Health care Fact Sheet #1

FOR IMMEDIATE RELEASE

March 11, 1998

VA Clarifies Rules For Health-Care Enrollment

Washington, D.C. -- In response to incorrect information distributed by

others on the Internet, the Department of Veterans Affairs (VA) is clarifying recent changes regarding veterans' eligibility for health care.

VA is required by law to establish an enrollment system for health-care services to be in place by Oct. 1, 1998. While veterans must be enrolled to receive care, it does not mean that veterans who have not applied for enrollment by that date will lose their eligibility for VA health care. Veterans can apply and be enrolled at the time they are in need of VA health care. Veterans who have received VA health-care services since Oct. 1, 1996, will have an application processed automatically on their behalf.

Applicants will be placed in one of seven enrollment priority groups specified by Congress. Based on the priority they are assigned, the number of other veterans requesting to be enrolled, and the funds available for VA health care, VA will determine how many veterans can be served. Veterans will be notified by mail beginning in late spring whether or not their application for enrollment has been accepted.

After Oct. 1, 1998, some veterans may still be treated without being enrolled. Veterans with service-connected disabilities may be treated for those disabilities, and veterans who were discharged or released from active duty for a disability incurred or aggravated while on active duty may be treated for that disability within the first 12 months after their discharge.

Veterans who are classified as being service-disabled with a rating of 50 percent or greater will continue to be eligible for VA health-care services without making application for enrollment.

While veterans in these categories do not have to be enrolled to be
treated, they are encouraged to do so to help VA plan its services and allocate its resources.

Those who are enrolled will be eligible for inpatient and outpatient
services, including preventive and primary care. Other services include: diagnosis and treatment; rehabilitation; mental health and substance abuse treatment; home health, respite and hospice care; and drugs and pharmaceuticals in conjunction with VA treatment.

Veterans accepted for enrollment will be eligible to receive care at any of VA's more than 1,100 service sites. While enrollment must be renewed every year, a veteran's enrollment will automatically be renewed unless he or she chooses not to re-enroll, or unless VA resources limit the number of veterans the department can cover. Certain veterans will be asked to provide income information annually in order for VA to properly classify them within the enrollment system, as required by law.

To apply for enrollment, veterans should call, write or visit their
nearest VA health-care facility. Most facilities have designated special enrollment coordinators to assist veterans and their families, and to answer any questions they may have.

Health care Fact Sheet #1

September 1997

	VA health care enrollment? It's a new system providing access for veterans to a comprehensive package of VA Health Care services. And, it's easy to use! Just answer a few questions and you will be assigned by VA to one of the newly established priority groups. VA will then send a letter confirming your enrollment and assignment. That's it!
VA will extend enrollment to every group for which resources are available. The enrollment process will begin October 1997 and will be repeated every year.

	You must be enrolled to receive Health Care after October 1998 unless you are in one of the following categories: You are rated by VA as having a service-connected disability of 50 percent or more It has been less than one year since you were discharged from military service for a compensable disability that the military determined was incurred or aggravated in the line of duty, and which has not yet been rated by VA. You are seeking care from VA only for a service-connected disability. VA encourages veterans in the above categories to also apply for enrollment so we can better plan for your Health Care needs.
	Starting in October 1997, all veterans may apply by contacting the nearest VA Health Care facility. If you have received VA Health Care services after October 1, 1996, you do not need to apply. In this case, VA will process an application on your behalf. When enrollment is confirmed, VA will notify you in writing. You can apply for enrollment anytime during the year.
	You will remain enrolled for one year. Your enrollment will be reviewed and renewed each year depending upon your priority group and available resources. If VA cannot renew your enrollment for another year you will be notified in writing 60 days before your enrollment expires.

The Enrollment Process

To help manage and improve health care delivery for veterans, P.L. 104-262 requires the VA to enhance and update its current enrollment procedures. Although the law won't take full effect until Oct. 1, 1998, the VA began a shakedown cruise for its new patient enrollment system on Oct. 1, 1997.

Veterans are being encouraged to sign on with the system during the test year to help the VA fix "bugs" in the process and assess demand. Once the law is executed this October, however, you will need to be enrolled to receive care unless you are in a mandatory priority group.

Using the VA's vernacular, you'll be "enrolled" once your application has been processed and your priority group status has been verified -- unless, in the future, enrollment in your priority group is restricted due to insufficient VA resources. Enrollees will receive a letter from the VA confirming acceptance for care for one year. If you do not receive a confirmation letter, chances are you have been "recorded" into the system but rejected for care.

