VA Caregiver Support Program Overview by Carol Vogler - May 2022

Providing a comprehensive overview of the VA Caregiver Support Program, Carol Vogler shares valuable insights into the mission, objectives, and programs available to support family caregivers of veterans. Learn about the PCAFC and PGCSS programs, eligibility criteria, application and appeal processes, and recent updates on assessments and benefits for caregivers. Discover the essential resources and services offered to promote the health and well-being of those caring for our nation's veterans.

• Caregiver Support Program
• Veterans Affairs
• Family Caregivers
• VA Mission Act
• Comprehensive Assistance

ceres Follow

Uploaded on Aug 09, 2024 | 0 Views

Download Presentation

Please find below an Image/Link to download the presentation.

The content on the website is provided AS IS for your information and personal use only. It may not be sold, licensed, or shared on other websites without obtaining consent from the author. Download presentation by click this link. If you encounter any issues during the download, it is possible that the publisher has removed the file from their server.

Presentation Transcript

1. VA Caregiver Support Program Carol Vogler May 2022

2. Introduction Carol D. Vogler caroldvogler@gmail.com 501-690-4627 Department of Veterans Affairs Regional Office Little Rock, Arkansas Senior Veterans Service Representative Retired January 2016 2

3. Purpose Provide an overview of the VA Caregiver Support Programs. VA Caregiver Support Program s mission is to promote the health and well-being of family caregivers who care for our Nation s veterans, through education, resources, support, and services. 3

4. Objectives Identify the VA Caregiver Support Programs Program of Comprehensive Assistance for Family (PCAFC) Program of General Caregiver Support (PGCSS) Program Eligibility Application process Appeal process 4

5. Text, email Description automatically generated 5

6. PCAFG Assessment News As part of the VA MISSION Act of 2018, VA has initiated a large-scale effort to complete reassessments of Legacy Participants, Legacy Applicants and their Family Caregivers VA is committed to supporting Veterans caregivers as a top priority. VA is listening to concerns and working diligently to address them as they continue to ensure veterans and their caregivers get the support they need and deserve. 6

7. PCAFG Assessment News - continued Here s what Veterans caregivers can expect: VA is going to review and examine the Program of Comprehensive Assistance for Family Caregivers (PCAFC) eligibility criteria. VA is going to complete reassessments of Legacy Participants, Legacy Applicants and their Family Caregivers. Any caregiver eligible for an increase in caregiver benefits will receive them. VA will not remove anyone from the program or decrease any support based on reassessments before we re-examine our current eligibility criteria. We will consider making changes if necessary. The program is still on track to expand to include Veterans of all service eras on October 1, 2022. 7

8. PCAFC Program of Comprehensive Assistance for Family Caregivers Primary caregivers, may receive: A monthly stipend (paid directly to the caregiver.) Access to health care insurance through Civilian Health and Medical Program of the Department of Veterans Affairs (CHAMPVA), if they do not already have health insurance. Mental health counseling. 8

9. PCAFC Certain beneficiary travel benefits when traveling with the Veteran to appointments. **Note for specific details, speak to the Caregiver Support Coordinator. At least 30 days of respite care per year, for the Veteran. Respite is short term relief for someone else to care for the Veteran while the caregiver takes a break. 9

10. PCAFC Secondary caregivers, may receive: Mental health counseling. Certain beneficiary travel benefits when traveling with the Veteran to appointments. **Note for specific details, speak to your Caregiver Support Coordinator. At least 30 days of respite care, per year for the veteran. Respite is short term relief for someone else to care for the veteran while the caregiver takes a break. 10

11. PCAFC Eligibility The veteran/service member must have a serious injury which is a single or combined service-connected disability rating of 70% or more, and meet the following eligibility requirements to participate in the Program of Comprehensive Assistance for Family Caregivers: The individual is either: A veteran; or A member of the Armed Forces undergoing a medical discharge from the Armed Forces. 11

12. PCAFC Eligibility continued The individual has a serious injury (including serious illness) incurred or aggravated in the line of duty in the active military, naval, or air service: On or after September 11, 2001; or On or before May 7, 1975 Effective October 1, 2022, after May 7, 1975, and before September 11, 2001. 12

13. PCAFC Eligibility continued The individual is in need of in-person personal care services for a minimum of six (6) continuous months based on any one of the following: An inability to perform an activity of daily living; or A need for supervision, protection, or instruction. It is in the best interest of the individual to participate in the program. 13

