{"aaData": [["BENEFICIARY CHILDREN OF WOMEN OF VIETNAM VETERANS", "
110
\n", "
\nCWVV\n
\n
\n", "
\nChildren of Women Vietnam Veterans (CWVV) Plan provides "NEEDED CARE" to \nan eligible child, such health care as the Secretary determines is needed \nby the child for that child's covered birth defects, or any disability\nthat is associated with those birth defects. (38 USC 1811-1816)\n \nFor more information:  \nhttps://www.domain.ext/COMMUNITYCARE/programs/dependents/cwvv/index.asp\n
\n
\n", "
CW01001
\n", ""], ["MEDS BY MAIL BENEFICIARY", "
310
\n", "
\nVFMP - MbM Rx\n
\n
\n", "
\nIndividuals who are eligible for benefits under one of these Veteran \nFamily Member Programs: Children of Women Vietnam Veterans, Civilian \nHealth and Medical Program of the Department of Veterans Affairs, or \nSpina Bifida AND who are also eligible for Veteran Family Member Program \nMeds by Mail coverage. These individuals are eligible if they do not have \nprivate or Medicare Part D primary pharmacy coverage.\n
\n
\n", "
MBM1001
\n", ""], ["VETERAN PLAN - WOMEN'S PROGRAMS", "
111
\n", "", "
\nWomen's Programs Plan provides a variety of services, including: \n - Birth control counseling and management (medical and surgical)\n - Pre-pregnancy care\n - Treatment and prevention of sexually transmitted infections\nA provider can assist with routine exams, diagnosis, and management of:\n - Pelvic/abdominal pain; Abnormal vaginal bleeding; Vaginal symptoms\n(dryness/infections); Breast and other women's cancers; Abnormal cervical \nscreening results; Infertility evaluation, including intrauterine \ninsemination (IUI).  VA is not authorized to provide or cover the cost of \nin-vitro fertilization (IVF).; Sexual dysfunction\n - Women's gender-specific health care (menopause evaluation and symptom \nmanagement, osteoporosis, incontinence, birth control, breast and \ngynecological care, maternity and limited infertility services).  \n - Screening and disease prevention programs (for example, mammograms,\nbone density screening, and cervical cancer screening)\nRoutine gynecologic services are available at VA facilities and include:\n - Human Papilloma Virus (HPV) vaccinations\n - Pelvic exams, ultrasounds \n
\n
\n", "", ""], ["VETERAN PLAN - NURSING HOME/COMMUNITY LIVING CENTERS (CLC)", "
113
\n", "", "
\nNursing Home/Community Living Centers Plan provides placement in nursing \n - Have a Service-connected disability rating of 70 percent or more; \n - Are unemployable or have an official rating of "permanent and total\ndisabled;" \n - Have a service-connected disability that is clinically determined to\nrequire nursing home care; \n - Are a Nonservice-connected veteran or a ""zero percent, noncompensable,\nService-connected"" veteran who requires nursing home care for any\nNonservice-connected disability and who meets income and asset criteria;\nor  \n - Need care, if space and resources are available. Other Veterans are\nhomes, when clinically indicated, may be available either through VA's \nevaluated on a case-by-case basis, with priority given to\nService-connected veterans and those who need care for post-acute\nrehabilitation, respite, hospice, geriatric evaluation and management, or\nspinal cord injury.\nCommunity Living Centers (CLC) or contract nursing homes. The mission of \nthe VA Community Living Centers (VACLC) program (formerly known as VA \nNursing Home Care Units) is to provide compassionate care to Veterans \nwith chronic stable conditions - those who suffer from dementia, who \nrequire rehabilitation or short-term specialized services (such as \nrespite or intravenous therapy), or who need comfort and care at the end \nof life. A Veteran is eligible for VA nursing home care if he or she is: \n
\n
\n", "", ""], ["VETERAN PLAN - HOME HEALTH", "
114
\n", "", "
\nHome Health Plan provides home health services VA's Skilled Home Health \nHomemaker/Home Health Aide (H/HHA) Services\nH/HHA services are personal care and related support services that enable\nfrail or disabled Veterans to live at home. \n(38 USC  1717)\nCare Services (SHHC) and Homemaker and Home Health Aid Services \n(H/HHA).\nSkilled Home Health Care (SHHC) Services \nSHHC services are in-home services provided by specially trained\npersonnel, including nurses, physical therapists, occupational therapists,\nspeech therapists, and social workers. Care includes clinical assessment,\ntreatment planning, treatment provision, health status monitoring, patient\nand family education, reassessment, referral, and follow-up.\n
\n
\n", "", ""], ["VETERAN PLAN - EYE GLASSES", "
115
\n", "", "
\nEye Glasses Plan provides service-connected Veterans receiving \n(38 CFR 17.149)\ncompensation, former Prisoners of War, Purple Heart Recipients, or \nVeterans in receipt of VA's Aid and Attendance or Housebound benefits and \nreceiving VA care or services, are provided eyeglasses based on clinical \nneed. \nOtherwise, VA provides eyeglasses only in special circumstances. However,\nVeterans otherwise receiving VA care or services may be eligible because\nof medically compelling reasons, as determined by a VA eye care \npractitioner. \n
\n
\n", "", ""], ["VETERAN PLAN - CLOTHING ALLOWANCE", "
116
\n", "", "
\nClothing Allowance Plan provides service-connected Veterans who must wear \na prescribed device that causes their clothing to wear or tear, or if \nclothing is damaged due to use of a topical ointment,  may receive an \nannual Clothing Allowance payment.  (38 USC  1162)\n
\n
\n", "", ""], ["VETERAN PLAN - HEARING AID", "
117
\n", "", "
\nHearing Aid Plan provides service-connected Veterans receiving \ncompensation, former Prisoners of War, Purple Heart Recipients, or \nVeterans in receipt of VA's Aid and Attendance or Housebound benefits and \nreceiving VA care or services, are provided hearing aids based on \nclinical need. \nOtherwise, VA provides hearing aids only in special circumstances.\nHowever, Veterans otherwise receiving VA care or services may be eligible\nbecause of medically compelling reasons, as determined by a VA\naudiologist. (38 CFR 17.149)\n
\n
\n", "", ""], ["VETERAN PLAN - NON VA EMERGENCY CARE", "
118
\n", "", "
\nIn case of emergencies, Veterans should always call 911.  VA does not \nhave to be contacted in advance. Veterans should always go to the nearest \nemergency room whether it's a VA or private facility.  If transported by \nambulance, the paramedics generally will go to the closest emergency room.\n
\n
\n", "", ""], ["VETERAN PLAN - MEDICATION AND SUPPLIES", "
119
\n", "", "
\nMedication and Supplies Plan provides safe, effective, and medically \nnecessary medications to ensure the highest quality care for our nation's \nVeterans.\n
\n
\n", "", ""], ["VETERAN PLAN - HOME IMPROVEMENTS", "
120
\n", "", "
\nHome Improvement Plan provides a Home Improvement and Structural \nAlteration Grant may be awarded for improvements or structural \nalterations needed to access home or essential bathroom facilities. \n
\n
\n", "", ""], ["BENEFICIARY NEWBORN", "
102
\n", "
\nNB\n
\n
\n", "
\nNewborn care and post-delivery care for a newborn child for the date of \n      or VA preauthorized maternity care from a non-VA provider\n   .  Authorized Community Provider or a non-VA facility (under a Non-VA \n      Medical Care authorization)\n   .  Newborn Eligible from the DATE OF BIRTH + 7 DAYS \n         o  Newborn begins eligibility on its date of birth\n         o  Eligibility continues for 7 consecutive calendar days\nbirth plus seven calendar days after the birth of the child when the birth \nmother is a woman Veteran enrolled in VA health care and receiving \nmaternity care furnished by VA or under authorization from VA and the child \nis delivered either in a VA facility, or in another facility pursuant to a \nVA authorization for maternity care at VA expense.\n \nNewborn:\n   .  Born to a woman Veteran receiving maternity services through the VA \n
\n
\n", "
NB01001
\n", ""], ["VETERAN PLAN - AUTOMOBILE ADAPTIVE EQUIPMENT", "
121
\n", "", "
\nVA's Automobile Adaptive Equipment program Plan provides equipment and \ntraining to enter, exit, or operate a motor vehicle for Service-connected \nVeterans whose Primary Care Provider decides that it is necessary to \ndrive safely and comply with State licensing laws. Please note that only \ncertain Service-connected conditions qualify.  Veterans may also be \neligible for financial assistance, in the form of a grant, to purchase a \nnew or used automobile (or other conveyance). \n
\n
\n", "", ""], ["VETERAN FOREIGN MEDICAL PROGRAM", "
122
\n", "
\nFMP\n
\n
\n", "
\nForeign Medical Program Plan provides pay for medical services for \n303-331-7590.\n \nFor information, visit:  \nhttps://www.domain.ext/COMMUNITYCARE/programs/veterans/fmp/index.asp\ntreating your service-connected disabilities, or any disability that is  \nassociated with and aggravates a service-connected disability if you live \nor travel outside the United States.  This program will also reimburse you\nfor certain treatment of medical services while you are outside the United\nStates, if needed as part of your VA-approved vocational rehabilitation\nprogram. If you are living or planning to travel outside the U.S. (other\nthan in the Philippines), you need to register with VA's Foreign Medical\nProgram office, P.O. Box 469061, Denver, CO 80246-9061, USA: telephone\n
\n
\n", "
FM01001
\n", "
NO
\n"], ["VETERAN PLAN - NON-VET PLANS", "
123
\n", "", "", "", ""], ["VA/DOD PLAN - TRICARE", "
124
\n", "", "
\nTRICARE Plan is a regionally managed health care program for active duty \nand retired members of the uniformed services, their families and \nsurvivors. VA bills TRICARE for Nonservice-connected medical treatment. \nThere are four options for health care: TRICARE Prime, TRICARE Extra, \nTRICARE Standard and TRICARE for Life. Each of these options has specific \nbenefits, exclusions, copayment and deductible requirements.\n
\n
\n", "", ""], ["VA/DOD PLAN - RETIREE", "
125
\n", "", "", "", ""], ["VA/DOD PLAN - ACTIVE DUTY SPONSOR", "
126
\n", "", "", "", ""], ["VA/DOD PLAN - ACTIVE DUTY DEPENDENT", "
127
\n", "", "", "", ""], ["VA/DOD PLAN - FORMER NON-REMARRIED SPOUSE", "
128
\n", "", "", "", ""], ["VA/DOD PLAN - RETIREE SPONSOR", "
129
\n", "", "", "", ""], ["VA/DOD PLAN - RETIREE DEPENDENT", "
130
\n", "", "", "", ""], ["VETERAN PLAN - STATE HOME VETERAN PLANS", "
103
\n", "", "
\nState Home Plan provides Nursing home care and medications for veterans \nwith service-connected disabilities.\nThe Secretary shall pay each State home for nursing home care at the rate\ndetermined under paragraph (2), in any case in which such care is provided\nto any veteran. (Public Law 109-461) (38 USC 1745)\n
\n
\n", "", ""], ["VA/DOD PLAN - RESERVIST SPONSOR", "
131
\n", "", "", "", ""], ["VA/DOD PLAN - RECRUIT SPONSOR", "
