Overview of Veterans Benefits Administration Files and Programs

Veterans Benefits Administration uses VA File 101 for matching records to VETSNET database, ensuring program integrity, reducing improper payments, and maximizing benefits. Key data elements include VA file numbers, award types, and award statuses to manage benefits efficiently.

• Veterans Benefits Administration
• VA File 101
• Program Integrity
• VETSNET Database
• Key Data Elements

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1. VA File 101 & Veterans Benefits Tim Dahlin Program Manager Medicaid Program Integrity Office

2. PARIS VA File Background Records (SSNs) submitted are matched against Veterans Benefit Admin VETSNET Compensation and Pension (C&P) extract VETSNET replaces Benefits Delivery Network (BDN), retains some BDN elements Provides information on client eligibility for VA benefits and confirms if clients are receiving income and/or Third Party Resource payments from Veterans Benefits Admin (VBA) 2

3. Benefits of VA File Match Reduces state expenditures and reimbursements Facilitates program integrity efforts Reduce improper payments Maximizes VA payments and medical benefits to veterans and family members Improves customer service Outreach efforts 3

4. PARIS - VA File Detail https://www.acf.hhs.gov/paris - PARIS Homepage System Info > DMDC Output Record Formats > Veterans (VETSNET) Output Record Format Extract Layout lists and defines all fields 4

5. Key Data Elements I VA File Number May be veteran SSN or other Veteran SSN Beneficiary SSN Payee Type 00 = veteran 10 = spouse 11-29 = child 5

6. Key Data Elements II Award Type (general) CPL = compensation & pension Live (veteran) CPDS = compensation & pension Death - Spouse CPDC = compensation & pension Death - Child Award Line Type: Compensation vs. Pension Compensation (C) or Pension (IP) : veteran Death Pension: survivor (IDP) Dependency & Indemnity Compensation survivor (DIC) *includes children * [TPL] 6

7. Key Data Elements III Award Status: Active, Suspended, Terminated Change Reasons (up to 3); Suspense Reason (e.g., Bad Address) Veteran AA (Aid & Attendance) Actually Beneficiary AA ; can be survivor claim with A&A Not income, but can be considered Third Party Resource applied to cost of Long Term Care services Spouse indicator (Y/N) Child count Combined Degree: disability % [TPL, VA nursing coverage] 7

8. Key Data Elements IV Entitlement Code (from BDN) Similar to Award Line / Type, but provides service period Gross Net Payment amounts Apportionments ($ to family): tied to original claim (Gross=0, but there is a Pay Amount) Other Income Sources and Amounts Annualized; cross-ref for unreported income? Receivables, Proceeds: $ owed to VA, $ due from VA Address; Fiduciary info 8

9. Observations Last Paid Date is provided, but not First Paid Date Can be difficult to ascertain when benefit began Effective Date Payment begins month after Eff Date (in theory) In reality, new awards typically delayed several months Gross/Net/Pay Amount data in whole dollars Compensation paid to the cent now Pensions paid in whole dollars 9

10. Interpreting VA Payments Compensation: no income test; pays the exact rate Veterans (regular), Special Monthly (SMC), Dependency & Indemnity (DIC), Parents Veterans may receive regular compensation with SMC (SMC-K) Aid & Attendance add-on for DIC (Spouse A&A for compensation). Specific rates each benefit type. Typically not countable as income. Improper denials? https://www.benefits.va.gov/COMPENSATION/ra tes-index.asp - VA Compensation Rates Website 10

11. Interpreting VA Payments II Pension: needs-based, rates listed are maximum and annualized. Paid in Whole Dollar. Veterans Pension: Veterans Pension Rate Table Effective 12/1/19 - Pension Survivors Pension: Survivors Pension Rate Tables - Effective 12/1/19 - Pension Aid & Attendance (A&A) add-on. Specific rates each pension type. Typically not countable as income. For some, entire award is considered A&A A&A, Unusual Medical Expense (UME) calculator may be helpful 11

12. Questions? Tim Dahlin, Program Manager Medicaid Program Integrity Office Health Care Authority tim.dahlin@hca.wa.gov Tel: 360-725-2077 12