GAO Says More Veterans Heading For Veterans Homes That May Not Be Ready

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“The report, released Aug. 2, found the number of veterans in VA funded nursing home care is expected to total about 44,000 by 2022.

Challenges in contracting with community nursing homes (CNHs), which provide the bulk of that care, could keep the agency from being able to meet demands."

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“Although the number of veterans in nursing homes is expected to rise 16% between 2017 and 2022 as veterans who served in Vietnam continue to age, the VA may not be prepared to handle the increase, according to a new report from the Government Accountability Office.

And while some of those issues may be helped by a recent VA healthcare law, known as the Mission Act, concerns remain, auditors wrote.

“While VA expects to continue placing more of the veterans needing nursing home care into CNHs, officials noted some challenges contracting with these homes,” the GAO report states. “Specifically, VA central office officials said that about 600 CNHs had decided to end their contracts with VA over the last few years for a variety of reasons. For example, officials from four of the [VA Medical Centers] we interviewed told us about CNH concerns that contract approvals can take two years, homes have difficulties meeting VA staff requirements, and VA’s payment rates were very low.”

In addition, the homes may not be able to handle the special needs some elderly veterans face, including behavioral issues or dementia, the study found.

“[VA officials] said homes may not have any of the necessary specialized equipment or trained staff, or may not have as many of these beds as needed, to meet certain veterans’ special care needs,” the report said. “VA officials told us that they are working to expand the availability of special needs care in each of the three setting.”

The VA covers the full or partial cost of nursing home care for veterans, depending on availability and the veteran’s disability rating or injuries. Veterans rated at 70 percent or higher for service-connected disabilities or those who are receiving nursing home care as the result of a service-connected disability are fully covered.

The system provides care in three types of homes. CNHs are publicly or privately owned and operated and contracted with the VA. State veterans homes are typically owned and operated under the preview of the state in which they are located. And community living centers, which often provide acute care, are owned and operated by the VA and associated with the local VA hospital.

Auditors found the VA should do a better job monitoring the quality and performance of nursing homes, an improvement that will be increasingly important as the number of veterans using the facilities increases.

VA officials contract out inspections of nursing homes, but do not regularly monitor contractors’ performance to determine whether or not inspections are being done correctly, the report said. And the way the system works with state veteran homes does not flag all quality problems, which keeps the system from tracking them.

Moreover, VA officials haven’t given VA hospital staff instructions on how to conduct on-site reviews of nursing homes without the contractor, which means they can’t hold those facilities accountable for correcting problems, the report said.

“By making enhancements to its oversight of inspections across all three settings, VA would have greater assurance that the inspections are effective in ensuring the quality of care within each setting,” the report said.

The report also recommended that VA clarify its communication on the types of nursing home care are available, giving more information on state veterans homes and how their quality compares to the other options.

VA officials generally concurred with all four recommendations. They said they plan to act on the report’s recommendation to increase oversight of inspectors while changing how issues with state veteran homes are flagged. They argued, however, that their employees don’t have the authority or oversight to inspect community nursing homes directly. They also said they would investigate whether or not it’s feasible to provide data on state veteran home quality.”

https://www.military.com/daily-news/2019/08/07/more-vets-will-be-headed-nursing-homes-and-va-may-not-be-ready-report.html

Veterans Administration Rolls Out New Claims Appeals Process

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"In what Department of Veterans Affairs officials are calling the biggest change to its appeals process in decades, the department will launch a new system for veterans challenging their disability claims decisions.

"The new process gives veterans three options for contesting their claims, with an eye toward drastically reducing the time it takes to receive a final decision.

At the height of the VA appeals backlog in 2013, some veterans had waited years for a decision and more than 610,000 claims sat unadjudicated. To tackle the backlog — defined as cases that weren’t decided within 125 days — the VA hired new employees, instituted mandatory overtime and introduced new processing systems.

Still, the problem persisted with an average wait time for a decision reaching up to three years and the number of backlogged appeals climbing to roughly 300,000 by 2017, when Congress passed the Appeals Modernization Act, or AMA.

Under the AMA, veterans will have three choices if they want to appeal the decision on their disability compensation or other VA claim.

The first option is the “supplemental claim lane,” in which they can introduce new evidence in their case and have a regional specialist review it and make a decision.

Or they can choose the “higher-level review lane,” in which they request that their case be reviewed by a senior adjudicator rather than the regional office. This review will consist largely of looking for errors or mistakes made in interpreting VA policies or laws governing the claim. If a problem is found, the senior claims adjudicator can require that a correction be made.

And finally, they can appeal the decision to the Board of Veterans’ Appeals — basically the same as the current system, although there will be several paths to consider if they request a board review. These paths include:

• A direct review, in which they don’t submit any additional information and waive their right for a hearing;
• Submission of extra evidence without a hearing;
• Or a full hearing, in which they can submit more evidence and testify before a judge.

When veterans receive their initial claims decision, they also will get a letter explaining the reasoning for it, as well as the appeal options “in clear language,” said Cheryl Mason, chairwoman of the VA’s Board of Veterans Appeals.

“What the AMA was built and designed to do was create a simplified process for veterans. … [Officials] realized that veterans were confused by the process; it was a complex system and it simply took too long,” she said.

The new system will be used throughout the VA for any claim that requires a decision, according to Dave McLenachen, director of the Veterans Benefits Administration appeals management office.

This includes education and insurance decisions, vocational rehabilitation and caregiver benefits applications, he said.

VA leaders hope that the new system will reduce the time it takes for veterans to receive a decision on their appeal to 125 days.

Currently, the VA’s claims backlog is 265,000 cases, while an additional 136,000 cases are under review by the Veterans Board of Appeals, for a total of more than 400,000 cases. VA officials said Thursday that the goal is to clear the backlog by 2020.

A pilot version of the new system, called the Rapid Appeals Modernization Program, or RAMP, was introduced shortly after the AMA was signed. According to McLenachen, more than 70,000 veterans with 84,000 claims appealed through RAMP. The VA has adjudicated 70 percent of those appeals, awarding about $250 million in retroactive benefits, he added.

RAMP will stop accepting new appeals on Friday. Veterans whose claims were filed through RAMP will continue to be processed.

Veterans whose claims are currently in the system and who don’t apply for a decision through RAMP by Friday can opt into the new system if they receive a statement of case from the VA or supply supplemental evidence and receive a supplemental statement from the VA.

Legislators and veterans service organizations helped craft the new system and have largely been supportive of it, although some have voiced concerns over legacy claims and the information technology infrastructure needed to support the new program.

VA officials said they are ready, having hired 605 new employees to handle the appeals.

Mason called the new system a “veteran-friendly change.”

“It gives veterans a choice and control over their process instead of getting stuck in the legacy system for three to seven years, on average,” she said.”

New VA Claims Appeals Process