Purchase Care Program
As a principal health benefits administration advisor to the Under Secretary
The Department of Veterans Affairs strives for excellence in patient care and veteran's benefits for its constituents through high quality, prompt and seamless service to United States veterans.
David Isaacks david.isaacks@va.gov
Will Beatty Willard.beatty@va.gov 303-370-5061
VHA CBO Field Office
3773 Cherry Creek North Drive, Ste 910
Denver, CO 80209.
Program Accomplishments
Fiscal Year 2009: The NonVA Purchase Care Program provided health care for 920,404 unique patients in FY 09. Fiscal Year 2010: No Current Data Available Fiscal Year 2011: No Current Data Available
Uses and Use Restrictions
Uses generally cover medically necessary health care for eligible recipients.
Restrictions are detailed in the underlying authority for each congressionally authorized program.
Eligibility Requirements
Applicant Eligibility
What follows is not a comprehensive listing of eligibility requirements.
For detailed eligibility requirements the USC and CFR s of each program should be consulted.
For Veterans generally eligibility is established by evidence of service by DD Form 214 or through the Veterans Benefits Administration.
Benefits provided are based on eligibility as established at 8 levels approved by the VHA Deputy Under Secretary for Health.
For Non Veteran Beneficiaries eligibility is established by adjudication of the Sponsoring Veteran as Permanently and Totally disabled (P&T) (38 CFR 17.52(a)(1)(iii)) and that the Non Veteran Beneficiary is a dependant of the Veteran by the VBA and is eligible for Chapter 35 Benefits.
Beneficiary Eligibility
As stated above under Applicant Eligibility.
Credentials/Documentation
Military Discharge Certificate (DD Form 214), VBA Adjudication of disability rating for Veteran beneficiaries, VBA Adjudication of eligibility for Chapter 35 Benefits for Non Veteran Beneficiaries. This program is excluded from coverage under OMB Circular No. A-87.
Aplication and Award Process
Preapplication Coordination
Preapplication coordination is not applicable.
Environmental impact information is not required for this program.
This program is excluded from coverage under E.O.
12372.
Application Procedures
This program is excluded from coverage under OMB Circular No. A-102. This program is excluded from coverage under OMB Circular No. A-110. Awards are initiated and authorized from the VA Regional Office processing the benefits claim. All subsequent benefit administration refers to the VARO adjudication of eligibility or to the status of the Veteran or Non Veteran Beneficiary as established by the VBA.
Award Procedures
Veterans initiate benefits eligibility claims through their serving VA Regional Office under the Veterans Benefits Administration. Where there is no disability claim involved the Veterans serving Veterans Administration Medical Center (VHA/VAMC) or Community Based Outreach Clinic (VHA/CBOC) establishes benefits eligibility through the VHA/CBO/Health Eligibility Center. Secondary validation of eligibility is performed for Non Veteran Beneficiary s by the administering Program Office.
Deadlines
Not Applicable.
Authorization
Department of Veterans Affairs and Housing and Urban Development and Independent Agencies Appropriatons Act, 1997, Public Law 104-204, 38 U.S.C 1752-1756.
Range of Approval/Disapproval Time
From 30 to 60 days. There are no deadlines for award of eligibility. When adjudication of a disability establishes the disability at a date prior to the date of adjudication each program has in place mechanisms to provide retroactive benefits. For programs requiring additional adjudication beyond that of the VBA ~89% of all applications were approved within 30 days in FY09.
Appeals
From 90 to 120 days. Appeals are available within each program beginning with local formal appeal, a second appeal process is provided by policy and upon adverse determination of a second appeal the final level of appeal is provided through the Board of Veterans Appeals.
Renewals
Not Applicable.
Assistance Considerations
Formula and Matching Requirements
Statutory formulas are not applicable to this program.
Matching requirements are not applicable to this program.
MOE requirements are not applicable to this program.
Length and Time Phasing of Assistance
Once eligibility is established the benefit is available for the life of the Veteran Beneficiary. For Non Veteran Beneficiaries where eligibility is based on adjudication as a dependant the benefit is terminated if dependant status is not maintained. The full spectrum of benefits are immediately available upon adjudication of eligibility. Method of awarding/releasing assistance: lump sum.
Post Assistance Requirements
Reports
Not Applicable.
Audits
This program is excluded from coverage under OMB Circular No. A-133. Each program has multiple levels of audits. Audits are conducted at the program level, at the Agency Inspector General level, and annually in accordance with the Improper Payments Information Act of 2002 (Public Law 107-300).
Records
Eligibility records are permanent. Records archive is performed according to VA Handbook 6300.1, Chapter 7. Definitions of Records are outlined in Attachment 1 (VA Handbook 6300.1, Chapter 7). Records Handling procedures are outlined in Attachments 1 (VA Handbook 6300.1 chapters 1-7), 2 (VA Privacy Act System of Records) and 3 (Subchapter B of the NARA portion of the Code of Federal Regulations §1220-1238). Records Storage procedures are outlined in Attachments 1 (VA Handbook 6300.1 Chapter 6) and 4 (VA Records Control Schedule, section XXXVIII). Vital Records Program procedures are outlined in Attachment 5 (VA Handbook 6300.2). Freedom of Information Act Implementation, Program Management and Request for Information under FOIA are outlined in Attachment 6&7 (VA Handbooks 6300.3 and 6300.4). Managing a Privacy Act System of Records is outlined in Attachments 7&8 (VA Handbook 6300.4 and VA Handbook 6300.5). Release of Veterans and Dependents Personal Information (Names and Addresses) is outlined in Attachment 9 (VA Handbook 6300.6). Computer Matching Programs are outlined in Attachment 10 (VA Handbook 6300.7). Electronic Records Management is outlined in Attachment 11 (VA Handbook 6301). Procedures for the Dissemination of Government Information are outlined in Attachment 12 (VA Handbook 6360.1).
Implementation for the Government Information Locator program is outlined in Attachment 13 (VA Handbook 6360.2).
Financial Information
Account Identification
36-0152-0-1-741.
Obigations
(Direct Payments for Specified Use) FY 09 $3,820,700,161; FY 10 est $3,836,616,950; FY 11 est $4,000,000,000
Range and Average of Financial Assistance
The amount of medical benefits paid for Veterans varies according to the need of the individual. Some eligible s make no claim in a benefit year. Others have claims paid as required. The NonVA Purchase Care Program paid an average of $4051.00 for each of 920,404 unique patients in FY09.
Regulations, Guidelines, and Literature
38 U.S.C. 1703 & 38 CFR 17.52 - 17.56./38 U.S.C. 1728 & 38 CFR 17.120 - 17.132/38 U.S.C. 1725 & 38 CFR 17.1000-.1008/38 U.S.C. 1781/38 U.S.C. 1724, 38 CFR 17.35, and 17.141
Literature available at http://vaww1.va.gov/cbo/ or http://www1.va.gov/cbo/
Information Contacts
Regional or Local Office
See Regional Agency Offices. David Isaacks david.isaacks@va.gov
Will Beatty Willard.beatty@va.gov 303-370-5061
VHA CBO Field Office
3773 Cherry Creek North Drive, Ste 910
Denver, CO 80209.
Headquarters Office
Michelle Staton, Department of Veterans Affairs, Chief Business Office (16), 810 Vermont Avenue, NW, Washington, District of Columbia 20420 Email: michelle.staton@va.gov Phone: (303) 370-5061.
Criteria for Selecting Proposals
Not Applicable.
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