132
\n", "", "", "", ""], ["VA/DOD PLAN - TEMPORARY DISABILITY RETIREMENT LIST (TDRL) SPONSOR", "
133
\n", "", "", "", ""], ["VA/DOD PLAN - TRICARE FOR LIFE (TFL)", "
134
\n", "", "", "", ""], ["VETERAN PLAN - LONG TERM CARE", "
112
\n", "", "", "", ""], ["PRESUMPTIVE (38 USC 1702-38 CFR 17.109)", "
135
\n", "
\nPP\n
\n
\n", "
\nPresumptive eligibility for psychosis and mental illness other than \npsychosis presumed to be service-connected for purposes of Department of \nVeterans Affairs (VA) medical benefits. In addition, VA will presume that \nPersian Gulf War Veterans are service-connected for purposes of VA medical\nbenefits if such Veterans develop mental illness other than psychosis\nwithin two years after discharge or release from service and before the\nend of the 2-year period beginning on the last day of the Persian Gulf War\n(end date not yet determined). (Public Law 110-181; 38 United States Code\n(U.S.C.) 1702 and the implementing regulation, 38 CFR 17.109)\n   \n1. Veterans who served in the United States active duty military,\npsychosis. Veterans eligible for benefits under 38 CFR 17.109 are \nnaval, or air service and developed such psychosis within 2 years after\ndischarge or release from the active duty military, naval or air service; \nand before the following date associated with the war or conflict in which\nthe Veteran served:\n   \n=========================================================================\n| Veteran Served During       | Date:                                   |\n=========================================================================\n| World War II                | July 26, 1949                           |\n-------------------------------------------------------------------------\neligible for treatment of an active psychosis or other mental illness. \n| Korean Conflict             | February 1, 1957                        |\n-------------------------------------------------------------------------\n| Vietnam Era                 | May 8, 1977                             |\n-------------------------------------------------------------------------\n| Persian Gulf War            | End of the 2-year period beginning on   |\n|                             | the last day of the Persian Gulf War    |\n|                             | (end date not yet determined)           |\n=========================================================================\n \n2. Mental Illness (other than Psychosis). Eligibility for benefits under \nAny treatment under this authority is exempted from copayments for \n38 CFR 17.109(b) is established for treatment of an active mental illness\n(other than psychosis), and such condition is exempted from copayments\nunder 38 CFR 17.108, 17.110, and 17.111 for any Veteran of the above \nlisted conflicts.\n \nVeterans and former service members assigned the Presumptive VHAP must \nmeet one of the following conditions:\n   o All Enrolled Veterans\n   o Non-Enrolled Veterans authorized to receive medical benefits limited\n     to this specific situation.\ninpatient, outpatient, medication and extended care services under \n   o Veterans not required to enroll and authorized to receive medical \n     benefits limited to this specific situation.\n   o Cancelled/Declined - Receive medical benefits for Presumptive\n     Psychosis conditions only\n   o Rejected - Receive medical benefits for Presumptive Psychosis and SC \n     conditions only \n   o Ineligible and SC 0% - Receive medical benefits for Presumptive  \n     Psychosis and SC conditions only \n   o Ineligible and MST - Receive medical benefits for Presumptive\n     Psychosis and MST conditions only\n17.108, 17.110, and 17.111.   \n   o Ineligible without a bar to benefits - Receive medical benefits for \n     Presumptive Psychosis conditions only.\n   o Former service members with Other Than Honorable (OTH) discharges who\n     present for certain services\n   o Presumptive (38 USC 1702-38 CFR 17.109)\n \nPresumptive (38 USC 1702-38 CFR 17.109) Plan provides certain Veterans \nwho experience psychosis within a specified time-frame are to have their\n
\n
\n", "
PP01001
\n", ""], ["VOCATIONAL REHABILITATION (CHAPTER 31)", "
136
\n", "", "
\nThe Vocational Rehabilitation and Employment (VR&E) Program is \njob-seeking skills, resume development, and other work readiness \nassistance   Assistance eligible Veterans with finding and keeping a job, \nincluding the use of special employer incentives and job accommodations   \nOn the Job Training (OJT), apprenticeships, and non-paid work \nexperiences   Post-secondary training at a college, vocational, technical \nor business school   Supportive rehabilitation services including case \nmanagement, counseling, and medical referrals   Independent living \nservices for Veterans unable to work due to the severity of their \ndisabilities   For Veterans with service-connected disabilities so severe \nthat they cannot immediately consider work, this program offers services \nauthorized by Congress under Title 38, USC, Chapter 31 and Code of \nto improve their ability to live as independently as possible.+C21\nFederal Regulations, Part 21. It is sometimes referred to as the Chapter \n31 program. This program assists Veterans with service-connected \ndisabilities to prepare for, find, and keep suitable jobs. Services that \nmay be provided by the VR&E Program include:  Comprehensive \nrehabilitation evaluation to determine abilities, skills, and interests \nfor employment   Vocational counseling and rehabilitation planning for \nemployment services   Employment services such as job-training, \n
\n
\n", "", ""], ["CAREGIVER PRIMARY FAMILY", "
101
\n", "
\nCG Pri\n
\n
\n", "
\nCaregiver Primary Family is an individual designated as a "primary \nprovider of personal care services" for the eligible Veteran under 38 \nU.S.C. 1720G(a)(7)(A) who the Veteran specifies on the joint application \nand is approved by VA as the primary provider of personal care services for \nthe Veteran.\n
\n
\n", "
CP01001
\n", ""], ["CAREGIVER SECONDARY FAMILY", "
137
\n", "
\nCG Sec\n
\n
\n", "
\nCaregiver Secondary Family is an individual approved as a provider of \npersonal care services for the eligible Veteran under 38 U.S.C. \n1720G(a)(6)(B), and generally serves as a backup to the Primary Family \nCaregiver.\n
\n
\n", "
CS01001
\n", ""], ["CAREGIVER GENERAL", "
138
\n", "
\nCG Gen\n
\n
\n", "
\nCaregiver General are "caregivers of covered Veterans" under the program \nin 38 U.S.C. 1720G(b), and provide personal care services to covered \nVeterans, but do not meet the criteria for designation or approval as a \nPrimary or Secondary Family Caregiver.\n
\n
\n", "
CG01001
\n", ""], ["VETERAN PLAN - MEDICAL BENEFITS PACKAGE (BASIC PLAN COVERAGE FOR SC, NSC, ETC.)", "
104
\n", "", "
\nMedical Benefits Package Plan provides a full spectrum of medically \nnecessary services, based on the judgment of your VA primary care \nprovider and in accordance with generally accepted standards of clinical \npractice. These services include: Primary Care, Health Promotion, Disease \nPrevention, Diagnosis, Palliative Care, Surgery, Prescriptions for \nMedications, Prosthetics, Critical Care, Mental Health Care, Women's \nHealth Care, Orthopedics, Radiology, Physical Therapy, Rehabilitation.\n
\n
\n", "", ""], ["CAMP LEJEUNE FAMILY", "
306
\n", "
\nCLF\n
\n
\n", "
\nThe Camp Lejeune Family Member Program (CLFMP) is for family members of\nto provide health care to Veterans who served on active duty at Camp \nLejeune and to reimburse eligible Camp Lejeune family members for health \ncare costs related to one or more of 15 specified illnesses or medical \nconditions listed in the law.\n \nFor more information: \nhttps://www.domain.ext/COMMUNITYCARE/programs/dependents/CLFMP.asp\nVeterans that lived or served at U.S. Marine Corps Base Camp Lejeune, \nNorth Carolina, between August 1, 1953, and December 31, 1987, and were\npotentially exposed to drinking water contaminated with industrial\nsolvents, benzene, and other chemicals.\n \nOn August 6, 2012, the Honoring America's Veterans and Caring for Camp \nLejeune Families Act of 2012 was signed into law. This law (H.R. 1627, \nnow Public Law 112-154) requires the Department of Veterans Affairs (VA) \n
\n
\n", "
CL01001
\n", ""], ["VETERAN PLAN - AIRBORNE HAZARD AND OPEN BURN PIT", "
140
\n", "", "", "", ""], ["VETERAN PLAN - VETERANS CHOICE BASIC", "
200
\n", "
\nThe Veteran must be enrolled in the VA health care system and does not \nqualify for the Services at this time.\n
\n
\n", "
\nThe Veteran must be enrolled in the VA health care system and does not \nqualify for the Services at this time.\n
\n
\n", "
VC01001
\n", "
YES
\n"], ["VETERAN PLAN - VETERANS CHOICE MILEAGE", "
201
\n", "
\nThe Veteran must be enrolled in the VA health care system.  The Veteran meets \nmileage criteria as described by legislation. This is calculated from the \nVA medical facility that is closest to the residence of the Veteran, defined \nas a VA hospital, community-based outpatient clinic, or VA health care center \nwith at least one full-time primary care physician. The distance is calculated \nusing driving distance.\n
\n
\n", "
\nThe Veteran must be enrolled in the VA health care system.  The Veteran meets \nmileage criteria as described by legislation. This is calculated from the \nVA medical facility that is closest to the residence of the Veteran, defined \nas a VA hospital, community-based outpatient clinic, or VA health care center \nwith at least one full-time primary care physician. The distance is calculated \nusing driving distance.\n
\n
\n", "
VC01002
\n", "
YES
\n"], ["VETERAN PLAN - VETERANS CHOICE WAIT-TIME", "
202
\n", "
\nThe Veteran must be enrolled in the VA health care system. Veteran is told \nby his/her local VA medical facility that he/she will need to wait more than \n30 days for an appointment from the date clinically determined by his/her \nVA health care provider or the date they wish to be seen if there is no \nclinically determined date.\n
\n
\n", "
\nThe Veteran must be enrolled in the VA health care system. Veteran is told \nby his/her local VA medical facility that he/she will need to wait more than \n30 days for an appointment from the date clinically determined by his/her \nVA health care provider or the date they wish to be seen if there is no \nclinically determined date.\n
\n
\n", "
VC01003
\n", "
YES
\n"], ["VETERAN PLAN - VC UNUSUAL OR EXCESSIVE BURDEN", "
203
\n", "
\nThe Veteran must be enrolled in the VA health care system. The Veteran who \n. A medical condition that impacts the ability to travel\n. Other factors (as determined by the Secretary of VA)\nresides 40 miles or less from the nearest VA medical facility may face an \nunusual or excessive burden in accessing such a facility based on: \n. Geographical challenges\n. Environmental factors such as:\n o Roads that are not accessible to the general public, such as a road through \n   a military base or restricted area\n o Traffic, or\n o Hazardous weather conditions\n
