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2008 national defense authorization act

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2008 national defense authorization act Powered By Docstoc
					                 Expansion of Eligibility for Combat Veterans

The National Defense Authorization Act (NDAA) of 2008 was signed by President
Bush on January 28, 2008. This Act extends the period of enhanced health care
eligibility provided a veteran who served in a theater of combat operations after
November 11, 1998 (commonly referred to as combat veterans or OEF/OIF
veterans) as follows:

      Currently enrolled veterans and new enrollees who were discharged
       from active duty on or after January 28, 2003 are eligible for the
       enhanced benefits, for 5 years post discharge.
      Veterans discharged from active duty before January 28, 2003, who
       apply for enrollment on or after January 28, 2008, are eligible for the
       enhanced benefit until January 27, 2011.

As before, veterans included in this authority may be enrolled in Priority Group 6,
if not eligible for a higher Priority Group placement, and may be charged copays
for medication and/or treatment of conditions that are clearly unrelated to their
combat service (e.g. common cold, broken bone). These veterans, while not
required to disclose income, may do so to determine their eligibility for a higher
priority status, beneficiary travel benefits and exemption of copays for care
unrelated to their military service.

There is no change to VA’s policy of continuing enrollment of veterans who enroll
with VA under this “Combat Veteran” authority after their enhanced eligibility
period ends. At the end of the enhanced eligibility period, VA will reassess the
veteran's information and make a new enrollment decision. If the veteran was in
Priority Group 6 and no other eligibility factors apply then he/she will continue
enrollment in either Priority Group 7 or Priority Group 8 depending on their
income level and will be required to make applicable copays.

VistA and national enrollment (Health Eligibility Center’s information system)
software enhancements to implement the provisions of NDAA are expected to be
released in early April.

Temporary Business Rules

1. Until these enhancements are available, local health care facility intake and
eligibility staff will be responsible for identifying individuals with combat service
after November 11, 1998, and for manually applying the business rules described
below to determine their eligibility for VA health care benefits based on their
combat status. Staff will advise the combat veteran of their eligibility for
enhanced benefits.

2. Within 2 business days, HEC staff will subsequently identify combat veterans
who were rejected due to the enrollment restriction and override the rejection,
effectively enrolling the veteran in Priority Group 6. The updated record will be
transmitted to facilities involved in the veteran’s care.

3. Until the software to support NDAA provisions is implemented, sites have
flexibility, on a case by case basis, to cancel bills for care after January 27, 2008,
which was potentially related to combat service after November 11, 1998. Once
the enhanced software is available, HEC will distribute a list of veterans affected
by the new authority to Business Implementation Managers (BIM) and to each
facility’s Revenue Coordinator. The Revenue Coordinator will be responsible for
taking appropriate action to cancel first and third party bills for health care
services provided after January 27, 2008.

4. HEC will maintain a log of record enrollment overrides in lieu of the combat
veteran status. Once the enhanced software is implemented and the veterans’
combat veteran status has been appropriately established in VistA and HEC
information systems, HEC will adjust the enrollment record to remove the
temporary override.

Sites are reminded to insure that combat veterans initially shown as rejected in
VistA are provided all required care and services while the manual process noted
above is implemented.

Questions concerning billing issues should be directed to Charlie Riley, 202-254-
0417 (Charles M. Riley in Outlook). For assistance with eligibility issues, contact
the VHA HEC Alert group via email or by phone at 404-235-1257.
                   Business Rules for Determining Combat Veteran Eligibility


      Combat Veteran Status before
                                                                    Combat Veteran Status on/after Enactment of
Enactment of National Defense Authorization
                                                                                      NDAA
      Act (NDAA) (January 28, 2008)

                                                                                       Scenario 1
                    Scenario 1
                                                      January 28,     Combat Veteran End Date will be to extended to
    Combat Veteran End Date is a Future Date;            2008           Service Separation Date + 5 years; Veteran
      Veteran is enrolled in Priority Group 6
                                                                           remains enrolled in Priority Group 6


                    Scenario 2                                                         Scenario 2
 Combat Veteran End Date is a Past Date, Service      January 28,    Combat Veteran End Date will be recalculated to
 Separation Date is on or after January 28, 2003;        2008         Service Separation Date + 5 years; Veteran is
  Veteran is in Priority Group 7, 8a, 8c, 8e or 8g                             enrolled in Priority Group 6


                    Scenario 3                                                  Scenario 3 (No Impact)
 Combat Veteran End Date is a Past Date; Service      January 28,    Combat Veteran End Date will be recalculated to
   Separation Date is before January 28, 2003;           2008          Service Separation Date + 5 years, Veteran
  Veteran is enrolled in Priority Group 7, 8a or 8c                   remains enrolled in Priority Group 7, 8a or 8c

                      Scenario 4
                                                                                       Scenario 4
 Combat Veteran End Date is a Past Date; Service
                                                      January 28,    Combat Veteran End Date will be recalculated to
   Separation Date is before January 28, 2003;           2008        January 27, 2011; Veteran is enrolled in Priority
 Veteran is in a Rejected Enrollment Status and in
                                                                                        Group 6
               Priority Group 8e or 8g

                                                                                        Scenario 5
                                                                      Veteran enrolls after January 27, 2008, Service
                    Scenario 5                        January 28,
                                                         2008         Separation Date is on or after January 28, 2003;
           Not enrolled Combat Veteran
                                                                      Combat Veteran End Date will be calculated to
                                                                            Service Separation Date + 5 years

                                                                                        Scenario 6
                                                                      Veteran enrolls after January 27, 2008, Service
                    Scenario 6                        January 28,
                                                         2008          Separation Date is before January 28, 2003;
           Not enrolled Combat Veteran
                                                                      Combat Veteran End Date will be calculated to
                                                                                     January 27, 2011