To
provide outpatient medical services, hospital care, medicines and
supplies to eligible veterans in receipt of VA health care.
TYPES
OF ASSISTANCE:
Provision of Specialized Services. Place Cursor Here for Definition
USES
AND USE RESTRICTIONS:
Hospital
care includes: (1) Medical services rendered in the course of the
hospitalization of any eligible veteran; (2) for certain eligible
veterans, an established rate of travel, currently 11 cents a mile
with a deductible imposed; (3) when medically indicated, payment
for specialized modes of transportation, such as by ambulance, of
any veteran with a service-connected disability or receiving, or
eligible to receive, VA pension, or whose income does not exceed
the applicable maximum annual VA pension rate; (4) such mental health
services, consultations, professional counseling, and training of
an eligible veteran or members of the immediate family as may be
necessary or appropriate to the effective treatment and rehabilitation
of the veteran; and (5) medical services rendered an eligible dependent
of a veteran totally and permanently disabled from a service-connected
disability or the widow, widower or child of a veteran who died
as a result of a service-connected disability, or who at the time
of death had total disability permanent in nature, resulting from
a service-connected disability, or who is the surviving spouse or
child of a person who died while on active duty and is not eligible
for Civilian Health and Medical program of the Uniform Service (CHAMPUS),
Medicare, or under the Civilian Health and Medical program, Veterans
Affairs (CHAMPVA). Outpatient medical services includes examination,
treatment, certain home health services, podiatric, optometric,
dental, supportive medical services and surgical services are provided
to veterans in VA facilities or under fee basis hometown care programs
when properly authorized. Persian Gulf veterans and veterans of
the Panama, Grenada, and Lebanon hostilities, in VA operated outreach
centers, on contract, or in a VA facility. Sexual trauma counseling
may be provided to a woman veteran which resulted from a physical
assault of sexual nature, battery of a sexual nature, or sexual
harassment which occurred while serving on active duty.
ELIGIBILITY
REQUIREMENTS:
Applicant
Eligibility: Must have enlisted in the armed
forces before September 7, 1980. Veterans who enlisted in the armed
forces after September 7, 1980, or entered on active duty after
October 16, 1981, must have 24 continuous months of active duty
service or completed the full period of time for which the individual
was called or ordered to active duty. In either case the individual
must have been discharged or released from active duty under conditions
other than dishonorable. Must be enrolled in the VA health care
system or have: A VA service- connected rating of 50 percent or
greater, an adjudicated service- connected disability; or been recently
discharged from the military (within the past 12 months) for a disability
the military determined was incurred or aggravated in the line of
duty. When approved by the VA and at the Department of Defense request,
active duty personnel may be transferred to/from a military hospital
to a VA health care facility.
Beneficiary
Eligibility: Dental care may be provided for
those veterans: (1) Who have a service-connected compensable dental
disability or condition; (2) who have a service-connected, non-compensable
dental condition or disability and were former prisoners of war;
(3) who have a service-connected, non-compensable condition or
disability resulting from combat wounds or service trauma; (4)
who were held prisoner of war for a period of not less than 90
days; (5) who have a service-connected disability rated as total;
(6) who have been found in need of training authorized under 38
U.S.C. Chapter 31; (7) who have a dental condition which is having
a direct and material detrimental effect upon a service- connected
condition; (8) who have service-connected, non-compensable disability
and who apply for treatment of such condition within 90 days following
discharge or release for active duty during the Persian Gulf War,
90 days (treatment under this latter authority is limited to one-
time correction of the service-connected dental condition); and
(9) those receiving outpatient or scheduled for inpatient care
may receive dental care if the dental condition is clinically
determined to be complicating a medical condition currently under
treatment.
Credentials/Documentation:
A copy of DD Form 214 or proof of active military service and
discharge, as applicable verification of: (a) establishment of
service-connected disability; (b) service during World War I;
(c) military retirement; (d) letter of authorization; (e) receipt
of increased pension or additional compensation or allowance based
on the need of regular aid and attendance or by reason of being
permanently housebound, or who but for the receipt of military
retired pay would be otherwise eligible; or (f) when applicable,
family household income and asset information.
Pre-application
Coordination: None. This program is excluded
from coverage under E.O. 12372.
Application
Procedure: Application may be made by completing
VA Form 10-10EZ, "Application for Health Benefits." Application
may be made: (1) In person at any VA health care facility; (2)
through any veteran's service organization's representative; or
(3) by mailing the 10-10EZ to the nearest VA health care facility.
Award
Procedure: Not applicable.
Deadlines:
Not applicable.
Range
of Approval/Disapproval Time: The same day
if the applicant applies in person; generally within 15 days if
by mail.
Appeals:
None.
Renewals:
None.
ASSISTANCE
CONSIDERATIONS:
Formula
and Matching Requirements: Not applicable.
Length
and Time Phasing of Assistance: Not applicable.
POST
ASSISTANCE REQUIREMENTS:
Reports:
Not applicable.
Audits:
Not applicable.
Records:
Not applicable.
FINANCIAL
INFORMATION:
Account
Identification: 36-0160-0-1-703.
Obligations:
(Salaries and Expenses) FY 01 $14,980,002,000; FY 02 est $14,813,080,000;
and FY 03 est $14,813,080,000.
Range
and Average of Financial Assistance: Not applicable.
In fiscal year 2001, visits totaled 35,777,000 which included 1,555,000
for contract visits. In fiscal year 2002, total outpatient visits
are estimated at 38,252,000, including 1,585,000 for contract visits.
It is estimated that 560,682 patients will receive inpatient hospital
treatment in fiscal year 2002. In fiscal year 2003, total outpatient
visits are estimated at 40,227,000 including 1,742,000 for contract
visits. It is estimated that 495,756 inpatients will be treated
in fiscal year 2003 in VA, State and contract inpatient facilities.
REGULATIONS,
GUIDELINES, AND LITERATURE:
38 CFR 17.42, 17.43, 17.43(b), 17.46; "Federal Benefits for Veterans
and Dependents," VA Pamphlet 80-99-1, $5.00, available from Superintendent
of Documents, Government Printing Office, Washington, DC 20420.
Fax orders to (202) 512-2250. Telephone orders (202) 512-1800 or
mail requests to: Superintendent of Documents, P.O. Box 371954,
Pittsburgh, PA 15250-7954.
INFORMATION
CONTACTS:
Regional
or Local Office: Contact the nearest VA Medical
Center. (See Appendix IV of the Catalog for the list of addresses
of VA facilities under Veterans Health Administration.)
Headquarters
Office: Director, Health Administration Services
(10C3), Department of Veterans Affairs, Washington, DC 20420.
Telephone: (202) 273-8302 or 273-8303.