\n
\n", "
\nThe Veteran must be enrolled in the VA health care system. The Veteran who \n. A medical condition that impacts the ability to travel\n. Other factors (as determined by the Secretary of VA)\nresides 40 miles or less from the nearest VA medical facility may face an \nunusual or excessive burden in accessing such a facility based on: \n. Geographical challenges\n. Environmental factors such as:\n o Roads that are not accessible to the general public, such as a road through \n   a military base or restricted area\n o Traffic, or\n o Hazardous weather conditions\n
\n
\n", "
VC01004
\n", "
YES
\n"], ["VETERAN PLAN - VETERANS CHOICE AIR, BOAT, OR FERRY", "
204
\n", "
\nThe Veteran must be enrolled in the VA health care system. The Veteran who \nresides 40 miles or less from the nearest VA medical facility and must travel \nby air, boat, or ferry to reach such a facility.\n
\n
\n", "
\nThe Veteran must be enrolled in the VA health care system. The Veteran who \nresides 40 miles or less from the nearest VA medical facility and must travel \nby air, boat, or ferry to reach such a facility.\n
\n
\n", "
VC01005
\n", "
YES
\n"], ["VETERAN PLAN - MILITARY SEXUAL TRAUMA", "
205
\n", "
\n\n
\n
\n", "
\n\n
\n
\n", "
MS01001
\n", ""], ["VETERAN PLAN CCP GRANDFATHER", "
211
\n", "
\nCCP G\n
\n
\n", "
\nEnrolled Veterans who have their eligibility extended from Veterans Choice \nto the new Community Care Program. There are two groups of Grandfathered \nVeterans:\n   .  Five Populated Density States\n   .  Received care through VA from either VA or community provider\nBoth groups require that the Veteran (1) be distance-eligible on the day \nbefore the MISSION Act was signed (June 5, 2018), and (2) is distance-\neligible under Veterans Choice rules as of the start of the MISSION Act on \nJune 6, 2019.\n
\n
\n", "
CC01001
\n", ""], ["VETERAN PLAN CCP STATE WITH NO FULL SERVICE MEDICAL FACILITY", "
209
\n", "
\nCCP N\n
\n
\n", "
\nEnrolled Veterans who reside in a state with no full-service VA medical \nfacility.\n
\n
\n", "
CC01002
\n", ""], ["VETERAN PLAN - CO-PAY RESPONSIBILITIES (SPECIAL MEDICAL COVERAGE BASED ON 'QUALIFYING FACTORS' SUCH AS CV,AO,SWAC,SHAD,CAMP LEJEUNE,ETC.)", "
105
\n", "", "
\nCo-Pay Responsibilities Plan  provides Veterans qualify for free \nhealthcare services based on a VA compensable service-connected condition \nor other qualifying factor, most Veterans are asked to complete an annual \nfinancial assessment, to determine if they qualify for free services. \nVeterans whose income exceed the established VA Income Thresholds as well \nas those who choose not to complete the financial assessment must agree \nto pay required copays to become eligible for VA healthcare services.\n
\n
\n", "", ""], ["VETERAN PLAN CCP URGENT CARE", "
210
\n", "
\nCCP U\n
\n
\n", "
\nEnrolled Veterans who have received care through VA from either a VA or \ncommunity provider within the past 24 months.\n Veteran will be charged copays based on their VA eligibility and number of \nvisits to Urgent Care per calendar year.\n Must receive care within the appropriate community care network of \nproviders. \n
\n
\n", "
CC01003
\n", ""], ["VETERAN PLAN CCP BASIC", "
208
\n", "
\nCCP B\n
\n
\n", "
\nVeterans enrolled in the Veterans Affairs (VA) health care system meet the \nprimary criteria for the new Community Care Program. These Veterans do not \nqualify for other static eligibilities for example: Grandfathered, Hardship \n(General Best Medical Interest), State No Full-Service VA, or Urgent Care. \nThese Veterans however can qualify for Service Not Available, Access \nStandards, or Best Medical Interest (Episodic).\n
\n
\n", "
CC01006
\n", ""], ["VETERAN PLAN CCP HARDSHIP DETERMINATION", "
212
\n", "
\nCCP H\n
\n
\n", "
\nEnrolled Veterans who are granted Hardship eligibility. Hardship (General) \ngrandfathered in). If the VA provider and the Veteran agree that there is a \nhardship determination, the Veteran would be eligible to receive community \ncare for one year.\n   .  Potential reasons for general best medical interest (hardship) \n      include geographical challenges, environmental factors, a medical \n      condition that impacts the ability to travel, or if a Veteran needs \n      to travel to their nearest VA medical facility by air, boat, or \n      ferry.\n       Examples include the presence of a body of water (including moving \n      water and still water), a geologic formation that cannot be crossed \nfall under the pathway of Best Medical Interest (BMI). \n      by road, roads that are not accessible to the general public (such as \n      a road through a military base or restricted area), traffic, or \n      hazardous weather.\n   .  In the future, VA providers will select a consult duration of either \n      6 months or 1 year from the consult duration drop-down menu. In June \n      2019, all hardship consults will have a one-year duration.\n   .  Primary Role: VA providers determine and manage General Best Medical \n      Interest (Hardship) eligibility unless otherwise noted.\n   .  Secondary Roles: Chief of Staff, Facility community care office\n   .  A hardship determination means that the Veteran is eligible to \n Example General BMI (Hardship): A veteran was just diagnosed with a \n      receive community care, but a review for clinical appropriateness is \n      still required by the designated Delegation of Authority.\n       Source: OCC Transition Guidebook, Chapter 2, Section 2.9\nmalignancy. The treatment plan includes surgery, chemotherapy and radiation \ntherapy which makes the veteran ill and weak. The duration of this \ntreatment plan will possibly be 9-12 months. The Veteran lives near a major \nuniversity Medical Center that offers not only comprehensive oncologic care \nbut also general and specialty care. The veteran has no other community \ncare eligibilities identified (Drive time or fixed eligibilities like \n
\n
\n", "
CC01007
\n", ""], ["VETERAN FULL MED BENEFITS TX AND RX COPAY EXMT", "
213
\n", "
\nFM\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, \n(CL), Military Sexual Trauma (MST), Toxic Exposure Risk Activity \n(TERA), or their status as an Indian.  Veterans assigned this VHAP meet \none of the following conditions:\n   .  Determined to be 50% or greater SC\n   .  Determined to be 10% to 40% Compensable SC*\n   .  Received a Medal of Honor (MOH)\n   .  Received a Purple Heart (PH)**\n   .  Has been a Prisoner of War (POW)\n   .  Determined to be Catastrophically Disabled (CD)\n   .  Determined to be Unemployable due to SC conditions\nwhich VA administers through an annual patient enrollment system. Veterans\n   .  In receipt of Aid & Attendance (A&A)\n   .  In receipt of Housebound (HB)\n   .  In receipt of a VA Pension\n   .  Discharge Due to Disability**\n   .  Military Disability Retirement**\n   .  Receive Medicaid**\n   .  Non-Service Connected (NSC)***\n \n *They are exempt from copay for medications related to their SC rated \ncondition, but they must complete a Pharmacy Copay Exemption Test and the \nwho meet Veteran status for VA healthcare benefits and are not subject to\noutcome is Rx Copay Exempt to be exempt from NSC medication copays.\n \n **They must complete a Pharmacy Copay Exemption Test and the outcome is Rx \nCopay Exempt to be exempt from NSC medication copays.\n \n ***NSC Veterans who are subject to Means Testing; the outcome of the Means \nTest is MT Copay Exempt and Rx Exemption status is Exempt.\n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \ncopay for their inpatient, outpatient services nor medications. Veterans\nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nare exempt from copayments for inpatient, outpatient services and \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nmedications related to their Service Connected (SC) related disability \nand special authority factor(s) - Agent Orange Exposure (AO), Southwest\nAsia Conditions (SWA), Ionizing Radiation (IR), Nose Throat Radium (NTR),\nShipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune \n
\n
\n", "
FB01001
\n", ""], ["VETERAN FULL MED BENEFITS TX COPAY EXMT AND RX COPAY REQ", "
214
\n", "
\nFM RxCo\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nShipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune \n(CL), Military Sexual Trauma (MST), Toxic Exposure Risk Activity (TERA).  \nVeterans assigned this VHAP meet one of the following conditions:\n   .  Determined to be 10% to 40% Compensable SC*\n   .  Received a Purple Heart (PH)**\n   .  Discharge Due to Disability**\n   .  Military Disability Retirement **\n   .  Granted a Financial Hardship based on the evidence provided*** \n   .  Receive Medicaid**\n   .  Non-Service Connected (NSC)****\nVA administers through an annual patient enrollment system. Veterans who \n*They are exempt from copay for medications related to their SC rated \ncondition, but they must complete a Pharmacy Copay Exemption Test and the \noutcome is Non-Exempt. They must pay copay for their NSC medication copays.\n**They must complete a Pharmacy Copay Exemption Test and the outcome is \nNon-Exempt.  They must pay copay for their NSC medication.\n***The Hardship assigns Means Test (MT) Status outcome of MT Copay Required \nfor Medical Benefits Treatments. The Hardship does not affect Pharmacy \nCopay Exemption Test outcome. If the Pharmacy Copay Exemption Test outcome \nis Non-Exempt, they are subject to NSC medication copays.  \n****NSC Veterans who are subject to Means Testing; the outcome of the Means \nmeet Veteran status for VA healthcare benefits and are not subject to copay \nTest is MT Copay Exempt and Rx Exemption status is Non-Exempt.\n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 \nUSC 5303A.\n \nfor their inpatient, outpatient services but are subject to copay for their \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nmedications.\n Veterans are exempt from copayments for inpatient, outpatient services and \nmedications related to their Service Connected (SC) related disability and \nspecial authority factor(s) - Agent Orange Exposure (AO), Southwest Asia \nConditions (SWA), Ionizing Radiation (IR), Nose Throat Radium (NTR), \n
\n
\n", "
FB01002
\n", ""], ["VETERAN FULL MED BENEFITS TX COPAY REQ AND RX COPAY EXMT 6", "
215
\n", "