14. PCAFC Eligibility continued Personal care services that would be provided by the Family Caregiver will not be simultaneously and regularly provided by or through another individual or entity. The individual receives care at home or will do so if VA designates a Family Caregiver. The individual receives ongoing care from a Primary Care Team or will do so if VA designates a Family Caregiver. 14

15. PCAFC Family Caregiver Eligibility Be at least 18 years of age. Be either: The eligible veteran s spouse, son, daughter, parent, stepfamily member, or extended family member; or Someone who lives with the eligible Veteran full-time or will do so if designated as a Family Caregiver. Be initially assessed by VA as being able to complete caregiver education and training. Complete caregiver training and demonstrate the ability to carry out the specific personal care services, core competencies, and additional care requirements. 15

16. PCAFC Application Complete VA Form 10-10CG Section I to be completed by Veteran or his/her Representative Section II to be completed by Primary Family Caregiver Section III to be completed by Secondary Family Caregiver Secondary Family Caregiver is not required Submit to Program of Comprehensive Assistance for Family Caregivers, Health Eligibility Center, 2957 Clairmont Road, NE, Suite 200, Atlanta, GA 30329-1647, or to local VA Medical Center Caregiver Support Coordinator NOTE: VA Form 10-10EZ should be completed ONLY if Veteran or service member is not enrolled in VA s health care system. 16

17. PCAFC Decision Process Veteran Assessment Caregiver Assessment Functional Assessment Review of medical records VISN Clinical Eligibility and Appeals Team (CEAT) reviews the assessments and Veterans medical chart to determine eligibility for the program. 17

18. PCAFC Decision Local Caregiver Coordinator is informed of eligibility determination by VISN staff. Caregiver Coordinator calls Veteran with decision and ensures eligibility decision is mailed to Veteran. Eligibility decision includes VA Form 10-305, Your Right to Seek Further Review of Program of Comprehensive Assistance for Family Caregivers (PCAFC) Decisions If Caregiver Coordinator is given the approval to continue the process the local staff will make a home visit to the Veteran. The Caregiver will complete the caregiver training. 18

19. PCAFC Legacy Participant A veteran and their Family Caregiver(s) were approved and designated by VA as eligible for PCAFC before October 1, 2020, is considered a Legacy Participant. As part of the VA MISSION Act of 2018, VA has initiated a large-scale effort to complete reassessments of Legacy Participants, Legacy Applicants and their Family Caregivers VA is committed to supporting veterans caregivers as a top priority. 19

20. PCAFC Appeal Process Decisions made before February 19, 2019 If disagreement with a PCAFC decision issued before February 19, 2019, this can now be appealed to the Board of Veteran s Appeals (Board). Veteran will need to submit a completed VA Form 10-307, Program of Comprehensive Assistance for Family Caregivers (PCAFC) Notice of Disagreement to: Veterans Affairs Evidence Intake Center P.O. Box 5154 Janesville, WI 53547 You can also seek review through the VHA Clinical Review Process. Please contact the Patient Advocate at your local VA medical facility for more information on the Clinical Review Process. 20

21. PCAFC Appeal Process Decisions made on or after February 19, 2019 Disagreement with a PCAFC decision issued on or after February 19, 2019, utilize one of the following options: VHA Clinical Review Process, Supplemental Claim, Higher-Level Review, or Appeal to the Board Clinical Review Process, a Supplemental Claim or request for Higher-Level Review is completed by VHA. 21

22. PCAFC Appeal Process Decisions made on or after February 19, 2019, continued Supplemental Claim new and relevant evidence that was not part of the record (not available) when we made the PCAFC decision should be submitted, complete VA Form 20-0995, Decision Review Request: Supplemental Claim. Submit to: Veterans Affairs Evidence Intake Center P.O. Box 5154 Janesville, WI 53547 22

23. PCAFC Appeal Process Decisions made on or after February 19, 2019, continued VHA Clinical Review Process is a written request for review of the PCAFC decision. Clinical review is conducted by a different Centralized Eligibility and Appeals Team (CEAT). Request a Higher-Level Review to ask for a higher-level decision maker in the Caregiver Support Program to look at the case. Additional evidence cannot be submitted with a Higher-Level Review. VA Form 20-0996, Decision Review Request: Higher-Level Review Submit completed VA Form 20-0996 (Higher-Level Review) to: Veterans Affairs Evidence Intake Center P.O. Box 5154 Janesville, WI 53547 23

