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VA Announces Changes to Emergency Care Payment Policy
and much more about VA health care after first part below..........

WASHINGTON (January 12, 2012) – The Department of Veterans Affairs announced today a change in regulations regarding payments for emergency care provided to eligible Veterans in non-VA facilities.
“This provision helps ensure eligible Veterans continue to get the emergency care they need when VA facilities are not available,” said Secretary of Veterans Affairs Eric K. Shinseki.
The new regulation extends VA’s authority to pay for emergency care provided to eligible Veterans at non-VA facilities until the Veterans can be safely transferred to a VA medical facility.
More than 100,000 Veterans are estimated to be affected by the new rules, at a cost of about $44 million annually.
VA operates 121 emergency departments across the country, which provide resuscitative therapy and stabilization in life-threatening situations. They operate 24 hours a day, seven days a week. VA also has 46 urgent care units, which provide care for patients without scheduled appointments who need immediate medical or psychiatric attention.
For more information about emergency care in non-VA facilities, visit www.nonvacare.va.gov.

What is Non-VA Care: Non-VA Care is medical care provided to eligible Veterans outside of the VA when VA facilities are not available. Known as ‘Fee Basis’, all VA medical centers can use this program when needed. The use of Fee Basis as a means to provide Non-VA care to Veterans, is governed by federal laws containing eligibility criteria and other policies specifying when and why it can be used. A pre-authorization for treatment in the community is required to use Fee Basis care -- unless the medical event is an emergency. Emergency events may be reimbursed on behalf of the Veteran in certain cases. See the Emergency Non-VA Care brochure for information.

Unavailability of VA Medical Facilities or Services: Fee Basis is used when VA medical facilities are not ‘feasibly available’. The local VA medical facility has criteria they use to determine whether Fee Basis may be used. If a Veteran is eligible for certain medical care the VA hospital or clinic should provide it as the first option. If they can’t -- due to a lack of available specialists, long wait times, or extraordinary distances from the Veterans home the VA may consider Fee Basis care in the Veteran’s community. Fee Basis care is not an entitlement program or a permanent treatment option.
Pre-Authorized Outpatient Medical Care
The Fee Program provides payment authorization for eligible veterans to obtain routine outpatient medical services through community providers. This authorization may be granted when it has been determined that direct VA services are either geographically inaccessible or VA facilities are not available to meet a veteran’s needs. All community services must be pre-authorized before a veteran receives treatment.
However, it may not be possible to contact VA prior to treatment in emergency situations. Each individual veteran’s eligibility status and medical care needs are reviewed to decide whether community treatment can be approved. The VA also requires a 72 hour notification for emergency room care to be considered pre-authorized.
Individual eligibility determinations are difficult, and therefore outside the scope of this general information. Please contact your local VA health care facility for individual veteran eligibility questions or concerns.
A local VA health care facility may request medical documentation to support adjudication of a submitted claim from a community health care provider. In addition, standard billing forms such as the CMS-1500 or CMS-1450 are required. Examples of these forms are shown on the Forms page.
Basic authorities and payment methodologies to provide preauthorized medical care are contained in: 38 U.S.C. 1703 & 38 CFR 17.52 – 17.56.
Pre-Authorized Inpatient Medical Care
The Fee Program provides payment authorization for eligible veterans to obtain routine inpatient medical services through community providers. This authorization may be granted when it has been determined that direct VA services are either geographically inaccessible or VA facilities are not available to meet a veteran's needs. All community services must be pre-authorized before a veteran receives treatment.
However, it may not be possible to contact VA prior to treatment in emergency situations. Each individual veteran’s eligibility status and medical care needs are reviewed to decide whether community treatment can be approved. The VA also requires a 72 hour notification for emergency room care to be considered pre-authorized.
Individual eligibility determinations are difficult, and therefore outside the scope of this general information. Please contact your local VA health care facility for individual veteran eligibility questions or concerns.
A local VA health care facility may request medical documentation to support adjudication of a submitted claim from a community health care provider. In addition, standard billing forms such as the CMS-1500 or CMS-1450 are required. Examples of these forms are shown on the Forms page.
Basic authorities and payment methodologies to provide preauthorized medical care are contained in: 38 U.S.C. 1703 & 38 CFR 17.52 – 17.56.
Emergency Care of Service-Connected Conditions
The Department of Veterans Affairs (VA) is authorized under Title 38 United States Code (U.S.C.) 1728 to make payment or reimbursement to a claimant for emergency treatment provided to a veteran for service connected conditions.
There is a timely filing limit for unauthorized inpatient or outpatient medical care claims. Claims must be submitted within 2 years from the date of care.
Individual eligibility determinations are difficult, and therefore outside the scope of this general information. Please contact your local VA health care facility for individual veteran eligibility questions or concerns.
A local VA health care facility may request medical documentation to support adjudication of a claim from a community health care provider. In addition, standard billing forms such as the CMS-1500 or CMS-1450 are required. For this type of unauthorized emergent care, VA requires claimants to fill out and submit VA Form 10-583. Examples of these forms are shown on the Forms page.
Basic authorities & payment methodologies to provide unauthorized medical care are contained in: 38 U.S.C. 1728 & 38 CFR 17.120 – 17.132.
Emergency Care of Non-Service-Connected Conditions
The Department of Veterans Affairs (VA) is authorized under Title 38 United States Code (U.S.C.) 1725 (also known as 'Mill Bill') to make payment or reimbursement to a claimant for emergency treatment provided to a veteran for non-service connected conditions in certain circumstances.
There is a timely filing limit for unauthorized inpatient or outpatient medical care claims. Claims must be submitted within 90 days from the date of care.
Individual eligibility determinations are difficult, and therefore outside the scope of this general information. Please contact your local VA health care facility for individual veteran eligibility questions or concerns.
A local VA health care facility may request medical documentation to support adjudication of a claim from a community health care provider. In addition, standard billing forms such as the CMS-1500 or CMS-1450 are required. For this type of unauthorized emergent care, VA requires claimants to fill out and submit VA Form 10-583. Examples of these forms are shown on the Forms page.
Basic authorities & payment methodologies to provide unauthorized medical care for non-service-connected events are contained in: 38 U.S.C. 1725 & 38 CFR 17.1000-.1008