\nFM TxCo 6\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nVeterans are exempt from copayments for inpatient, outpatient services and \nmedications related to their Service Connected (SC) related disability and \nspecial authority factor(s) - Agent Orange Exposure (AO), Southwest Asia \nConditions (SWA), Ionizing Radiation (IR), Nose Throat Radium (NTR), \nShipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune \n(CL), Military Sexual Trauma (MST), Toxic Exposure Risk Activity (TERA).\n \nVeterans assigned this VHAP meet one of the following conditions:\n   .  0% SC, non-compensable *\n   .  Non-Service Connected (NSC)\nVA administers through an annual patient enrollment system. Veterans who \n   .  MT Status in MT Copay Required\n   .  Priority Group 6 (i.e., AO, SWA, IR, EC, SHAD, CV, CL)\n* They are subject to copays for their inpatient, outpatient services and \nare exempt from copay for their medications.\n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nmeet Veteran status for VA healthcare benefits and current Means Test is \nservice, and meet the minimum duty service requirement according to 38 \nUSC 5303A.\n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nbased on Net Worth Adjudication. Their income plus net worth is above the \nNational Threshold, but income alone is below the VA Pension Threshold.\n \n They are subject to copays for their inpatient, outpatient services and \nnot subject to copay for their medications. \n \n
\n
\n", "
FB01003
\n", ""], ["VETERAN FULL MED BENEFITS TX COPAY REQ AND RX COPAY EXMT 7", "
216
\n", "
\nFM TxCo 7\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nVeteran authorized to receive medical benefits with:\n   .  Copay charges for Treatment\n   .  No Copay charges for Medication\n \nMust be in:\n   .  MT Status in a Pending Adjudication\n   .  Priority Group 7  \n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nVA administers through an annual patient enrollment system. Veterans who \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 \nUSC 5303A.\n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nmeet Veteran status for VA healthcare benefits and current Means Test is \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nbased on Net Worth Adjudication. Their income plus net worth is above the \nNational Threshold, but income alone is below the VA Pension Threshold. \n \nThey are subject to copays for their inpatient, outpatient services but not \nsubject to copay for their medications. \n \n
\n
\n", "
FB01007
\n", ""], ["VETERAN FULL MED BENEFITS TX COPAY REQ AND RX COPAY EXMT 8", "
217
\n", "
\nFM TxCo 8\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nMust be in:\n   .  MT Status in MT Copay Required\n   .  Priority Group 8a/b/c/d (i.e., SC 0% and NSC)\n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\nVA administers through an annual patient enrollment system. They are \n5303A.\n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nsubject to copayment for their inpatient, outpatient services but not \nsubject to copayment for their medications. \n \nVeteran authorized to receive medical benefits with:\n   .  Copayment charges for Treatment\n   .  No Copayment charges for Medication\n \n
\n
\n", "
FB01008
\n", ""], ["VETERAN FULL MED BENEFITS TX AND RX COPAY REQ 6", "
218
\n", "
\nFM TxCo RxCo 6\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nMust be in:\n   .  Priority Group 6 (i.e., AO, SWA, IR, SHAD, CV, CL, TERA)\n   .  Treatment or Medications for SA conditions are Copay Exempt\n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 \nVA administers through an annual patient enrollment system. They are \nUSC 5303A.\n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nsubject to copays for their inpatient, outpatient services and subject to \ncopay for their medications. \n \nVeteran authorized to receive medical benefits with:\n   .  Copay charges for Treatment\n   .  Copay charges for Medication\n \n
\n
\n", "
FB01004
\n", ""], ["VETERAN FULL MED BENEFITS TX AND RX COPAY REQ 8", "
219
\n", "
\nFM TxCo RxCo 8\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nVeterans are exempt from copayments for inpatient, outpatient services and \nmedications related to their Service Connected (SC) related disability and \nspecial authority factor(s) - Agent Orange Exposure (AO), Southwest Asia \nConditions (SWA), Ionizing Radiation (IR), Nose Throat Radium (NTR), \nShipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune \n(CL), Military Sexual Trauma (MST).\n \nVeterans assigned this VHAP meet one of the following conditions:\n   .  0% SC, Non-Compensable *\n   .  NSC\nVA administers through an annual patient enrollment system. Veterans who \n   .  Priority Group 8a/b/c/d (i.e., SC 0% Non-Compensable or NSC)\n*They are exempt from copay for medications related to their SC condition, \nbut they must complete a Means Test to determine their copay status for NSC \ninpatient, outpatient services and medications. The outcome of Means Test \nwas MT Copay Required for their inpatient, outpatient services and Non-\nExempt for their Pharmacy Copay Exemption Test.\n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nmeet Veteran status for VA healthcare benefits and must complete a Means \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\nTest (MT) to determine their copay status for their Medical Treatment and \n5303A.\nMedication. Veterans receiving inpatient, outpatient services for Non-\nService Connected (NSC) conditions and whose income exceeds the applicable \nNational Income Threshold are subject to copayments for inpatient, \noutpatient services and medications.\n \n
\n
\n", "
FB01009
\n", ""], ["VETERAN PLAN - BENEFICIARY TRAVEL", "
106
\n", "", "
\nBeneficiary Travel Plan provides a mechanism under 38 U.S.C. 111 for the \nVeterans Health Administration (VHA) to make payments for travel expense \nincurred in the United States to help veterans and other persons obtain \ncare or services from VHA.\n
\n
\n", "", ""], ["VETERAN FULL MED BENEFITS TX GMT COPAY REQ AND RX COPAY EXMT", "
220
\n", "
\nFM TxCoG\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nstatus is Exempt. These Veterans are subject to copays for their inpatient \nservices at a reduced rate, copayment for their outpatient services at the \nfull copay rate, but no copayment for their medications.\n \nVeterans are exempt from copayments for inpatient, outpatient services and \nmedications related to their Service Connected (SC) related disability and \nspecial authority factor(s) - Agent Orange Exposure (AO), Southwest Asia \nConditions (SWA), Ionizing Radiation (IR), Nose Throat Radium (NTR), \nShipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune \n(CL), Military Sexual Trauma (MST), Toxic Exposure Risk Activity (TERA).\nVA administers through an annual patient enrollment system. Veterans who \n \nVeterans assigned this VHAP meet one of the following conditions:\n   .  0% SC, non-compensable \n   .  Non-Service Connected\n   .  Priority Group 7 (i.e., SC 0% Non-Compensable or NSC)\n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nmeet Veteran status for VA healthcare benefits and must complete a \nEligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 \nUSC 5303A.\n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nFinancial Assessment to determine their copay status for their inpatient, \noutpatient services and medications.\n \nVeterans with gross household income below the geographically adjusted \nincome limits for their resident location and who agreed to pay copays. The \nMeans Test outcome of GMT Copay Required and outcome of their Rx Exemption \n
\n
\n", "
FB01005
\n", ""], ["VETERAN FULL MED BENEFITS TX GMT COPAY REQ AND RX COPAY REQ", "
221
\n", "
\nFM TxCoG RxCo\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nstatus is Non-Exempt. These Veterans are subject to copays for inpatient \nservices at a reduced rate, copays for outpatient services at the full \ncopay rate, and copays for medications.\n \nVeterans are exempt from copayments for inpatient, outpatient services and \nmedications related to their Service Connected (SC) related disability and \nspecial authority factor(s) - Agent Orange Exposure (AO), Southwest Asia \nConditions (SWA), Ionizing Radiation (IR), Nose Throat Radium (NTR), \nShipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune \n(CL), Military Sexual Trauma (MST), Toxic Exposure Risk Activity (TERA).\nVA administers through an annual patient enrollment system. Veterans who \n \nVeterans assigned this VHAP meet one of the following conditions:\n   .  0% SC, Non-Compensable\n   .  Non-Service Connected\n   .  Priority Group 7 (i.e., SC 0% Non-Compensable or NSC)\n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nmeet Veteran status for VA healthcare benefits and must complete a Means \nEligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 \nUSC 5303A.\n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nTest to determine their copay status for their inpatient, outpatient \nservices and medications.\n \nVeterans with gross household income below the geographically adjusted \nincome limits for their resident location and who agree to pay copays. The \nMeans Test outcome of GMT Copay Required and outcome of their Rx Exemption \n
\n
\n", "
FB01006
\n", ""], ["VETERAN RESTRICTED MED BENEFITS", "
222
\n", "
\nRM\n
\n
\n", "
\nVeterans who are not enrolled but can be seen for their Service Connected \n  o Ineligible and SC 0% - Receive medical benefits for SC conditions only\n  o Ineligible and MST - Receive medical benefits for MST conditions only\n(SC) conditions only (and/or MST if MST is indicated). Veterans who are \neligible to be screened for Military Sexual Trauma and Presumptive \nPsychosis or other active mental illness. Veterans are exempt from \ncopayments for the screening encounter. Veterans assigned this VHAP meet \none of the following conditions: \n \n  o Cancel/Decline - Receive medical benefits for SC conditions only \n  o Rejected - Receive medical benefits for SC conditions only \n
\n
\n", "
RM01001
\n", ""], ["NON VETERAN OTHER RESTRICTED MED BENEFITS", "
223
\n", "
\nORM\n
\n
\n", "
\nVeterans who are eligible to be screened for Military Sexual Trauma and \n     present for certain services.\nPresumptive Psychosis or other active mental illness. Veterans are exempt \nfrom copayments for the screening encounter. Non Veterans authorized to \nreceive medical benefits limited to a very specific situation includes \nany of the following: \n \n   o MST - Non Veteran (Active Duty) \n   o Presumptive (38 USC 1702-38 CFR 17.109) \n   o Former Servicemembers with Other Than Honorable (OTH) discharges who\n
\n
\n", "
OR01001
\n", ""], ["RESTRICTED EXAMINATION ONLY", "
224
\n", "
\nREO\n
\n
\n", "
