VA MANDATORY NURSING HOME ELIGIBLE COPAY EXEMPT (75)    HEALTH BENEFIT PLAN (25.11)

Name Value
NAME VA MANDATORY NURSING HOME ELIGIBLE COPAY EXEMPT
PLAN CODE 284
SHORT DESCRIPTION
Full ECS Ex
LONG DESCRIPTION
Veterans enrolled in VA Health Care System and have one of the following: 
 
From VHA Directive 1601A.02: Veterans are eligible to receive care in VA 
CLCs if they meet the nursing home eligibility criteria and if VA 
determines there is a need for a specific level of care and services 
available in a particular VA CLC. Certain Veterans have mandatory 
eligibility for nursing home care while other Veterans may be provided 
nursing home care on a space and resource available basis.
 Mandatory Eligibility for necessary nursing home care, when clinically 
indicated:
 i. Any Veteran in need of nursing home care for a service-connected (SC) 
disability.
 ii. Any Veteran in need of nursing home care who has a single or combined 
SC disability rating of 70 percent or greater. This includes a Veteran with 
a single disability rated 60 percent but who has a total disability rating 
based on individual unemployability.  
COVERAGE CODE EC01001