State Homes
VA's State Home program provides an economical alternative to constructing, maintaining and operating VA facilities for the provision of quality care to eligible Veterans. Under this program, the states provide quality care for eligible veterans in three different types of programs: nursing home, domiciliary, and adult day health care. Presently, there are 186 state home operations. For FY 2009, this program provided care to over 22,000 Veterans. VA’s contributions towards state home per diem expenses are projected to be $760 million for FY 2010.The program is expected to have future growth. Per diem costs are projected to increase to $1.2 billion by FY 2012.
http://www.nonvacare.va.gov/state-homes-training-presentations.asp
State Homes - Program Contacts
CBO Field Office (CBO FO)
Suite 495
3773 Cherry Creek North Drive
Denver, Colorado 80209
Phone: (303) 398-5908
FAX: (303) 370-7700

VHA Chief Business Office
1722 Eye Street, NW
Washington, D.C. 20420
Phone: (202) 461-1733
Fax: (202) 495-6006

CBO Field Office (CBO FO)
Suite 495
3773 Cherry Creek North Drive
Denver, Colorado 80209
Phone: (303) 398-5908
FAX: (303) 370-7700
State Homes - Payment Rate Information
FY 2011 Basic State Home Per Diem Rates:
The Basic State Home Per Diem Rates for Fiscal Year (FY) 2011 are as follows:
Adult Day Health Care: $73.51
Domiciliary: $38.90
Hospital Care: Discontinued
Nursing Home: $94.59
FY 2010 Basic State Home Per Diem Rates:
The Basic State Home Per Diem Rates for Fiscal Year (FY) 2010 are as follows:
Adult Day Health Care: $69.63
Domiciliary Care: $35.84
Hospital Care: $77.53
Nursing Home Care: $77.53
FY 2009 Basic State Home Per Diem Rates:
The Basic State Home Per Diem Rates for Fiscal Year (FY) 2009 are as follows:
Adult Day Health Care: $66.82
Domiciliary Care: $34.40
Hospital Care: $74.42
Nursing Home Care: $74.42
FY 2008 Basic State Home Per Diem Rates:
The Basic State Home Per Diem Rates for Fiscal Year (FY) 2008 are as follows:
Adult Day Health Care: $64.13
Domiciliary Care: $33.01
Hospital Care: $71.42
Nursing Home Care: $71.42
SVNH Per Diem Rates for 70% SCV for FY 07, FY08, FY09, and FY10, under Public Law 109-461 as displayed in table below:
STATE VETERANS NURSING HOME PER DIEM RATES FOR P1A VETERANS UNDER PUB. L. 109-461
The FY 2011 state home per diem rates ("prevailing" rates) for selected Veterans in state nursing homes under Pub. L. 109-461 are:
SVNH Per Diem Rates FY2011
Under the 109-461 payment methodology, the amounts payable vary for each state home. The rates payable are noted in column J (109-461 per diem payable).
The rates noted above are the amounts payable for each day of care for eligible veterans. The FY 2011 rates may be paid now, beginning with claims (VA Forms 10-5588s) submitted for October 2010.
State Homes - Forms
VA Form 10-5588
STATE HOME REPORT AND STATEMENT OF FEDERAL AID CLAIMED, May 2009 edition
http://www.va.gov/vaforms/medical/pdf/vha-10-5588-fill.pdf

VA Form 10-10SH
STATE HOME PROGRAM APPLICATION FOR VETERAN CARE MEDICAL CERTIFICATION, April 2009 edition
http://www.va.gov/vaforms/medical/pdf/vha-10-10SH-fill.pdf

VA Form 10-0460
Request for Prescription Drugs from an Eligible Veteran in a State Home, February 2009 edition
http://www.va.gov/vaforms/medical/pdf/vha-10-0460-fill.pdf

VA Form 10-10EZ
Application for Medical Benefits, November 2009 edition
https://www.1010ez.med.va.gov/sec/vha/1010ez/Form/1010EZ-fillable.pdf
State Homes - Policy and Regulations
Final Rule: 19426 Federal Register / Vol. 74, No. 81 / Wednesday, April 29, 2009

38 CFR, Part 17: MEDICAL

38 CFR, Part 51: PER DIEM FOR NURSING HOME CARE OF VETERANS IN STATE HOMES

38 CFR, Part 52: PER DIEM FOR ADULT DAY HEALTH CARE OF VETERANS IN STATE HOMES

38 CFR, Part 58: FORMS

38 CFR, PART 59: GRANTS TO STATES FOR CONSTRUCTION OR ACQUISITION OF STATE HOMES

VA Manual M-1, Part I, Chapter 3: STATE VETERANS' HOMES, September 30, 1992
(scheduled to be replaced in 2011 with VHA Handbook 1601.SH.1, State Home Per diem Payment Program)
http://www.nasvh.org/dir_statehomes/statedir.cfm