costs about $600 more annually per enrollee, but on average, each member of a family of three using TRICARE Standard will pay only about $20 more per month than if they were using Prime.
“The first thing TRICARE beneficiaries should know about the reduction in the number of Prime service areas is that it doesn’t mean they’re losing their TRICARE benefit,” said Dr. Jonathan Woodson, assistant secretary of defense for health affairs. “Next, it’s important to remember this change does not affect most of the more than 5 million people using TRICARE Prime, and (it affects) none of our active duty members and their families.”
All affected beneficiaries will receive a letter this month following up on their initial notification to ensure they have the time and information to make important decisions about their future health care options, officials said.
Current details on Prime service areas and the option for beneficiaries to sign for email updates are available at www.tricare.mil/PSA. A ZIP code tool is available on the site to help beneficiaries determine if they live in an affected area.
As always, officials noted, TRICARE beneficiaries still are covered by TRICARE Standard. For those living within 100 miles of a remaining Prime service area, re-enrolling in Prime may be an option, depending on availability. To do this, beneficiaries must waive their drive-time standards, and they may have to travel long distances for primary and specialty care.
“I urge all impacted beneficiaries to carefully consider their health care options – they should talk them over with family members and their current health care provider,” Woodson said. “Many beneficiaries may be able to continue with their current provider using the Standard benefit. Being close to your health care team usually offers the best and safest access to care.”
Those enrolled in TRICARE Prime are assigned a primary care provider who manages their health care. Retirees pay an annual enrollment fee and have low out-of-pocket costs under this plan. TRICARE Standard is an open choice option with no monthly premiums and no need for referrals, but it has cost shares and an annual deductible.
The Prime service areas being eliminated are not close to existing military treatment facilities or base realignment and closure sites, officials said. Prolonged protests resulted in a staggered transition, they added, and all Prime service areas were retained until all three new regional contracts were in place.
The West region completed the transition April 1. To provide affected beneficiaries with enough time to plan, Defense Department officials elected to delay the Prime service area reductions until Oct. 1. [Source: TMA News Release 7 Aug 2013]
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