New regulations for VA health care

[Gimpy]

##### Means Test VA Uses to determine copayments 2004 #####

Department of Veterans Affairs
VHA Directive 2003-069 Veterans Health Administration Washington, DC
20420
December 15, 2003

MEANS TEST AND GEOGRAPHIC-BASED MEANS TEST THRESHOLDS FOR CALENDAR
YEAR 2004

1. PURPOSE: This Veterans Health Administration (VHA) Directive
provides the Means Test Thresholds, Medicare Deductible Rate, and
Child Income Exclusion for calendar year 2004. In addition, this
Directive provides an internet link to the United States (U.S.)
Housing and Urban Development's (HUD) income limits for Fiscal Year
(FY) 2003 for use by VHA in calendar year 2004. 2. BACKGROUND a.
Title 38 United States Code (U.S.C.) Section 1722(c) requires that
on January 1 of each year, the Secretary of Veterans Affairs
increase the means test threshold amounts by the same percentage the
maximum rates of pension benefits were increased under 38 U.S.C.
Section 5312(a) during the preceding calendar year. Under the
provisions of 38 U.S.C. Section 5312, the Department of Veterans
Affairs (VA) is required to increase the benefit rates and income
limitations in the pension and parents' Dependency and Indemnity
Compensation (DIC) Program by the same percentage, and effective the
same date, as increases in the benefit amounts payable under Title
II of the Social Security Act. b. On November 17, 2003, the Veterans
Benefits Administration (VBA) announced that effective December 1,
2003, veterans' benefits will receive an increase of 2.1 percent. c.
Public Law 107-135, the Department of Veterans Affairs Health Care
Programs Enhancement Act of 2001, directed VA to implement a
Geographic-based Means Test (GMT) (see 38 U.S.C. Section 1705(a)
(7)). VA uses HUD's "low-income" geographic-based income limits as
the thresholds for VA's GMT. NOTE: The Health Eligibility Center
(HEC) controls the GMT for VA; as such, HEC will install Patch
IVMB*2*776 before January 1, 2004. As explained in more detail in
VHA Directive 2003-005, a veteran's income from the previous year is
compared with the appropriate GMT threshold for the previous fiscal
year to determine if the veteran should be placed in priority
category 7. HUD's "low income" geographic based income limits for FY
2003 can be found at:
http://www.huduser.org/datasets/il/fmr03/index.html. The easiest way
to find the limit for a geographical area is to click on the State
on the map. NOTE: Be sure to use only the "low income" limits in the
chart. c. Definitions (1) "Below the means test threshold" is
defined as those veterans whose attributable income and net worth
are such that they are unable to defray the expenses of care;
therefore, they are not subject to co-payment charges for hospital
and outpatient medical services. Within the Veterans Health
Information Systems and Technology Architecture (VistA) system such
veterans are designated as "Means Test Copay Exempt." THIS VHA
DIRECTIVE EXPIRES DECEMBER 31, 2004

VHA DIRECTIVE 2003-069
December 15, 2003

(2) "Above the means test and GMT threshold" is defined as those
veterans whose attributable income and net worth are such that they
are able to defray the expenses of care; therefore they must agree
to pay a co-payment for hospital care and outpatient medical
services. Within the VistA system these veterans are designated
as "Means Test Copay Required." (3) "Above the means test and below
the GMT threshold" is defined as those veterans whose attributable
income and net worth are such that they are able to defray the
expense of care, but whose inpatient medical care co-payments are
reduced 80 percent. Within the VistA system these veterans are
identified as "GMT Copay Required." 3. POLICY: It is VHA policy that
it comply with the annual means test and GMT for calendar year 2004.
4. ACTION a. Medical Facility Director. Before January 1, 2004, each
medical facility Director, or designee, is responsible of installing
patch DG*5.3*551. NOTE: The new means test and GMT threshold rates
are effective January 1, 2004. b. Means Test Thresholds. The
following new Means Test Thresholds are effective January 1, 2004,
through December 31, 2004: (1) Veterans with no dependents: (a)
Below Means Test Threshold: $25,162. (b) Above Means Test Threshold:
$25,163. (2) Veterans with one dependent: (a) Below Means Test
Threshold: $30,197. (b) Above Means Test Threshold: $30,198. (3)
Veterans with two dependents: (a) Below Means Test Threshold:
$31,885. (b) Above Means Test Threshold: $31,886. (4) Veterans with
three dependents: (a) Below Means Test Threshold: $33,573. (b) Above
Means Test Threshold: $33,574.

VHA DIRECTIVE 2003-069
December 15, 2003

(5) Veterans with four dependents: (a) Below Means Test Threshold:
$35,261. (b) Above Means Test Threshold: $35,262. (6) Veterans with
five dependents: (a) Below Means Test Threshold: $36,949. (b) Above
Means Test Threshold: $36,950. c. Entering Data. The following
information is used to enter the data (see subpar. 4b) into VistA:
(1) Select Means Test Data: 2004. (2) Means Test Data: 2004. (3)
Veteran with no dependents: $25,162. (4) Veterans with one
dependent: $30,197. (5) Amount the threshold is increased beginning
with the second dependent: $1,688. (6) Threshold property: $80,000.
(7) Child Income Exclusion: $7,950. d. The Medicare deductible:
$876. e. The income and/or asset threshold for net worth
development: $80,000. f. Maximum annual Rate of Pension: Base rate:
(1) The base rate is $9,894. NOTE: The base pension rate is also
used to determine if certain veterans are subject to co-payments for
Extended Care Services. (2) The base rate with one dependent is
$12,959. (3) Add $1,688 for each additional dependent. 5. REFERENCES
a. Title 38 U.S.C. Sections 1705(a)(7) and 1722.

VHA DIRECTIVE 2003-069
December 15, 2003

b. Title 38 Code of Federal Regulations (CFR) Sections 17.36(b)(7),
17.47(d), and 7.111(f)(2). c. VHA Directive 2003-005, Implementation
of Geographic Means Testing and Revised Inpatient Co-payments
Requirements.

6. FOLLOW-UP RESPONSIBILITY:
The Chief Business Office (16), is responsible for the contents of
this Directive. Questions may be addressed to 202-254-0320.

7. RESCISSIONS: VHA Directive 2002-082 is rescinded. This VHA
Directive expires December 31, 2004. S/ Nevin M. Weaver for Robert
H. Roswell, M.D. Under Secretary for Health DISTRIBUTION: CO: E-
mailed 12/16/2003 FLD: VISN, MA, DO, OC, OCRO, and 200 ? E-mailed
12/16/2003

http://www.va.gov/publ/direc/health/direct/12003069.pdf

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