\nVeterans being registered for a Registry exam (i.e., Burn Pit, Agent\nFor Eligible Individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible Individuals are ones who served in the active military service, \nregardless of length of service, and who were discharged, excluding \nanyone who received a dishonorable discharge or was discharged or \ndismissed by reason or while serving in the Armed Forces, was the victim \nof a physical assault of a sexual nature, a battery of a sexual nature, \nor sexual harassment.\nOrange, etc.) or Compensation and Pension (C&P) exam as requested by the\nVeterans Benefits Administration (VBA). The Veterans are not subject to\nCopayment Requirements for exam.\n \nIncludes any of the following: \n \no Veterans being registered for a Registry Exam or C&P exam\n \n
\n
\n", "
EX01001
\n", ""], ["HUMANITARIAN", "
225
\n", "
\nHM\n
\n
\n", "
\nCivilians presenting to VA for care with no VA eligibility qualifications.\no Pending; Other - VES cannot determine enrollment status. \no Pending; No Eligibility Code - VES cannot determine enrollment status. \no Pending - VES cannot determine enrollment status. \no Unverified - VES cannot determine enrollment status. \no Enrollment Status is Closed Application, for reason Pending Proof of \n  Qualifying Service\n \nNote: Non-enrolled Veterans can be under Humanitarian. They would be a \n      Veteran:\no Verified in VES but choose NOT to enroll and be in a "Registration \n  Only" status.\no Pending; Eligibility Unverified - Veterans who do not have a prior \n  period of enrollment and are still within the 365-day period who\n  have not provided evidence of Veteran status.\n
\n
\n", "
HM01001
\n", ""], ["APPLICANT IN PROCESS", "
226
\n", "
\nINC\n
\n
\n", "
\nVeterans who applied for VA healthcare benefits, but eligibility has not \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible Individuals are ones who served in the active military service, \nregardless of length of service, and who were discharged, excluding \nanyone who received a dishonorable discharge or was discharged or \ndismissed by reason or while serving in the Armed Forces, was the victim \nof a physical assault of a sexual nature, a battery of a sexual nature, \nor sexual harassment.\nbeen verified or a final enrollment determination could not be made.\n   .  Pending; Means Test Required - Veterans whose Veterans Status has \n      been verified and who have not provided initial Means Test to \n      determine enrollment.\n   .  Pending; Purple Heart Unconfirmed - A temporary eligibility for 14 \n      days.\n \nFor Eligible Individuals, under Veterans Comprehensive Prevention, Access \n
\n
\n", "
AN01001
\n", ""], ["ALLIED BENEFICIARIES", "
227
\n", "
\nAB\n
\n
\n", "
\nAllied Beneficiaries are former members of the armed forces of nations \nallied with the United States (U.S.) in World War I (except any nation \nwhich was an enemy of the United States during World War II) or in World \nWar II.\n \nAllied Beneficiaries must have a letter from the Service Personnel Veterans \nAgency (SPVA) stating their approved disabilities (War Pension Letter).\n
\n
\n", "
AL01001
\n", ""], ["OTHER FEDERAL AGENCY", "
228
\n", "
\nOFA\n
\n
\n", "
\nOther Federal Agencies (Civil Service Commission, Department of Commerce, \nFederal Aviation Admin., Office of Economic Opportunity, Office of \nEmployee's Comp., Peace Corps, Veterans Administration and any other agency \nthat gets injured and comes to VA). \n   .  Sharing Agreement (excludes DoD)\n   .  Other Federal Agency\n \n       **If approved OWCP case**\n
\n
\n", "
OF01001
\n", ""], ["TRICARE", "
229
\n", "
\nTRI\n
\n
\n", "
\nTRICARE Health Plan\n     Retiree Family and Reserve Select enrollees\n \n * VA/DoD Health Care Resource Sharing Agreements not applicable (ref. \n   VA/DoD Direct Resource Sharing Agreements)\n   - (e.g. dual eligible Veteran elects Veteran benefit vs TRICARE \n     Health Plan) \n \n * If patient has a Veteran status and on Active Duty Orders, then all \n   Active Duty rules apply   \n   - Even if treatment is Service Connected - Patient considered TRICARE \n-------------------\n     Prime enrollee   \n   - Includes active Reserve and National Guard - Federal orders must \n     exceed 30 days\nPatient receiving care at a VAMC as a TRICARE patient of the Department \nof Defense:\n \n * TRICARE Authorization:\n   - Required for TRICARE Prime patients - Retiree and Retiree Family \n     enrollees\n   - NOT required for TRICARE Select patients - AD Family, Retiree, \n
\n
\n", "
AC01001
\n", ""], ["VETERAN PLAN - DENTAL", "
107
\n", "", "
\nDental Plan provides: Outpatient dental services and treatment, and \nrelated dental appliances, shall be furnished under this section only for \na dental condition or disability.  Inpatient dental services that are \nprofessionally determined by a VA dentist, in consultation with the \nreferring physician, to be essential to the management of the patient's \nmedical condition under active treatment while receiving hospital, \nnursing home or domiciliary care.\n(38 USC 1712)\n
\n
\n", "", ""], ["VETERAN FULL MED BENEFITS TX GMT COPAY REQ AND COPAY EXMT 6", "
239
\n", "
\nFM TxCoG 6\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nstatus is Exempt. These Veterans are subject to copays for inpatient \nservices at a reduced rate, copays for outpatient services at the full \ncopay rate, and no copays for medications. \n \nVeterans are exempt from copayments for inpatient, outpatient services and \nmedications related to their Service Connected (SC) related disability and \nspecial authority factor(s) - Agent Orange Exposure (AO), Southwest Asia \nConditions (SWA), Ionizing Radiation (IR), Nose Throat Radium (NTR), \nShipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune \n(CL), Military Sexual Trauma (MST), Toxic Exposure Risk Activity (TERA).\nVA administers through an annual patient enrollment system. Veterans who \n \nVeterans assigned this VHAP meet the following condition:\n   .  Priority Group 6 (i.e., SC 0% Non-Compensable or NSC)\n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 \nmeet Veteran status for VA healthcare benefits and must complete a \nUSC 5303A.\n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nFinancial Assessment to determine their copay status for their inpatient, \noutpatient services and medications.\n \nVeterans with gross household income below the geographically adjusted \nincome limits for their resident location and who agreed to pay copays. The \nMeans Test outcome of GMT Copay Required and outcome of their Rx Exemption \n
\n
\n", "
FB01012
\n", ""], ["VETERAN FULL MED BENEFITS TX GMT AND RX COPAY REQ 6", "
240
\n", "
\nFM TxCoG RxCo 6\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nstatus is Non-Exempt. These Veterans are subject to copays for inpatient \nservices at a reduced rate, copays for outpatient services at the full \ncopay rate, and copays for medications\n \nVeterans are exempt from copayments for inpatient, outpatient services and \nmedications related to their Service Connected (SC) related disability and \nspecial authority factor(s) - Agent Orange Exposure (AO), Southwest Asia \nConditions (SWA), Ionizing Radiation (IR), Nose Throat Radium (NTR), \nShipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune \n(CL), Military Sexual Trauma (MST), Toxic Exposure Risk Activity (TERA).\nVA administers through an annual patient enrollment system. Veterans who \n \nVeterans assigned this VHAP meet the following condition:\n   .  Priority Group 6 (i.e., SC 0% Non-Compensable or NSC) and MT outcome \n      is GMT and Rx Exemption status is Non-Exempt\n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nmeet Veteran status for VA healthcare benefits and must complete a Means \nservice, and meet the minimum duty service requirement according to 38 \nUSC 5303A.\n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nTest to determine their copay status for their inpatient, outpatient \nservices and medications\n \nVeterans with gross household income below the geographically adjusted \nincome limits for their resident location and who agreed to pay copays. The \nMeans Test outcome of GMT Copay Required and outcome of their Rx Exemption \n
\n
\n", "
FB01013
\n", ""], ["VETERAN FULL MED BENEFITS TX AND RX COPAY EXMT 6", "
241
\n", "
\nFM 6\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nShipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune \n(CL), Military Sexual Trauma (MST), Toxic Exposure Risk Activity (TERA).\n \nVeterans assigned this VHAP meet the following condition:\n   .  Determined to be 0% Compensable SC*\n \n*They are exempt from copay for medications related to their SC rated \ncondition, but they must complete a Pharmacy Copay Exemption Test and the \noutcome is Rx Copay Exempt to be exempt from NSC medication copays.\n \nVA administers through an annual patient enrollment system. Veterans who \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 \nUSC 5303A.\n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nmeet Veteran status for VA healthcare benefits and are not subject to copay \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nfor their inpatient, outpatient services nor medications. \n \nVeterans are exempt from copayments for inpatient, outpatient services and \nmedications related to their Service Connected (SC) related disability and \nspecial authority factor(s) - Agent Orange Exposure (AO), Southwest Asia \nConditions (SWA), Ionizing Radiation (IR), Nose Throat Radium (NTR), \n
\n
\n", "
FB01010
\n", ""], ["VETERAN FULL MED BENEFITS TX COPAY EXMT AND RX COPAY REQ 6", "
242
\n", "
\nFM RxCo 6\n
\n
\n", "
\nAll enrolled Veterans have a comprehensive medical benefits package, which \nConditions (SWA), Ionizing Radiation (IR), Nose Throat Radium (NTR), \nShipboard Hazard and Defense (SHAD), Combat Veteran (CV), Camp Lejeune \n(CL), Military Sexual Trauma (MST), Cleland Dole Act World War II \n(WWII), Toxic Exposure Risk Activity (TERA).\n \nVeterans assigned this VHAP must meet one of the following conditions:\n   .  Determined to be 0% Compensable SC*\n   .  Cleland Dole Act World War II (WWII)\n \n*They are exempt from copay for medications related to their SC rated \nVA administers through an annual patient enrollment system. Veterans who \ncondition, but they must complete a Pharmacy Copay Exemption Test and the \noutcome is Non-Exempt. They must pay copay for their NSC medication copays.\n \nFor eligible individuals, under Veterans Comprehensive Prevention, Access \nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 \nUSC 5303A.\nmeet Veteran status for VA healthcare benefits and are not subject to copay \n \nFor eligible individuals, under Dr. Kate Hendricks Thomas Supporting \nExpanded Review for Veterans in Combat Environments (SERVICE) Act, VA \nwill furnish clinically appropriate breast cancer risk assessment for \ncare. Eligible individuals are Veterans who served in the active military \nservice, and meet the minimum duty service requirement according to 38 USC\n5303A.\nfor their inpatient, outpatient services but are subject to copay for their \nmedications.\n \nVeterans are exempt from copayments for inpatient, outpatient services and \nmedications related to their Service Connected (SC) related disability and \nspecial authority factor(s) - Agent Orange Exposure (AO), Southwest Asia \n