24. PCAFC Appeal Process VA Form 10-305, Your Right to Seek Further Review of Program of Comprehensive Assistance for Family Caregivers (PCAFC) Decisions, is included with the eligibility determination. Provides guidance on how to proceed when an unfavorable decision is received. 24

25. PCAFC Appeal Process Decision Review Option: Supplemental Claim If there is new and relevant evidence that was not part of the record when the PCAFC decision was made. Submit VA Form 20-0995, Decision Review Request: Supplemental Claim Include additional evidence to be considered Submit to: Claims Intake Center PO Box 4444, Janesville, WI 53547-4444 25

26. PCAFC Appeal Process Decision review option: Higher Level Review (HLR): No additional evidence can be submitted Request HLR and informal conference by completing VA Form 20-0996 An informal conference to talk with the reviewer on the phone to inform them of the error in decision or why the decision should be changed Only one informal conference is allowed for each HLR. Submit to: Claims Intake Center PO Box 4444, Janesville, WI 53547-4444 26

27. PCAFC Appeal Process Decision review option: Board Appeal Option 1: Direct Review, a Veterans Law Judge will review appeal based on evidence of record. No new evidence can be submitted. Option 2: Submit more evidence, Additional evidence can be submitted the the Veterans Law Judge to review. Evidence must be submitted within 90 days of the Decision Review Request: Board Appeal (VA Form 10182) 27

28. PCAFC Appeal Process Decision review option: Board Appeal continued Option 3: Request a hearing with a Veterans Law Judge Virtual Hearing Videoconference hearing at VA near veteran In-person hearing at the Board in Washington, D.C. To request a Board Appeal, submit a complete the Decision Review Request: Board Appeal (VA Form 10182) to: Board of Veterans Appeals PO Box 27063, Washington, D.C. 20038 28

29. PCAFC Appeal Process Review options for decisions issued before February 19, 2019 Disagreement with a PCAFC decision issued before February 19, 2019, can now be appealed to the Board of Veterans Affairs (Board). You will need to submit a completed VA Form 10-307, Program of Comprehensive Assistance for Family Caregivers (PCAFC) Notice of Disagreement to: Veterans Affairs Evidence Intake Center P.O. Box 5154 Janesville, WI 53547 Seek review through the VHA Clinical Review Process. Please contact the Patient Advocate at the local VA medical facility for more information on the Clinical Review Process. 29

30. PCAFC Court of Veterans Appeals for Veterans Claims No. 20-4961 Jeremy Beaudette & Maya Beaudette V. Denis McDonough April 19, 2021, the Court of Appeals for Veterans Claims issued a decision which gives Veterans and their Caregivers the opportunity to appeal adverse benefits decision under the Program of Comprehensive Assistance for Family Caregivers to the Board of Veterans Affairs (BVA) once they have exhausted the Veteran Health Administration (VHA) appeals process. 30

31. 31

32. PGCSS Program of General Caregiver Support Services Peer support mentoring Skills training Coaching Telephone support Online programs Referrals to available resources to caregivers of veterans 32

33. PGCSS Eligibility Veteran must be enrolled in Veterans Affairs (VA) healthcare Veteran must be receiving care from a caregiver Caregivers who participate in PGCSS are called General Caregivers General Caregivers do not have to be a relative General Caregivers do not have to live with the veteran 33

34. General Caregiver Definition A General Caregiver is a person who provides personal care services to a veteran enrolled in VA health care who: needs assistance with one or more activities of daily living or needs supervision or protection based on symptoms or residuals of neurological care or other impairment or injury 34

35. General Caregiver application Reach out to the facility CSP Team/Caregiver Support Coordinator or request a referral from the Veteran's provider Complete an intake with the facility CSP Team/Caregiver Support Coordinator Veteran will need to agree to receive care from the caregiver, the caregiver will be listed in their healthcare record Enroll and begin to utilize the support and services offered 35

36. References Electronic Code of Federal Regulations, Title 38, Chapter 1, Part 71 https://www.knowva.ebenefits.va.gov/ https://www.americanbar.org/groups/health_law/section- news/2021/05/cou-app/ http://www.uscourts.cavc.gov/documents/BeaudetteJandM_20- 4961.pdf https://www.caregiver.va.gov/ https://www.caregiver.va.gov/Care_Caregivers.asp https://www.va.gov/family-member-benefits/comprehensive- assistance-for-family-caregivers/ 36

37. QUESTIONS? Carol Vogler 501-690-4627 caroldvogler@gmail.com