The VA's Health Administration Service director, Kent Simonis, points out that veterans "intending" to seek care from the VA as their primary provider are encouraged to apply for enrollment. The 11th ACVVC is urging all veterans to apply even if they presently are not seeking VA care so that they have a place-marker in the system for future access.

So far, the federal organization has publicized this "test year" mainly by communicating with the various veterans' service organizations (VSOs), such as the 11th ACVVC. which have been alerting and assisting their members with the process. According to Kizer, the VA will be marketing the enrollment process more aggressively this year and is looking forward. to a. significant response from veterans during the test period. For those currently receiving care from the VA, the organization's officials emphasize that it will continue to treat veterans during the test year -- as resources allow -whether or not they apply for enrollment.

The newly collected data will be analyzed by the agency to document current demand, track trends, and predict future usage for planning and budgetary purposes. Additionally, the data will give the Veteran's Health Administration a means of keeping expenditures within appropriations levels by limiting enrollment or re-enrollment within lower priority groups or subgroups on a year-to-year basis.

Test-year Progression
Here's what's happening during the test year. The VA began automatic processing of enrollment applications on behalf of veterans who have received care since Sept. 30, 1996. If you fit into this category, you need take no action to get enrolled. However, you should check to be sure that you agree with your priority group ranking and preferred location for care when you receive your confirmation letter.

If you haven't received VA care since Sept. 30, 1996, there are two basic application pathways. You may file a "stand-alone" application, either in person at any VA medical facility or regional office or by mail. You also can file your enrollment application when you present yourself for care at a VA facility. For those with Internet access who want to go straight to the VA for information, access the VA Health Care Enrollment Fact Sheet ( www.va.gov/ health/elig ).

The Benefits of Enrollment
Although the law states that veterans must be enrolled by Oct. 1, 1998, to receive care (see table, facing page, for exceptions), this will NOT be your last chance to apply for enrollment. Both stand-alone and intake applications will continue to be accepted for enrollment as long as your priority group is not under restriction at the time.

By the way, many 11th ACVVC members have incomes higher than the statutory-means threshold. If that's your situation, and you've never bothered to seek a rating for a potential SC condition, now would be the perfect time to do it. Even a compensable 0 percent rating would move you from priority group 7 to group 6.

Here are a number of potential benefits to taking the plunge:

Convenience and speed. You'll only need to go through the whole process once, and it will be valid throughout the VA system. After that you need only update requested information on your enrollment anniversary date. Mother significant benefit is that you'll already have the "paperwork" done before you present for care. This should save you time and hassle, especially if you want to go to the VA, for the first time, for non-SC care.
Enhanced medical care. As part of the enrollment process, you will be asked to indicate your preferred location for care and will be assigned a primary-care provider. You'll then be in the pipeline for various preventive-care services and VA updates on program implementation.
Portability. Presenting your enrollment information at any VA facility will give that staff the means to get vital information from your primary-care provider quickly. Provisions also are being made to accommodate the dual-residency needs of "snowbirds."
Predictability. Beginning with the date in your enrollment in the system -- which will be confirmed in writing -- and continuing for one year, you may receive VA services. If, however, restrictions are imposed on the priority group to which you belong, you will be notified before your anniversary date that you may not reenroll. (That's one reason the ACVVC recommends against canceling your health insurance.) How and when those restrictions on enrollment will be imposed has yet to be determined, said Kizer last December.

During this test year, the VA is taking applications for all priority groups while providing care as it has in the past. "The higher priority folks are going to get taken care of in any case," Kizer explains. "For veterans in the lower priority groups ..., if [they're] enrolled, then we're committed to provide necessary care for a year.

"One of the reasons we're doing this test year is to get a sense of what the numbers are likely to be," he continues, "and whether we are going to have to limit [our services] to just the top priority groups or whether we could cover all seven."

VA Movement
After decades of stagnation, the VA health care system is well and truly on the move. Its stated goal is both worthy and essential to its future: to provide care more effectively and efficiently within the challenging fiscal constraints facing government and health care in general today. During the first of what may be many shakedown cruises, veterans and their advocates would be well-advised to get involved, communicate with each other and the VA, and stay vigilant.

Stump's vow rings as true today as it did in 1996, when the Veterans Health Care Eligibility Reform Act was reported out of committee. "This bill is just one step on the path to comprehensive reform," he said, "and I have given veterans my word that even if [it] is signed into law, our work is not done

For more information contact your nearest VA Health Care facility

Last Update 04/05/98