\n
\n", "
FB01011
\n", ""], ["EMPLOYEE ONLY", "
283
\n", "
\nEmp O\n
\n
\n", "
\nEmployees who are not Veterans (e.g., contract, volunteer, or Full-time \nEquivalent). Records assigned this carve out will be shared with Health \nInformation Exchange (HIE) to support disclosure logic. These records \nwill also be assigned Humanitarian as the Core profile for any \nnon-Employee activities.\n
\n
\n", "
EM01001
\n", ""], ["VA MANDATORY NURSING HOME ELIGIBLE COPAY EXEMPT", "
284
\n", "
\nFull ECS Ex\n
\n
\n", "
\nVeterans enrolled in VA Health Care System and have one of the following: \n \nFrom VHA Directive 1601A.02: Veterans are eligible to receive care in VA \nCLCs if they meet the nursing home eligibility criteria and if VA \ndetermines there is a need for a specific level of care and services \navailable in a particular VA CLC. Certain Veterans have mandatory \neligibility for nursing home care while other Veterans may be provided \nnursing home care on a space and resource available basis.\n Mandatory Eligibility for necessary nursing home care, when clinically \nindicated:\n i. Any Veteran in need of nursing home care for a service-connected (SC) \ndisability.\n ii. Any Veteran in need of nursing home care who has a single or combined \nSC disability rating of 70 percent or greater. This includes a Veteran with \na single disability rated 60 percent but who has a total disability rating \nbased on individual unemployability.  \n
\n
\n", "
EC01001
\n", ""], ["VA EXTENDED CARE SERVICES COPAY EXEMPT", "
285
\n", "
\nRef ECS Ex\n
\n
\n", "
\nVeterans Enrolled in VA Health Care System are exempt from extended care \n   .  Care authorized under 38 U.S.C. 1710(e) for Vietnam-era herbicide-\n      exposed Veterans, radiation-exposed Veterans, Persian Gulf War \n      Veterans, post-Persian Gulf War combat-exposed Veterans, or Camp \n      Lejeune Veterans pursuant to Section 17.400.\n   .  Care for treatment of sexual trauma as authorized under 38 U.S.C. \n      1720D.\n   .  Care or services authorized under 38 U.S.C. 1720E for certain \n      Veterans regarding cancer of the head or neck.\n   .  A Veteran who VA determines to be catastrophically disabled, as \n      defined in 38 CFR 17.36(e), is exempt from copayments for adult day \ncopayments if they have one of the following:\n      health care, non-institutional respite care, and non-institutional \n      geriatric care.\n   .  A Veteran receiving care for psychosis or a mental illness other than \n      psychosis pursuant to Section 17.109.\n   .  A Veteran who was awarded the Medal of Honor.\n   .  Receiving hospice care as part of extended care services\n \nThese Veterans do not have mandatory eligibility for nursing home care and \nmay be provided needed nursing home care on a space and resources available \nbasis.\n   .  A Veteran with a compensable service-connected disability.\n \nThese Veterans do not pay copayments for extended care services provided by \nVA (directly or paid for by VA), and do not complete VA Form 10-10EC.\n   .  A Veteran whose annual income (determined under 38 U.S.C. 1503) is \n      less than the amount in effect under 38 U.S.C. 1521(b).\n   .  Care for a Veteran's non-compensable zero percent service-connected \n      disability.\n   .  An episode of extended care services that began on or before November \n      30, 1999.\n
\n
\n", "
EC01002
\n", ""], ["VA EXTENDED CARE SERVICES COPAY REQUIRED", "
286
\n", "
\nRef ECS Copay\n
\n
\n", "
\nVeterans enrolled in VA Health Care System may have an extended care copay \n   .  Care authorized under 38 U.S.C. 1710(e) for Vietnam-era herbicide-\n      exposed Veterans, radiation-exposed Veterans, Persian Gulf War \n      Veterans, post-Persian Gulf War combat-exposed Veterans, or Camp \n      Lejeune Veterans pursuant to Section 17.400.\n   .  Care for treatment of sexual trauma as authorized under 38 U.S.C. \n      1720D.\n   .  Care or services authorized under 38 U.S.C. 1720E for certain \n      Veterans regarding cancer of the head or neck.\n   .  A Veteran who VA determines to be catastrophically disabled, as \n      defined in 38 CFR 17.36(e), is exempt from copayments for adult day \nif they DO NOT have one of the following:\n      health care, non-institutional respite care, and non-institutional \n      geriatric care.\n   .  A Veteran receiving care for psychosis or a mental illness other than \n      psychosis pursuant to Section 17.109.\n   .  A Veteran who was awarded the Medal of Honor.\n   .  Receiving hospice care as part of extended care services\n \nThese Veterans do not have mandatory eligibility for nursing home \ncare and may be provided needed nursing home care on a space and \nresources available basis.\n   .  A Veteran with a compensable service-connected disability.\n \nThese Veterans may have copayments for extended care services provided by \nVA (directly or paid for by VA), and are required to complete VA Form 10-\n10EC. The monthly copayment amount is calculated based on VA Form 10-10EC \ninformation.\n \nIncludes Veterans who may have to pay copayments for extended care services \nprovided by VA (directly or paid for by VA), because they refuse to provide \nfinancial information but agree to pay VA the applicable copayment amount \n(documented on VA Form 10-10EC).\n   .  A Veteran whose annual income (determined under 38 U.S.C. 1503) is \n \nFor extended care services furnished through the Veterans Community Care \nProgram under Section 17.4000 through 17.4040, the copayment amount at the \ntime of furnishing such care or services by a non-VA entity or provider is \n$0. VA will determine and assess the Veteran's copayment amount at the end \nof the billing process, but at no time will a Veteran's copayment be more \nthan the amount identified in paragraph 38 CFR 17.111(b)(1) or (2).\n      less than the amount in effect under 38 U.S.C. 1521(b).\n   .  Care for a Veteran's non-compensable zero percent service-connected \n      disability.\n   .  An episode of extended care services that began on or before November \n      30, 1999.\n
\n
\n", "
EC01003
\n", ""], ["VA EXTENDED CARE SERVICES INELIGIBLE", "
287
\n", "
\nInel ECS\n
\n
\n", "
\nIndividuals who may receive extended care services on a Humanitarian basis \ninclude:\n   .  Veterans who are not enrolled in VA Health Care System, non-Veterans, \n      and other patients who have no eligibility for Extended Care.\n   .  Veterans who refuse to provide financial information and do not agree \n      to pay VA the applicable copayment amount (documented on VA Form 10-\n      10EC) or refuse to pay the required copayments.\n
\n
\n", "
EC01004
\n", ""], ["ASSISTED REPRODUCTIVE TECHNOLOGY", "
288
\n", "
\nART\n
\n
\n", "
\nART - Assisted reproductive technologies (ART) are all treatments or \npregnancy.  This includes, but is not limited to, in vitro fertilization; \nembryo transfer; gamete intrafallopian transfer; zygote intrafallopian \ntransfer; tubal embryo transfer; gamete and embryo cryopreservation;\noocyte and embryo donation; and, gestational surrogacy.\nprocedures that include the in vitro handling of both human oocytes and \nsperm, or of embryos, for the purpose of establishing a pregnancy.  This \nincludes, but is not limited to, in vitro fertilization; embryo transfer; \ngamete intrafallopian transfer; zygote intrafallopian transfer; tubal embryo  \ntransfer; gamete and embryo cryopreservation; oocyte and embryo donation;  \nand, gestational surrogacy. ART- Assisted reproductive technologies (ART)\nare all treatments or procedures that include the in vitro handling of both \nhuman oocytes and sperm, or of embryos, for the purpose of establishing a  \n
\n
\n", "
AR01001
\n", ""], ["CHAMPVA STANDARD", "
108
\n", "
\nCHAMPVA\n
\n
\n", "
\nThe Civilian Health and Medical Program of the Department of Veterans \ndependents of a:\n   . Veteran who is rated Permanently and Totally (P&T) disabled due to a\n     Service-connected condition.\n   . Veteran who died from VA rated Service-connected condition, or who,\n     at the time of death, was rated Permanently and Totally disabled.\n   . Veteran who died on active duty and in the line of duty (not due to\n     misconduct).\n \nFor more information, call 1-800-733-8387 or go to: \nhttps://www.domain.ext/COMMUNITYCARE/programs/dependents/champva/index.asp\nAffairs (CHAMPVA) is a comprehensive health care program in which the VA\nshares the cost of covered health care services and supplies with eligible\nbeneficiaries. The program is administered by the Veterans Health\nAdministration Office of Community Care (VHA OCC) in Denver, Colorado.\n \nCHAMPVA plan provides health care to dependents who may qualify for VA's \nCivilian Health and Medical Program of the Department of Veteran Affairs \n(CHAMPVA). They must not have eligibility under TRICARE and must be \n
\n
\n", "
CV01001
\n", ""], ["HIGH RISK VETERAN", "
289
\n", "
\nHRV\n
\n
\n", "
\nHigh Risk Veteran\n
\n
\n", "
HR01001
\n", "
YES
\n"], ["DENTAL COMPREHENSIVE CARE", "
292
\n", "
\nDen Comp\n
\n
\n", "
\nVeterans receive any dental treatment that is reasonably necessary \nand clinically determined by the treating dentist to meet the \nVeteran's dental needs. A recall program must be established for \nthose Veterans who are eligible for comprehensive and repeat dental \ncare. The goal of care is to attain and sustain oral health and \nfunction including prosthetic rehabilitation as indicated.\n \nDerived from the VHA Handbook 1130.01 dated February 11, 2013\n
\n
\n", "
DE01001
\n", ""], ["DENTAL FOCUSED EMERGENT CARE", "
293
\n", "
\nDen Emer\n
\n
\n", "
