Veterans Medical Care Benefits

To provide outpatient medical services, hospital care, medicines and supplies to eligible veterans in receipt of VA health care.



Agency - Department of Veterans Affairs

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.

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.)
Website Address

http://www.va.gov



Program Accomplishments

In fiscal year 2007, visits totaled 62,936,000 which included 6,177,000 for contract visits and 1,055,000 for readjusment counseling. In fiscal year 2007, 811,388 patients received inpatient hospital treament. In fiscal year 2008, total outpatient visits are estimated at 64,856,000, including 6,604,000 for contract visits and 1,113,000 for readjustment counseling. It is estimated that 827,808 patients will receive inpatient hospital treatment in fiscal year 2008. In fiscal year 2009, total outpatient visits are estimated at 70,457,000 including 7,211,000 for contract visits and 1,222,000 for readjustment counseling. It is estimated that 843,438 inpatients will be treated in fiscal year 2009 in VA, State and contract inpatient facilities.

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.

Aplication and Award Process

Preapplication Coordination

None.

This program is excluded from coverage under E.O.

12372.

Application Procedures

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 Procedures

Not applicable.

Deadlines

Not applicable.

Authorization

38 U.S.C. 102(2), 1705, 1710, and 5303A.

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.

Obigations

(Salaries and Expenses) FY 07 $35,232,474,000; FY 08 est $40,478,018,000; and FY 09 est $41,448,363,000.

Range and Average of Financial Assistance

Not applicable.

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.

Criteria for Selecting Proposals

Not applicable.



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