\nDental Focused Emergent Care is:\n   .  Treatment provided to active duty military, military \n     and applies only to Class II beneficiaries who have met \n     the criteria as specified in Paragraph 7c1(a)-(f) and \n     7c2(a) and (b) of this Handbook. The Chief or designee \n     can use the document to assist in development of \n     appropriate treatment recommendations.\n  7. United States Department of Defense (DoD) \n     responsibilities. Under 38 U.S.C. 1712(a)(2), DoD must \n     notify the Veteran at the time of discharge or release \n     of the VA Class II- dental benefit available to newly \n     discharged Veterans, including notice of the applicable \n      retirees, CHAMPVA inpatients that are completed after \n     time-limit for these benefits (i.e., including the \n     need to apply for this benefit within 180 days of their \n     discharge or release). If a Veteran requests dental \n     treatment after that 180 day period and states the \n     required notification was not provided to the Veteran \n     upon discharge or release, the Chief Business Office \n     should send a VA Form 10-7131 Exchange of Beneficiary \n     Information to VBA to investigate. If no indication of \n     notification was documented by DoD, or the DD-214 \n     indicates dental treatment was not completed within 90 \n      hospital discharge.\n     days of discharge and no Class II treatment has been \n     provided, then Veteran may be provided a one-time \n     course of dental care.\n \nDerived from the VHA Handbook 1130.01 dated February 11, 2013 \n   .  Treatment of an emergent/urgent oral condition involving \n      acute pain, infection, trauma and/or hemorrhage; or suspicion \n      of an oral malignancy.\n   .  Inpatients in a non-acute care unit.\n   .  Residents in VA Community Living Centers.\n   .  Residents in VA Domiciliary Centers.\n**Inpatients specified under sharing agreements and employees or \n   .  Treatment of an oral condition complicating the management of \npatients officially authorized treatment for work related oral-\ndental injuries.**\n   a. A Veteran who is actively engaged in a Chapter 31 vocational \n      rehabilitation program may receive dental care to the extent \n      needed to meet any of the following goals: \n         1. Make possible the Veteran's entrance into a \n            rehabilitation program;\n         2. Achieve the goals of the Veteran's vocational \n            rehabilitation program;\n         3. Prevent interruption of a rehabilitation program;\n      the medical condition for which the Veteran was admitted.\n         4. Hasten the return to a rehabilitation program of a \n            Veteran in interrupted or leave status;\n         5. Hasten the return to a rehabilitation program of a \n            Veteran placed in discontinued status because of \n            illness, injury or dental condition;\n         6. Secure and adjust to employment during the period of \n            employment assistance; or\n         7. Enable the Veteran to achieve maximum independence in \n            daily living.\n   b. Requests for Class V dental care must be forwarded to the \n   .  Treatment of an oral condition complicating the management of \n      Dental Service by the Chapter 31 Vocational Rehabilitation \n      Program on VA Form 28-8861. This form needs to be provided \n      for each episode of care requested. Dental care must not be \n      provided beyond the anticipated rehabilitation date as \n      specified on the form.\nAny Veteran scheduled for admission or who is receiving care under \nChapter 17 of title 38, U.S.C., may receive outpatient dental care \nif the dental condition is clinically determined to be complicating \nthe medical condition currently under VA treatment. Eligibility for \neach episode of dental care will be predicated on referral and \n      the medical condition for which the patient was admitted that \nconsultation, followed by a decision based upon clinical judgment. \nThe goal is to provide focused care to treat only the oral \nconditions that are complicating impact to the clinical management \nof the medical condition currently under treatment. This \nclassification includes medically necessary dental care for \nVeterans receiving care for Military Sexual Trauma under Title 38 \nU.S.C. 1720D.\n \nLimitations of Treatment Provided Under Class II.\n  1. Dental Prostheses and Implants Provided by VA. Class II \n      was initiated but not completed while the Veteran was an \n     dental beneficiaries are not eligible to receive \n     ongoing maintenance. Once adjustments are satisfactory, \n     the episode of prosthetic care is considered to be \n     complete and subsequent treatment is the responsibility \n     of the Veteran.\n  2. Periodontal Conditions. Specific treatment authorized \n     for periodontal conditions of Class II beneficiaries is \n     expected to provide maximum benefit by the time that \n     episode of overall care is completed. When that \n     treatment is satisfactorily completed as authorized, \n      inpatient.\n     further treatment or follow-up for the periodontal \n     condition is not authorized.\n  3. Impacted Teeth. Impacted teeth are a developmental \n     abnormality. Consideration for surgical extraction must \n     be based on sound professional judgment to resolve \n     existing disease or symptoms.\n  4. Malposed Teeth. Malposed teeth are considered a \n     developmental abnormality and a pre-existing condition \n     relative to the start of military service. Orthodontic \n     care in this circumstance is not authorized.\n   .  Treatment provided to inpatients that are completed after \n     For cases in which trauma incurred in the line of duty \n     resulted in malalignment of the teeth or when \n     restorative procedures for which the Veteran is \n     eligible require orthodontic intervention, orthodontic \n     care may be provided.\n  5. Veterans with Orthodontic Appliances. When Veterans \n     present at VA facilities with orthodontic appliances \n     for the purpose of correcting developmental \n     malocclusion and have not had their treatment completed \n     by the military prior to discharge, they must be \n      hospital discharge.\n     informed that VA does not assume the responsibility for \n     any phase of the orthodontic care unless directly \n     related to rehabilitation of combat trauma to the \n     maxillofacial region.\n  6. Service Connection of Dental Conditions for Treatment \n     Purposes. VBA may, upon request, provide documentation \n     to the Dental Service defining service connection of \n     specific teeth for dental treatment purposes. (see \n     Title 38 CFR 3.381). The regulation provides for \n     identification of teeth treated during military service \n
\n
\n", "
DE01002
\n", ""], ["DENTAL HUMANITARIAN", "
294
\n", "
\nDen Hum\n
\n
\n", "
\nTreatment of an emergent oral condition such as acute pain, \ninfection, trauma and/or hemorrhage.\n \nDerived from the VHA Handbook 1130.01 dated February 11, 2013\n
\n
\n", "
DE01003
\n", ""], ["INELIGIBLE", "
290
\n", "
\nInel\n
\n
\n", "
\nNon-Veterans and Non-Service Connected Veterans who applied for VA \neligible based on income but refuse to agree to pay copayment.   \nNon-Veterans and Veterans assigned this VHAP meet one of the following \nconditions:\n  \n   o Enrollment Status is Rejected, Below Enrollment Group Threshold (EGT)\n   o Enrollment Status is Closed Application, for reason Pending Means \n     Test Required   \n   o Enrollment Status is Not Eligible; Ineligible Date  \n   o Enrollment Status is Not Eligible; Refuse to pay copay\nhealthcare services, but are not enrolled due to an enrollment decision, \nor after a one year period the application is administratively closed due \nto no receipt of information needed to verify Veteran status and/or \nfinancial information used to determine enrollment status.\n \nVeterans who are eligible to be screened for Military Sexual Trauma and \nPresumptive Psychosis or other active mental illness. Veterans are exempt \nfrom copayments for the screening encounter. Also, Veterans who are \n
\n
\n", "
IN01001
\n", ""], ["CAREGIVER IN PROCESS", "
291
\n", "
\nCG Inp\n
\n
\n", "
\nCaregiver In Process - Is an individual who is undergoing \nevaluation for enrollment in Program of Comprehensive Assistance \nfor Family Caregivers or Program of General Caregiver Support \nServices.\n
\n
\n", "
CI01001
\n", ""], ["VA DOD SHARING MEDICAL RESOURCES", "
295
\n", "
\nSHAGR\n
\n
\n", "
\nVA/DoD Health Care Resource Sharing Agreements (38 USC 8111)\n* Inactive Reserve and National Guard / Patients potentially enrolled \n  at VAMC (ref VHA Directive 1601A.02)(e.g. VAMC provides annual health \n  screenings or fitness for duty screenings)\n* If patient has a Veteran status and on Active Duty Orders (ref. \n  Active Duty Health Plan) / Includes active Reserve and National Guard -\n  Federal orders must exceed 30 days\n------------------------------------------------------------\nPatient receiving care at Department of Defense (DoD) under a Health Care \nResource Sharing Agreement:\n* Eligible Veteran referred to DoD for health care treatment  / (ref. \n  VHA OCC DoD Referral Management SOP)\n* TRICARE authorization not applicable (ref. TRICARE Health Plan) / \n  (e.g. dual eligible Veteran elects TRICARE Health Plan vs Veteran\n  benefit\n
\n
\n", "
DR01001
\n", ""], ["STATE VETERAN HOME", "
296
\n", "
\nSVH\n
\n
\n", "
\nPrevailing rate - VA does not provide medications as the rate covers all care \n   .  You require the aid of another person in order to perform personal \n      functions required in everyday living, such as bathing, feeding, \n      dressing, attending to the wants of nature, adjusting prosthetic \n      devices, or protecting yourself from the hazards of your daily \n      environment\n   .  You are bedridden, in that your disability or disabilities requires \n      that you remain in bed apart from any prescribed course of \n      convalescence or treatment\n   .  You are a patient in a nursing home due to mental or physical \n      incapacity\nincluding medications. They are Veterans with 70% or greater SC, in the SVH \n   .  Your eyesight is limited to a corrected 5/200 visual acuity or less in \n      both eyes; or concentric contraction of the visual field to 5 degrees \n      or less\n      House Bound Rules:\n   .  This increased monthly pension amount may be added to your monthly \n      pension amount when you are substantially confined to your immediate \n      premises because of permanent disability.\nbecause of their SC, or Totally Disabled based on Individual Unemployability \n(TDIU)\nBasic rate - VA provides medications if the Veteran meets one of the \neligibility criteria. 50%-60% SC we provide all medications. 40% SC and below \nOnly for SC, Aid and Attendance rules apply Aid & Attendance Rules: The Aid & \nAttendance (A&A) increased monthly pension amount may be added to your \nmonthly pension amount if you meet one of the following conditions:\n
\n
\n", "
SV01001
\n", ""], ["EMPLOYEE VETERAN", "
297
\n", "
\nEmp Vet\n
\n
\n", "
\nThis profile ONLY applies to Veterans who are also VA employees. Records \nassigned this carve out will be shared with Health Information Exchange \n(HIE) to support disclosure logic. The Veteran MUST have a defined \nVeteran Core Plan. The intention of this profile is to associate it to \nthe encounter when the episode of care is for employee related services \nand to prevent inappropriate billing based on the employee's Veteran \nstatus.\n
\n
\n", "
EV01001
\n", ""], ["OWCP", "
298
\n", "
\nOWCP\n
\n
\n", "
\nFederal Employee who incurred an injury or illness at a federal facility such \nas the VA and have an approved Office of Workers Compensation Program (OWCP) \nclaim by Department of Labor.\n
\n
\n", "
OW01001
\n", ""], ["BENEFICIARY SPINA BIFIDA", "
109
\n", "
\nSB\n
\n
\n", "
\nSpina Bifida (SB) Plan provides monetary allowances, vocational training \nhealth care claims after a determination of eligibility has been made by \nthe Denver VA Regional Office (VARO).\n \nFor more information, call 1-888-820-1756 or go to: \nhttps://www.domain.ext/COMMUNITYCARE/programs/dependents/spinabifida/index.asp\nand rehabilitation, and VA-financed health care benefits to certain \nKorean and Vietnam Veterans' birth children who have been diagnosed with \nspina bifida.  For the purpose of the program, spina bifida is defined as \nall forms or manifestations of spina bifida (except spina bifida occulta).\n \nThe Veterans Health Administration Office of Community Care (VHA OCC) in \nDenver, CO, manages the SB Health Care Benefits Program, including \nauthorization of benefits and the subsequent processing and payment of \n
\n
\n", "
SB01001
\n", ""], ["VETERAN PLAN CCP RESTRICTED CARE", "
300
\n", "
\nCCP R\n
\n
\n", "
\nVHA Profile Veteran Plan CCP Restricted Care is assigned if one of the \n(MST); or Mental Health Other Than Honorable (OTH); as otherwise \ndocumented in their record. \n \nFor COMPACT Act 2020, eligible Individuals are ones who served in the \nactive military service, regardless of length of service, and who were \ndischarged, excluding anyone who received a dishonorable discharge or was \ndischarged or dismissed by reason; are not enrolled in the health care \nsystem established by section 1705 of this title; and served in the Armed \nForces for a period of more than 100 cumulative days: and was deployed in \na theater of combat operations, or while serving in the Armed Forces, was \nfollowing eligibilities is met: \nthe victim of a physical assault of a sexual nature, a battery of a \nsexual nature, or sexual harassment.\nNot enrolled Covered Veterans who are otherwise entitled to hospital \ncare, medical services, extended care services and community care \nservices, however they are only eligible for care related to their \nservice connected conditions (less than 50% SC, and 0% non-compensable); \nwas discharged or released from active military service for a disability \nincurred or aggravated in the line of duty for that disability for the \n12-month period following discharge or release; Military Sexual Trauma \n
\n
\n", "
CR01001
\n", ""], ["VETERAN PLAN CCP ENTITLED CARE", "
301
\n", "
\nCCP E\n
\n
\n", "
\nA covered Veteran is any Veteran who is enrolled in the system of annual \npatient enrollment established and operated under section 1705 of this title; \nor is not enrolled in such system but is otherwise entitled to hospital care, \nmedical services, extended care services and community care services.\nThe VHAP Veteran Plan CCP Entitled Care is assigned to the Veterans who are \nnot enrolled and SC 50% to 100%.\n
\n
\n", "
CE01001
\n", ""], ["COLLATERAL OF VETERAN OTHER", "
299
\n", "
\nColl Vet\n
\n
\n", "
\nCollateral of Veteran Other identifies collateral population not identified \n   .  Documented in the treatment plan and progress notes in such a way as to \n      demonstrate the role of the person in assisting the Veteran to achieve \n      a specific treatment goal or goals.\nThis includes VHA Transplant Program, Marriage/Family Counseling, \nExamples of collateral visits include\n   .  An initial and follow-up contacts for a person assisting a Veterans \n      physical rehabilitation program in the home\n   .  Participation of a family member in outpatient family psychotherapy,\n   .  Continuing education and follow through with primary care giver such as \n      residential care sponsor\nin other specific VHA Profiles. A person, related to or associated with a \n   .  VHA Transplant Program\nVeteran (spouse, family member, or significant other) receiving care from the \nDepartment of Veterans Affairs (VA). The person is seen by a professional \nmember of the VA health care facility's (HCF's) staff either within the \nfacility or at a site away from the facility for reasons relating to the \nVeteran's clinical care.\nThe purpose of this clinical contact must be\n   .  An integral part of the Veteran's treatment plan, and\n
\n
\n", "
CO01001
\n", ""], ["DISHONORABLE VA OR FFP", "
302
\n", "
\nDVA\n
\n
\n", "
\nNon-Service Connected Veterans who applied for VA healthcare services, \nfelony under Federal or State Law.\n \n . Enrollment Status is Not Eligible; Ineligible Date\nbut are not eligible to enroll due to a dishonorable discharge or a \nstatutory bar pertaining to a period of service which deprives a claimant \nof all VA benefits for any claim based on that period of service. Service \nConnected or Non-Service Connected Veterans who have been identified as \nfugitive felons are no longer eligible to receive health care services, \nincluding medications and any community care at VA expense. A Fugitive \nFelon is a person fleeing to avoid prosecution, custody or confinement or \nviolating a condition of probation or parole imposed for commission of a \n
\n
\n", "
DV01001
\n", ""], ["ACTIVE DUTY", "
303
\n", "
\nAD\n
\n
\n", "
\nActive Duty (AD) and AD Family Prime\n   Prime enrollee\n - Includes active Reserve and National Guard - Federal orders must \n   exceed 30 days\n------------------------------------\nPatient receiving care at a VAMC as AD of the Department of Defense:\n*TRICARE Authorization:\n - Required for TRICARE Prime patients - AD and AD Family Prime\n \n*If patient has a Veteran status and on Active Duty Orders, then all \n Active Duty rules apply\n - Even if treatment is Service Connected - Patient considered TRICARE \n
\n
\n", "
AD01001
\n", ""], ["JOINT INCENTIVE FUND", "
304
\n", "
\nJIF\n
\n
\n", "
\nVA/DoD Joint Incentive Fund (JIF)\n* TRICARE authorization not applicable (services are not billed to \n  TRICARE)\n---------------------------------\nPatient receiving care at either VA Medical Center or Department of \nDefense (DoD) facility under an active JIF project in which bi-directional\nbilling for shared resources will not occur:\n* Eligible Veteran referred to DoD for health care treatment  / (ref. VHA \n  OCC DoD Referral Management SOP)\n* Eligible DoD beneficiaries (including TRICARE beneficiaries) referred \n  to VA for health care treatment\n
\n
\n", "
JF01001
\n", ""], ["CHAMPVA CAREGIVER", "
305
\n", "
\nCHAMPVACG\n
\n
\n", "
\nThe VHA Office of Community Care (VHA OCC) is responsible for enrolling \nprocessing reconsiderations, and providing customer service support to \nPrimary Family Caregivers for questions related to stipend payment and \nCHAMPVA benefits.\n \nFor more information:\nhttps://www.domain.ext/COMMUNITYCARE/programs/caregiver/index.asp\nthe eligible Primary Family Caregiver into the Civilian Health and \nMedical Program of the Department of Veterans Affairs (CHAMPVA) when \nthere is no other health insurance (OHI) coverage, to include TRICARE, \nMedicare, Medicaid, commercial health plans through employment and \nindividual plans.\n \nVHA Office of Community Care is also responsible for processing health \ncare claims for eligible Primary Family Caregivers under CHAMPVA, \n
\n
\n", "
CV01002
\n", ""], ["HUD VASH RESTRICTED CARE", "
307
\n", "
\nHUDVASH\n
\n
\n", "
\nVeterans who are enrolled and not enrolled Veterans and former service \n \n   o Cancelled/Declined - Receive medical benefits for HUD-VASH \n     conditions only \n   o Rejected - Receive medical benefits for HUD-VASH and SC conditions\n     only \n   o Ineligible and SC 0% - Receive medical benefits for HUD-VASH and \n     SC conditions only \n   o Ineligible and MST - Receive medical benefits for HUD-VASH and \n     MST conditions only  \n   o Ineligible with a bar to benefits (excluding Dishonorable, Bad \nmembers can be seen for services related to their enrollment in the \n     Conduct General Court Martial and Fugitive Felon Program (FFP)) -\n     Receive medical benefits for HUD-VASH conditions only\n   o Former service members with Other Than Honorable (OTH) discharges \n     who present for certain services\n   o Presumptive (38 USC 1702-38 CFR 17.109) \nHousing and Urban Development Veterans Affairs Supportive Housing \n(HUD-VASH) program. These Veterans and former service members are not \nsubject to copayment requirements and are exempt from copayments for \ninpatient services and medications related to their HUD-VASH services.\n \nVeterans and former service members assigned the HUD-VASH Restricted Care \nVHAP must meet one of the following conditions:  \n
\n
\n", "
HUD1001
\n", ""], ["CLINICAL EVALUATION", "
308
\n", "
\nCE01\n
\n
\n", "
\nPatients who qualify for Clinical Screenings for evaluation of conditions \n   o Enrollment Status is Not Eligible; Ineligible Date\n   o Enrollment Status is Not Eligible; Refuse to pay copay\n   o Veterans being registered and enrollment status is Registration Only\n   o Veterans enrolled\nrelating to Presumptive Psychosis and/or Military Sexual Trauma. The \npatients are not subject to copayment for these screenings. \n \nIncludes the following Non-Veterans and Veterans assigned this VHAP meet \none of the following conditions:\n   o Enrollment Status is Rejected, Below Enrollment Group Threshold (EGT)\n   o Enrollment Status is Closed Application, for reason Pending Means\n     Test Required\n
\n
\n", "
CE01001
\n", ""], ["COMPACT ELIGIBLE", "
309
\n", "
\nCOMPACT\n
\n
\n", "
\nFor eligible individuals, under Veterans Comprehensive Prevention, Access \n   o Cancelled/Declined - Receive medical benefits for SC conditions\n     only\n   o Rejected - Receive medical benefits for SC conditions only\n   o Pending; Means Test Required - Veterans whose Veterans Status has \n     been verified and who have not provided initial Means Test to\n     determine enrollment.\n   o Enrollment Status is Rejected, Below Enrollment Group Threshold (EGT)\n   o Enrollment Status is Closed Application \n   o Enrollment Status is Not Eligible; Refuse to pay copay\nto Care, and Treatment Act of 2020 (COMPACT), Section 201, VA will \nfurnish, reimburse, pay for emergent suicide care, make referrals, as \nappropriate, for care following the period of emergent suicide care. \nEligible individuals are Veterans who served in the active military \nservice must meet the minimum duty requirements, and who were discharged, \nexcluding anyone who received a dishonorable discharge or was discharged \nor dismissed by reason that is a bar to benefits.\n \n
\n
\n", "
CP0110
\n", ""]]}